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Psoriatic arthritis

Key points about psoriatic arthritis

Psoriatic arthritis is an inflammatory arthritis characterised by a particular type of swelling of your skin (psoriasis) and joints.
It happens when your body mistakenly uses its immune system to attack the area between your joints.
It generally starts in middle age and affects more women than men.
Symptoms include joint swelling, tenderness and stiffness but can also include tiredness, skin changes and weight loss.
It's treated with medicines to reduce swelling and pain.

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Rheumatoid and psoriatic arthritis are forms of arthritis called "inflammatory arthritis". In both of these conditions, your body mistakenly uses its immune system to attack the area between your joints. This can damage your joints, and cause joint pain and loss of joint function.

Rheumatoid arthritis (RA) can start at any age although it most commonly starts in middle age and affects more women than men. The cause of RA isn't known.

Image credit: Canva

The symptoms of inflammatory arthritis are:

joint pain, tenderness and swelling
stiffness when getting up in the morning or after periods of inactivity
other symptoms not related to the joints, eg, tiredness, skin changes and weight loss.

However, these symptoms can also occur in other forms of arthritis and other diseases.

Inflammatory arthritis can be difficult to diagnose as other conditions can have the same symptoms. Your GP may ask you about your symptoms and how long you've had them. They will also examine your affected joints. They may want to rule out other conditions such as septic arthritis and gout.

If your doctor suspects you have inflammatory arthritis, or is concerned about your symptoms, they may suggest you have some blood tests. You may also have joint X-rays to see if your joints are being damaged by your arthritis. An MRI scan may be done to look at your joints in more detail.

You are likely to be referred to a rheumatology specialist to confirm the diagnosis.

Medicines for inflammatory arthritis are used to relieve pain, reduce swelling and slow or stop joint damage. Each person responds differently to arthritis medicines. This means you need to work with your rheumatologist (a doctor who specialises in arthritis and related conditions) to identify the treatment that works best for you.

Your GP will probably monitor your treatment and refer you back to a rheumatologist if necessary.

Common medicines for rheumatoid arthritis include:

disease-modifying anti-rheumatic drugs (DMARDs)
pain relief medicines such as paracetamol and codeine
non-steroidal anti-inflammatory drugs (NSAIDs)
corticosteroids (also called steroids).

Disease-modifying anti-rheumatic drugs (DMARDs)

These medicines change the underlying condition rather than just treating the symptoms. They slow down the disease and its effects on your joints.
DMARDs should be started as early as possible after inflammatory arthritis has been diagnosed. They can only be started by a rheumatologist and you will need to have regular blood and urine tests to look for possible side effects and assess how well the medicine is working.

There are 2 main groups of DMARDs – conventional DMARDs and biological therapies.

- Conventional DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, leflunomide and azathioprine. Most people are started on methotrexate because it is often the most effective and is well studied. It may take 2–6 months of treatment before the medicine is fully effective.
- Biological therapies, also called biologics, include tumour necrosis factor (TNF) inhibitors (infliximab, adalimumab, etanercept), rituximab, tocilizumab and secukinumab. They can be used if other treatments haven't worked well, and are usually used in combination with other DMARDs.

Pain relief medicines

Pain relief medicines such as paracetamol and codeine are often used along with other medication.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as ibuprofen, diclofenac and naproxen reduce inflammation and swelling of your joints. They start working quickly and relieve pain and swelling but do not reduce damage to your joints.

Taking NSAIDs is safe, but extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers, kidney problems or if you smoke.

Corticosteroids (also called steroids)

Corticosteroids are used at the start of treatment to reduce the pain and swelling of your joints, while waiting for other medicines to take effect. They may also be used to treat sudden flare-ups.

You may take these as tablets, such as prednisone, or as injections directly into the joint or into a muscle or vein.

Important to know

If you take an ACE inhibitor or angiotensin II receptor blocker (ARB) (for example, cilazapril, enalapril, quinapril, losartan or candesartan) and a diuretic (for example, furosemide or bendroflumethiazide), taking a non-steroidal anti-inflammatory drug (NSAID) (for example ibuprofen or aspirin in high doses) could harm your kidneys. The term for this is "triple whammy". Read The Triple Whammy – Safe use of NSAIDs(external link) for more details. Check with your doctor, practice nurse or pharmacist if you're not sure if you're taking an ACE inhibitor or angiotensin II receptor blocker (ARB) and a diuretic.

Although there's no cure for inflammatory arthritis, there are many things you can do to reduce pain and stiffness and to help prevent joint damage and disability.

Have regular check-ups with your GP(external link). Your doctor can advise you on treatment options and other things you can do to help reduce pain, swelling and inflammation. Your doctor will monitor you after you start on preventative maintenance treatment, and you'll need to have regular blood tests.
Try some non-drug treatments, such as physiotherapy(external link), hydrotherapy(external link) and occupational therapy(external link). Ask your GP or rheumatologist about these options, and how you can access them.
Stop smoking(external link) as this can increase your risk of inflammatory arthritis.
Eating well(external link) and aiming for a healthy weight(external link) can improve your overall health and wellbeing.
Keep physically active(external link) to help keep your joints flexible and your muscles strong. Your GP will be able to give you general advice about physical activity. Tai chi, walking, swimming and gentle exercise classes are all excellent for arthritis. Your doctor can refer you to Green Prescription(external link) for help to get more active, or to a physiotherapist for more detailed advice on specific exercises.
Also see Arthritis NZ – physical activity(external link) for more information about the benefits of keeping active.
Contact Arthritis NZ(external link). They offer a range of services to people who are affected with all types of arthritis, and several programmes that cover aspects of managing this group of conditions. You can also discuss individual self-management with a trained arthritis educator.