Psoriatic arthritis

People with psoriatic arthritis may be more likely to develop itchy, red eyes due to:

• inflammation of the membrane that covers the front of the eye and the inside of the eyelid (conjunctivitis)
• inflammation around the pupil of the eye (iritis/uveitis).

People with psoriasis and psoriatic arthritis may have a greater chance than other people of developing heart disease, so it's important to tackle anything that could add to this risk such as smoking, high alcohol intake, being overweight, and blood pressure problems. Psoriatic arthritis doesn't usually affect other major organs such as the kidneys, liver or lungs.

What is the outlook?

Psoriatic arthritis can vary a great deal between different people. About a third of people who have it will have a mild form of the disease that remains very stable over time. Others will have more severe symptoms that require long-term treatment. The condition will usually have some affect on your quality of life, but psoriatic arthritis is unlikely to be as disabling as rheumatoid arthritis can be.

Research suggests that something – perhaps an infection – acts as a trigger in people who are susceptible to this type of arthritis because of their genetic make-up. Sometimes the arthritis develops in a single joint after an accident or injury to that joint.

It can be difficult to distinguish between psoriatic arthritis and rheumatoid arthritis. If several joints are affected doctors will consider features such as the pattern of arthritis (which joints are affected).

A blood test for rheumatoid factor may be used to help rule out rheumatoid arthritis. X-rays of the back, hands and feet can also be helpful, as psoriatic arthritis can affect the bones and joints in these areas.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Anti-inflammatory drugs act by blocking the inflammation that occurs in the lining of your joints. They can be very effective in controlling the pain and stiffness. Usually you will feel a benefit within hours of taking these drugs but the effect will only last for a few hours, so the tablets have to be taken regularly.

Examples include ibuprofen, diclofenac, indometacin and naproxen. If you have trouble taking any of these because of stomach problems, your doctor may recommend drugs called proton pump inhibitors alongside the NSAIDs to reduce the effects on the stomach.

Alternatively, some NSAIDs (known as COX-2-specific NSAIDs or coxibs) are designed to reduce stomach problems. 

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying drugs help by tackling the causes of the inflammation in the lining of the joints. The aim is to change the way the disease progresses. It may be several weeks before DMARDs start to have an effect on your joints. Sometimes these drugs are given by injection.

Disease-modifying drugs are normally used as a second-line treatment and the decision to use them will depend on a number of factors including the effects of the anti-inflammatory drugs, the activity of the arthritis and the likelihood of further joint damage.

Examples of disease-modifying drugs include:

• hydroxychloroquine
• ciclosporin
• methotrexate
• sulfasalazine.

Biologic drugs are a newer group of drugs that may be used if other DMARDs aren't working well enough. These are given either by injection or through a drip. The biologics include:

• adalimumab
• etanercept
• infliximab.

With almost all disease-modifying drugs you will need to have a regular blood test and, in some cases, a urine test. The tests allow your doctor to monitor the effects of the drug on your disease, but also to check for possible side-effects.

Anti-inflammatory drugs can be taken along with disease-modifying drugs, and sometimes more than one disease-modifying drug is needed.

Steroid treatments

Steroid injections are often recommended for joints that are particularly troublesome and for the painful bony sites where ligaments and tendons become inflamed.

Treatments for the skin

Treatment is usually with ointments – there are five main types:

• tar-based ointments
• dithranol-based ointments (it's very important not to let these come into contact with normal skin)
• steroid-based creams and lotions
• vitamin D-like ointments such as calcipotriol and tacalcitol
• vitamin A-like (retinoid) gels such as tazarotene.

If the creams and ointments don't help the psoriasis your doctor may suggest:

• light therapy, involving short spells of exposure to ultraviolet light
• retinoid tablets (similar to vitamin A).

Many of the disease-modifying drugs used for psoriatic arthritis will also help the skin disease. Similarly, some of the treatments for psoriasis may help the arthritis.

Physical therapies

A physiotherapist can advise on exercises which will help to maintain mobility in your joints and on therapies to help ease pain or discomfort. An occupational therapist will be able to advise you on how to protect your joints from damage and may give you splints to wear for your hands and wrists.

Surgery

Surgery isn't often needed in psoriatic arthritis. Very occasionally a damaged tendon may need surgical repair. And sometimes, after many years of disease, a joint worn out by inflammation is best treated by replacement with an artificial joint.

Exercise

Inflammation can lead to muscle weakness and stiffness in the joints. Exercise is important to prevent this and to keep the joints functioning properly. You will need to find the right balance between rest and exercise for yourself, but your doctor or a physiotherapist will be able to advise on suitable forms of exercise depending on which joints are most affected.

Diet and nutrition

No specific diets have been found to be very effective for psoriatic arthritis, although fish oils (i.e. fish body oils and not fish liver oils) from sea-water fish may sometimes reduce the amount of anti-inflammatory drugs needed.

Being overweight will put extra strain on your joints, particularly the leg and back joints, while keeping to a healthy weight will reduce the strain. It's also important to control your weight because of the increased risk of heart disease. We recommend a healthy, balanced diet with plenty of fresh vegetables and fruit.

Work and benefits

People with arthritis are likely to have some difficulties with work. However help is available.

Work assessment and if necessary retraining can be arranged by a Disability Employment Adviser, who can be contacted through your local Jobcentre Plus office.

The Employment Medical Advisory Service can also help by providing equipment to make it easier to do your job.

Sex and pregnancy

Sex can sometimes be painful, particularly for a woman whose hips are affected. Experimenting with different positions will usually provide a solution.

Psoriatic arthritis will not in itself affect your chances of having children or a successful pregnancy. The arthritis often improves during the pregnancy, although it may worsen again after the baby is born.

Some of the drug treatments given for psoriatic arthritis should be avoided when trying to start a family. For instance, sulfasalazine can cause a low sperm count (this is not permanent) and you should not try for a baby if you or your partner are on methotrexate or have been using it in recent months. If you are considering starting a family you should discuss your drug treatment with your doctor well in advance so that your medications can be changed.

Your children will be more likely than the next person to get psoriatic arthritis but the risk is still low. Both psoriasis and psoriatic arthritis occur more frequently in some families than in others. Your children may be more likely than most to get psoriatic arthritis, but the risk of passing it on directly is still low.