Achy Joints and Itchy Skin – Can it be Psoriatic Arthritis?

By Jack Toole, MD, FRCPC

Psoriatic arthritis is a less common form of arthritis and occurs in approximately 30 per cent of people who have psoriasis (a disorder causing areas of the skin to become inflamed and be covered with silvery or grey scales).

Although psoriasis may start at any age (commonly in the late teens), the arthritis component usually makes its appearance later - in the 20s, 30s and 40s.

(Check out Psoriasis Guide for more information about psoriasis.)

Who gets it?

Men are just as likely as women to get this disease, which affects the joints -- often in the knees -- but is also seen in the wrists, ankles, fingers and toes.

How will I know if I have it?

  • Fingers or toes may become red and swell and your nails might also get small holes in them or detach from the skin
  • Pain and swelling at areas where tendons and ligaments attach to bone, such as the elbow or back of the heel.

What causes Psoriatic Arthritis?

We don’t know specifics of what causes psoriatic arthritis, but we can point to hereditary, environmental and immunological factors to play some role.

Hereditary:
  • Approximately 40 per cent of patients with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis
  • Children of parents who have psoriasis are three times more likely to have it. If an identical twin has psoriasis, there is a 75 per cent chance the other will too
Environmental:
  • Some infections and trauma may trigger psoriatic arthritis, but in most cases cause and effect cannot be absolutely confirmed
Immunological:
  • There are a number of immunological abnormalities reported in both psoriasis and psoriatic arthritis

Is there a cure?

There is no cure for psoriatic arthritis so medication, physiotherapy and daily-living adjustments are used to minimize pain and stiffness.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling of the joints and decrease stiffness, but they won’t prevent further joint damage
  • People with severe psoriatic arthritis are often given disease-modifying anti-rheumatic drugs (DMARDs). These drugs try to stop psoriatic arthritis from getting worse, although it can take two to six months before you notice a difference.
  • Occasionally a (steroid) cortisone injection into an infected joint or tendon brings short-term relief of inflammation and swelling
  • People with severe, advanced psoriatic arthritis may require surgery.

Eight ways to feel better:

  1. Keep skin moist -- use lanolin cream, light mineral oil, petroleum jelly, cocoa butter lotion or baby oil, and use a humidifier in the winter
  2. Reduce pain and prevent further joint damage by doing moderate exercise, which helps maintain a healthy weight, putting less strain on your joints
  3. Apply heat to relax aching muscles, reduce pain and soreness
  4. Apply cold to lessen pain and swelling
  5. After heavy work or doing the same task repeatedly, do an easier task or take a rest
  6. Use a cart to carry your grocery bags
  7. Try deep breathing exercises. Developing good relaxation or meditation and coping skills can give you a greater feeling of control over your arthritis

About the author:
Jack Toole, MD, FRCPC, Professor of Medicine, University of Manitoba. Area of specialty: general dermatology with a special interest in pediatric dermatology.


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