Published: 18 Jun 2025

ICD9: 696.0      ICD10: L40.59      ICD11: FA21

Psoriatic arthritis (PsA) is a type of arthritis that affects some people who have psoriasis, a chronic skin condition characterized by red, scaly patches.
It's a chronic inflammatory disease, meaning it causes inflammation in the joints and surrounding tissues.

Here's a breakdown of key aspects of psoriatic arthritis:

Key Characteristics:

Combination of Skin and Joint Problems: PsA combines the symptoms of psoriasis (skin plaques, nail changes) with arthritis symptoms (joint pain, stiffness, swelling). However, the skin and joint conditions don't always occur together. Someone might develop psoriasis first, followed by arthritis years later, or vice versa. In some cases, the arthritis appears before any noticeable skin problems.
Inflammation: The immune system mistakenly attacks healthy tissues, causing inflammation in the joints, tendons, and other areas.
Chronic and Progressive: PsA is a long-term condition. While there may be periods of remission (when symptoms are mild or absent), the disease can also flare up (when symptoms worsen). Without treatment, PsA can lead to joint damage.

Symptoms:

The symptoms of PsA can vary from person to person, but commonly include:

Joint Pain, Stiffness, and Swelling: This is the most common symptom. Any joint can be affected, but it often involves the small joints of the fingers and toes. Enthesitis (inflammation where tendons and ligaments attach to bone) is also common, leading to pain at the heels, elbows, or other areas.
Dactylitis (Sausage Fingers or Toes): Inflammation of the entire finger or toe, making it look swollen and sausage-like. This is a hallmark feature of PsA.
Nail Changes: Pitting (small dents) of the nails, thickening, discoloration, and separation of the nail from the nail bed are common.
Skin Lesions (Psoriasis): Red, scaly patches on the skin, typically on the scalp, elbows, knees, and lower back.
Fatigue: Feeling tired and lacking energy is common.
Eye Inflammation (Uveitis): Eye pain, redness, and blurred vision. This is a serious complication that requires prompt treatment.
Reduced Range of Motion: Difficulty moving affected joints.
Back Pain: Inflammation can affect the spine (spondyloarthritis), leading to back pain and stiffness.

Causes:

The exact cause of psoriatic arthritis isn't fully understood, but it's believed to be a combination of:

Genetic Factors: PsA tends to run in families. Certain genes, particularly those related to the immune system, are associated with a higher risk of developing the condition.
Environmental Factors: Exposure to certain triggers, such as infections or trauma, may play a role in activating the immune system and triggering PsA in people who are genetically predisposed.
Immune System Dysfunction: PsA is an autoimmune disease, meaning the immune system mistakenly attacks healthy tissues, causing inflammation.

Diagnosis:

There's no single test to diagnose psoriatic arthritis. Diagnosis is based on a combination of factors:

Medical History: The doctor will ask about your symptoms, family history, and any history of psoriasis.
Physical Examination: The doctor will examine your joints, skin, and nails for signs of PsA.
Imaging Tests:
X-rays: To look for joint damage.
MRI (Magnetic Resonance Imaging): To provide more detailed images of the joints and surrounding tissues, showing inflammation and early damage.
Ultrasound: To visualize soft tissues around the joints and detect inflammation.
Blood Tests:
Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP): These tests measure inflammation in the body. However, they aren't specific to PsA.
Rheumatoid Factor (RF) and Anti-CCP (Anti-Cyclic Citrullinated Peptide) Antibody: These tests are usually negative in PsA, which helps to differentiate it from rheumatoid arthritis.
HLA-B27: This genetic marker is sometimes associated with psoriatic arthritis, particularly when the spine is involved (spondyloarthritis).

Treatment:

There is no cure for psoriatic arthritis, but treatment can help to:

Reduce Pain and Inflammation:
Improve Joint Function:
Prevent Joint Damage:
Manage Skin Symptoms:

Treatment options may include:

Medications:
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): To relieve pain and inflammation.
Disease-Modifying Antirheumatic Drugs (DMARDs): Such as methotrexate, sulfasalazine, and leflunomide, to slow down the progression of the disease.
Biologic Agents: Such as TNF inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, and T-cell inhibitors, which target specific parts of the immune system to reduce inflammation.
Targeted Synthetic DMARDs (tsDMARDs): Such as apremilast and JAK inhibitors, which also target specific pathways in the immune system.
Physical Therapy: To improve joint mobility, strength, and function.
Occupational Therapy: To learn ways to protect your joints and make daily tasks easier.
Joint Injections: Corticosteroid injections can be used to reduce inflammation in specific joints.
Surgery: In rare cases, joint replacement surgery may be necessary if the joints are severely damaged.
Lifestyle Modifications:
Exercise: Regular exercise can help to improve joint function and reduce pain.
Healthy Diet: Eating a healthy diet can help to reduce inflammation and improve overall health.
Weight Management: Losing weight if you're overweight can help to reduce stress on your joints.
Stress Management: Stress can worsen PsA symptoms. Finding ways to manage stress, such as through yoga, meditation, or deep breathing exercises, can be helpful.

Important Considerations:

Early Diagnosis and Treatment: Early diagnosis and treatment are crucial to prevent joint damage and improve long-term outcomes.
Individualized Treatment: Treatment plans are tailored to each individual's specific symptoms and needs.
Multidisciplinary Approach: Managing PsA often requires a team of healthcare professionals, including a rheumatologist (a doctor specializing in arthritis), a dermatologist (a skin doctor), a physical therapist, and an occupational therapist.

If you think you may have psoriatic arthritis, it's important to see a doctor for diagnosis and treatment.