Psoriatic arthritis: Diagnosis and treatment
How is psoriatic arthritis diagnosed?
A single medical test is not available to diagnose psoriatic arthritis. To find out whether you have psoriatic arthritis, your doctor will do the following:
- Look at your medical records.
- Ask you specific questions. This usually includes questions such as whether any of your blood relatives have psoriasis or psoriatic arthritis.
- Examine your joints. This examination includes looking at your body to see whether you have swollen joints. Your doctor will gently press on the skin around certain joints to find out whether the area is tender.
- Send you for medical testing. This may include x-rays and a blood test.
Before giving you a diagnosis, your doctor considers your test results and everything he or she learned while meeting with you. In case you’re wondering, the result from your blood test cannot tell whether you have psoriatic arthritis. It tells your doctor whether you have inflammation throughout your body. People who have psoriatic arthritis have body-wide inflammation. Many other diseases also cause body-wide inflammation. Inflammation is a piece of the puzzle.
Because psoriatic arthritis can look like other types of arthritis, patients often see a dermatologist or rheumatologist for a diagnosis. A rheumatologist is a medical doctor who specializes in diagnosing and treating arthritis and other diseases of the joints, muscles, and bones. Rheumatologists and dermatologists generally have the most experience diagnosing and treating psoriatic arthritis.
If you are diagnosed with psoriatic arthritis, it is important to know that treatment can:
- Ease swelling, pain, stiffness, and other symptoms.
- Stop the arthritis from getting worse and damaging your joints.
- Improve your quality of life.
How is psoriatic arthritis treated?
Today, there are many treatment options for psoriatic arthritis. A treatment plan often includes several of the following:
- Therapy (physical, occupational, massage).
- Patient education.
- Exercise and rest.
- Devices to protect joints.
Therapy (physical, occupational, massage): These therapies can reduce pain. They can make it easier to move and do everyday tasks. If therapy can help, your doctor will write a prescription for the type(s) of therapy you need. Your therapist will work with your doctor and report your progress.
Patient education: Learning about psoriatic arthritis is important. The more you know, the better you can control this disease. Take time to learn the signs and symptoms. Ask your doctor what you should do when the arthritis flares. Learn about arthritis-friendly exercises and exercises that you should not do — at least for a while.
Exercise and rest: Each plays an important role. Arthritis-friendly exercises can help reduce pain, make it easier to move, and sometimes restore lost movement. Rest is important when psoriatic arthritis flares.
Devices to protect joints: Braces, splints, and supports can protect affected joints and prevent further damage. They offer support for painful areas and can stop painful movements. You should not buy one without first talking with your doctor. The device must fit you properly. It must support the area that needs support. Your doctor may recommend that a physical or occupational therapist fit you.
Medicine: Medicine can reduce swelling and ease pain. A few medicines can prevent the arthritis from worsening. The medicines that are often part of a treatment plan for psoriatic arthritis are as follows:
When psoriatic arthritis is mild, patients usually can reduce signs and symptoms with:
- Non-steroidal anti-inflammatory drugs (NSAIDS) (pronounced en-saids): These help reduce swelling and pain. Some NSAIDs that may be part of a treatment plan for psoriatic arthritis do not require a prescription. These include aspirin, ibuprofen, naproxen, and nabumetone.
Prescription NSAIDs include arthritis medicines such as celecoxib.
Some people see their psoriasis worsen when they begin taking an NSAID. If this happens, call your dermatologist.
Tip: If you are taking aspirin or another medicine in the NSAID family, take the medicine immediately after you drink a glass of milk or eat a meal. This helps to protect your stomach. You should not drink alcohol when an NSAID is part of your treatment plan.
- Shots of corticosteroids: When arthritis develops in a few joints, injecting this medicine into the swollen joints can quickly reduce swelling and pain.
Some people require stronger medicine to control their psoriatic arthritis. Your doctor may prescribe a disease-modifying, anti-rheumatic drug (DMARD) (pronounced dee-mard). DMARDs also reduce swelling and pain. Some DMARDs can prevent the arthritis from worsening and destroying joints. DMARDs that may be part of a treatment plan for psoriatic arthritis include:
- Methotrexate: This medicine can reduce swelling in the joints and also is approved to treat psoriasis.
- Injectable biologics: This type of medicine can prevent the arthritis from progressing and destroying the joints. Some of the biologics approved to treat psoriatic arthritis also can treat psoriasis.
To provide you with the most effective treatment, your doctor may prescribe 2 DMARDs. Prescribing both methotrexate and a biologic can help patients who have extensive or aggressive psoriatic arthritis. This combination has become a standard of care for aggressive psoriatic arthritis.
All medicine can cause side effects. Before taking a medicine, ask your doctor about possible side effects.
Surgery: If you have badly damaged joints or medicine does not help, surgery may be an option. Surgery can lessen pain. It can help you move more easily. It can improve the appearance of damaged joints. After surgery, you may be able to perform everyday tasks more easily. Surgery requires downtime. It involves some risk.
Following a treatment plan helps to reduce the signs and symptoms of psoriatic arthritis. Some medicines also can help prevent the arthritis from destroying the joints. There is currently no way to know whose psoriatic arthritis will later destroy joints. This is why doctors recommend an early diagnosis and proper treatment.