Psoriatic arthritis (PsA) is a chronic autoimmune disease that sometimes occurs with an inflammatory skin condition called psoriasis. It can significantly affect a person’s life. Prognosis can vary from person-to-person, but early diagnosis and aggressive treatment can reduce the impact it has on a person’s quality of life.
How psoriatic arthritis progresses is dependent on the type of PsA a person has, if the skin is involved, the stage it was in at the time of diagnosis, treatment received, and treatment response.
Psoriasis—an inflammatory, autoimmune skin condition that causes skin cells to build up and form scales and itchy, dry patches—might be a sign of what is to come. According to the National Psoriasis Foundation, 10 to 30% of people with psoriasis will develop PsA. Both conditions are long-term and may get worse over time, although treatments can help to relieve symptoms and slow down disease progression.
Not everyone who has PsA will develop psoriasis. However, having psoriasis first makes it easier for your healthcare provider to diagnose PsA later down the road.
While PsA can develop years after the onset of psoriasis, some people will develop joint pain long before they notice skin symptoms. Whether PsA sets in before or after psoriasis, the symptoms are similar and may include:
- Swollen, inflamed, sore finger and toe joints
- Shoulder, knee, and other large joint pain
- Inflammation and pain in the neck and back
- A condition called dactylitis—sometimes called sausage fingers—where the fingers and toes are so swollen they resemble sausages
- Enthesitis, or inflammation at the site of insertion of a tendon or ligament on bone. Common spots for enthesitis to happen are around the heel, bottom of the foot, front of the knee, hip, elbow, and spine
Long-Term, Active PsA
Overtime, PsA may start to cause joint damage. In the small joints—fingers and toes—a person may clearly see joint deformity that has resulted from ongoing inflammation. Joint damage can limit your ability to perform tasks of daily living and to participate in activities you once enjoyed. It may also result in more pain and disability. Joint problems, deformity, and disability may limit a person’s ability to be active, which with time make joints stiff and muscles weak.
If you are lucky, you will never get to know what it is like to have damaged and deformed joints. And thanks to the powerful medications designed to halt disease progression, there is a good chance for many people with PsA to experience disease remission, or in the least, low disease activity. While remission—a period where disease symptoms, including inflamed joints are gone—is a better goal, low disease activity is also possible and helpful in showing down PsA.
A number of drugs can help in achieving remission or low disease activity for people with PsA. These include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs can help to relieve pain and swelling in joints. Most of these are available over-the-counter (OTC). Your healthcare provider can prescribe a stronger version if needed. Celebrex (celecoxib) is another type of NSAID called a COX-2 inhibitor, available as a prescription only. COX-2 inhibitor drugs relieve pain and inflammation without the stomach side effects NSAIDs are known for.
Corticosteroids: These drugs help with reducing pain and inflammation. They are only used in the short-term because they cause adverse side effects. Your healthcare provider may also give you a corticosteroid with an injection to the affected joint or joints.
Traditional disease-modifying antirheumatic drugs (DMARDs): Traditional DMARDs include methotrexate, hydroxychloroquine, and sulfasalazine. These drugs slow down immune system processes that cause chronic inflammation. Many of these drugs have been used to treat PsA and a variety of autoimmune disease for many decades.
Biologic DMARDs: Biologics are newer drugs that have been useful in treating PsA that is severe and/or includes psoriasis. Biologic drugs include tumor necrosis factor (TNF) blockers, interleukin (IL) blockers, and drugs that inhibit T- and B-cells. These drugs are genetically modified proteins that target specific parts of your immune system known for fueling inflammation.
JAK inhibitors: Janus kinase (JAK) inhibitors inhibit the activity of JAK family of enzymes by interfering with their signal pathways. They can help ease joint pain and swelling, and skin symptoms associated with PsA. These drugs include Xeljanz (tofacitinib), Olumiant (baricitinib), and Rinvoq (upadacitinib).
It’s important to note that the Food and Drug Administration (FDA) has approved these JAK inhibitors only for autoimmune patients who haven’t responded to or cannot tolerate one or more tumor necrosis factor (TNF) inhibitors. This is because research shows an increased risk of heart-related events such as heart attack or stroke, cancer, blood clots, and death with JAK inhibitor use.
Talk to your healthcare provider about the best treatments for your unique situation.
With the exception of NSAIDs and steroids, some of these drugs can take up to three months to be fully effective. Once you and your healthcare provider find an effective treatment, you will likely to see major improvement with a year. In fact, one study reported in the journal Arthritis Research & Therapy in 2017 finds up to 60% of people with PsA were able to achieve minimal disease activity within one year of treating with biologics and/or traditional DMARDs.
Remission does not mean psoriatic arthritis is cured. You will still need to take medications while in remission.
Research shows people who stop taking medications will have symptoms return within a few months. For example, one 2015 article in Annals of Rheumatic Disease reported on an observational study of 26 PsA patients for six months and found disease relapse in 20 of the patients who had discontinued treatment. Tapering off medications can be safely attempted in patients with low disease activity.
Psoriatic arthritis does not usually affect a person’s life expectancy and it is not life-threatening. However, it can increase the risk for other conditions (co-morbidities) that can, such as cardiovascular disease, fatty liver disease, high blood pressure, and diabetes.
Some research has suggested people with PsA have a shorter lifespan than others in the general population. But this is similar to other autoimmune diseases, including RA. This is likely because people with PsA have a higher risk for developing conditions that may decrease life expectancy.
Quality of Life
Research on quality of life for people with PSA seems to show that people with PsA seem to have a lower quality of life than others in the general population due to decreased physical function and increased risk for life-threatening diseases. One 2012 report in the journal Rheumatology found people with PsA have a poor quality of life compared to people with psoriasis due to the burden of arthritis, age, and co-morbidities.
It is hard to know exactly how PsA will affect a person’s life because PsA varies from person-to-person. For some people, the condition does progress early and quickly and causes severe symptoms. For others, PsA is slow progressing and symptoms are not significant or life-altering. Most people, however, will experience symptoms and pain, including periods of flare-ups—where the disease is active—and periods of low disease activity or remission.
Regardless of the extent of a person’s PsA symptoms, PsA poses two main quality of life challenges for people living with the condition: pain and well-being.
PsA causes pain, stiffness, fatigue, and other disease symptoms. In addition, skin changes may lead to discomfort. Severe symptoms can limit a person’s ability to perform daily activities.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce mild pain. If you are finding these drugs aren’t enough to manage pain, talk to your healthcare provider about stronger, pain relievers or alternatives to pain medication. Keep in mind that NSAIDs may not be safe in people with kidney disease or in those who take blood thinners.
Staying active can help to relieve joint stiffness and prevent muscle weakness. Try light exercises, such as swimming, walking, yoga, and gentle stretching. Occupational and physical therapies can also help to improve joint strength and mobility and help you to find new ways to do things when pain and stiffness make it hard to carry activities.
The physical symptoms of PsA may have a negative effect on a person’s life, including the personal, social, and professional aspects. The risk for mental health conditions, including anxiety and depression, is higher in people with psoriatic arthritis. A study reported by The Journal of Rheumatology in 2014 finds the prevalence of both anxiety and depression is higher in people with PsA—up to 37%—compared to people with psoriasis. Further, depression and anxiety were associated with more inflamed joints, disability, pain, and fatigue.
If you are experiencing depression, anxiety, or other mental health symptoms, talk to your healthcare provider. Treatment is available and managing mental health concerns eventually results in better disease outcomes and improved quality of life.
A Word From Get Meds Info
Living a chronic inflammatory condition, such as psoriatic arthritis, can have a profound effect on your physical and mental health. Early diagnosis and treatment are vital to avoiding disability and joint damage, staying mobile, and enjoying a good quality of life.
Your quality of life can be greatly improved by working closely with your healthcare provider to identify what things make your disease worse and how to manage them, and also in finding the right treatment plan to reduce the risk of complications and co-morbidities. As newer treatments become available, the outlook for people with PsA will continue to improve so don’t get discouraged.