Psoriatic Arthritis

Psoriatic arthritis is a disease involving inflammation of the spine, joints of the hands and feet, and entheses (where muscle or ligament attaches to bone). The disease also affects other parts of the body, such as the eyes, gut or skin.^a

Psoriatic arthritis is associated with psoriasis,¹ a chronic condition in which people develop red, scaly patches on the skin.^b Approximately one-third of people with psoriasis develop psoriatic arthritis.² While psoriatic arthritis usually occurs in 40 and 50 year olds, it can affect various age groups, including young children and the elderly.³

Psoriatic arthritis can limit the person’s physical activities and impair work performance, and may also affect the person’s quality of life.^b

Psoriatic arthritis is an autoimmune disease, in which the immune system reacts to the body’s own tissues.c Genetic, immunological, and environmental factors contribute to the development of psoriatic arthritis.^d

• Genetic factors: 

  Certain genes have been implicated in the development of psoriatic arthritis.^e,f

• Immunological factors: 

  The immune system plays a role in the development of psoriatic arthritis.^f

• Environmental factors: 

   Lifting heavy loads, bacterial infections, cigarette smoking, injuries and stressful life events are  also associated with the development of psoriatic arthritis.^d

People with psoriatic arthritis have inflammation in the joints of their hands or feet.^g Inflammation leads to pain, tenderness, and sometimes also swelling, which can make performing daily activities difficult, such as getting dressed, getting in and out of a car, and walking outdoors on flat ground.^g,h

Hallmark features of psoriatic arthritis include:

• Dactylitis:

   Inflammation of joints and tendons (connective tissues that join muscles to bones) leads to swelling of the entire finger or toe, which becomes “sausage-shaped”.^g,i

• Enthesitis:

   Inflammation can also affect the entheses (where the tendon inserts into bone),ⁱ leading to tenderness, swelling and pain, particularly at the back of the heels and in the sole of the foot.^e,i

• Spondylitis:

   Inflammation of joints in the spine may manifest as back pain.^g Some people with psoriatic arthritis do not have the symptoms associated with spondylitis at all.^g

• A reddish or purplish discolouration over the inflamed joint is also a key feature in psoriatic arthritis.^g

People with psoriatic arthritis may also experience symptoms occurring outside the joint. Such symptoms include:

• Psoriasis

   A chronic skin condition, which can manifest as red coloured plaques on the elbows, knees, scalp and in the lower back.^j

• Nail changes

   Which may include pitting, thickening, separation of the nail from the nail bed, and scaling under the nail.^k

• Eye conditions

​​​​​​​​​​​​​​   Which may present as inflammation of the conjunctiva (term “conjunctivitis”) or inflammation of the iris (termed “iritis”).^g

There are many practical things that people with psoriatic arthritis can do to improve their symptoms, such as maintaining a balanced diet and a healthy weight, as well as exercising regularly.^l

Be sure to seek the advice of a medical professional on what is best for you before making dietary changes or starting any exercise programme.

The diagnosis of psoriatic arthritis is based on clinical assessment, imaging studies and blood tests.

• During clinical assessment, the presence of dactylitis, enthestitis, and nail lesions helps distinguish psoriatic arthritis from other forms of arthritis, such as rheumatoid arthritis and osteoarthritis.¹
• Imaging studies, such as radiography, ultrasonography, and magnetic resonance imaging (MRI), help identify abnormalities in psoriatic arthritis such as bone destruction and proliferation.³
• Additionally, blood tests may be used to confirm the diagnosis of psoriatic arthritis.^l The absence of the rheumatoid factor (RF) supports a diagnosis of psoriatic arthritis and distinguishes it from rheumatoid arthritis, which is known to involve RF.^l

Patient Organisations:

• Arthritis Australia is a charitable not-for-profit organisation, and is the peak arthritis body in Australia. Resources available through its website include arthritis information sheets, booklets and news. To find a support group near you, please select one of the following:

1. Arthritis Australian Capital Territory (ACT)

2. Arthritis & Osteoporosis New South Wales 

3. Arthritis & Osteoporosis Northern Territory (AONT) 

4. Arthritis Queensland

5. Arthritis South Australia

6. Arthritis & Osteoporosis Tasmania

7. MOVE muscle, bone & joint health (Arthritis & Osteoporosis Victoria)

8. Arthritis & Osteoporosis Western Australia

• The Australian Rheumatology Association is an association of rheumatologists in Australia that is a specialty society of the Royal Australasian College of Physicians. The Patient’s Home webpage offers people with diseases that affect the joints, muscles, and bones an extentive range of information, including medicine information sheets and consumer information sheets.

For more information about psoriatic arthritis, please consult a healthcare professional.

1. De Vlam K, Gottlieb AB, Mease PJ. Acta dermato-venereologica. 2014;94:627-637. https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-1833

2. Osterhaus JT, Purcaru O. Arthritis Research and Therapy. 2014;16:R140. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226958/

3. Liu J-T, Yeh H-M, Liu S-Y, et al. World Journal of Orthopedics. 2014;5:537. http://www.wjgnet.com/2218-5836/full/v5/i4/537.htm

a. Paramarta J, Baeten D. Rheumatology. 2013:ket407.

b. Mease PJ, Armstrong AW. Drugs. 2014;74:423-441.

c. Bellone M. Autoimmune disease: pathogenesis. John Wiley & Sons: Encyclopedia of Life Sciences. DOI: 10.1038/npg.els.0004000.

d. Boehncke W, Qureshi A, Merola J, et al. British Journal of Dermatology. 2014;170:772-786.

e. Arthritis Australia. Taking control of your Psoriatic Arthritis: A practical guide to treatments, services and lifestyle choices, 2009.

f. FitzGerald O, Winchester R. Arthritis Research and Therapy. 2009;11:214.

g. Gladman DD. Dermatologic Therapy. 2009;22:40-55.

h. Kavanaugh A, Helliwell P, Ritchlin CT. Rheumatology and Therapy. 2016; 1-12.

i. Cantini F, Niccoli L, Nannini C, et al. International Journal of Rheumatic Diseases. 2010;13:300-317.

j. Lowes MA, Suárez-Fariñas M, Krueger JG. Annual review of immunology. 2014;32:227-255.

k. Duarte GV, Faillace C, de Carvalho JF. Best Practice and Research Clinical Rheumatology. 2012;26:147-156.

l. Brockbank J, Gladman D. Drugs. 2002;62:2447-2457.