Psoriatic arthritis tests, diagnosis, and treatment Health ConditionsHealth ConditionsAlzheimer's & DementiaAnxietyArthritisAsthma & AllergiesBreast CancerCancerCardiovascular HealthCOVID-19Dermatology & SkincareDiabetesEnvironment & SustainabilityExercise & FitnessEye HealthHeadache & MigraineHealth EquityHIV & AIDSHuman BiologyInflammatory Bowel DiseaseLeukemiaLGBTQIA+Men's HealthMental HealthMultiple Sclerosis (MS)NutritionParkinson's DiseasePsoriasisSexual HealthWomen's HealthDiscoverNewsLatest NewsOriginal SeriesMedical MythsHonest NutritionThrough My EyesNew Normal HealthPodcastsHow to understand chronic painWhat is behind vaccine hesitancy?The amazing story of hepatitis C, from discovery to cureNew directions in dementia researchCan psychedelics rewire a depressed, anxious brain?Why climate change matters for human healthToolsGeneral HealthDrugs A-ZHealth HubsHealth ToolsBMI Calculators and ChartsBlood Pressure Chart: Ranges and GuideBreast Cancer: Self-Examination GuideSleep CalculatorHealth ProductsAffordable Therapy OptionsBlood Pressure MonitorsDiabetic SuppliesFitness TrackersHome GymsGreen Cleaning ProductsHow to Shop for CBDQuizzesRA Myths vs FactsType 2 Diabetes: Managing Blood SugarAnkylosing Spondylitis Pain: Fact or FictionConnectAbout Medical News TodayWho We AreOur Editorial ProcessContent IntegrityConscious LanguageNewslettersSign UpFollow UsMedical News TodayHealth ConditionsDiscoverToolsConnectSubscribe What to know about psoriatic arthritisMedically reviewed by Nancy Carteron, M.D., FACR — By Goretti Cowley on June 28, 2022Psoriatic arthritis (PsA) is a chronic inflammatory joint disease associated with the skin condition psoriasis. Psoriatic arthritis can affect multiple body tissues, including the joints, skin, and nails. In PsA, an overactive immune system mistakenly attacks healthy body tissues, resulting in pain and inflammation. It is unclear why some people with psoriasis develop PsA while others do not. This article describes PsA, including the different types. We also provide information on diagnosing and treating PsA and offer advice on when to consult a doctor. Finally, we cover the outlook for people living with PsA and compare the differences between PsA and rheumatoid arthritis. What is psoriatic arthritis Share on PinterestOleg Breslavtsev/Getty ImagesPsA is a form of chronic inflammatory arthritis that affects around 15% of people with the skin condition psoriasis. Medical experts do not yet understand why some people with psoriasis go on to develop PsA while others do not. PsA can cause pain and inflammation in multiple body tissues, including:the joints, such as:large, weight-bearing jointssmaller joints in the fingers and toesjoints of the spine and pelvistendonsnailseyesgastrointestinal tract Psoriasis and PsA are autoimmune conditions in which the immune system mistakenly attacks healthy body cells and tissues. Experts do not fully understand what causes these conditions. However, around 40% of people with PsA have a family member with psoriasis or PsA, suggesting a genetic link. Diagnosing psoriatic arthritis There is no definitive test for PsA. To diagnose the condition, a doctor will:take a detailed medical historyperform a physical examorder imaging tests, which can detect inflammation in the joints If preliminary investigations suggest that a person may have PsA, the doctor may make a referral to a rheumatologist. This is a doctor who specializes in disorders of the musculoskeletal system. The rheumatologist will aim to rule out other forms of arthritis, such as rheumatoid arthritis (RA), osteoarthritis, and gout. They may order the following tests to assist with the diagnosis:blood tests to assess the following:erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, which measure inflammation in the bodyrheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies, which may warrant a diagnosis of RA rather than PsAantinuclear antibodies (ANAs), which can help exclude diseases like lupuslevels of the different types of blood cells within a person’s bloodkidney function, liver function, and electrolyte levelsMRI scans, X-rays, and ultrasound scans to detect any inflammation and wear in the joints Types of psoriatic arthritis There are five main types of PsA. These types differ according to the area of the body the condition affects, as well as the number of joints involved. The five types of PsA are:Asymmetrical oligoarticular (AO) arthritis: This type affects fewer than five joints. Medical professionals refer to it as “asymmetrical,” as symptoms appear on only one side of the body. Around 35% of people with PsA have AO arthritis.Symmetrical polyarthritis (SP): This type affects five or more joints. Medical professionals refer to it as “symmetrical,” as symptoms appear on both sides of the body. The symptoms can occasionally resemble those of RA. Around 50% of people with PsA have SP, making this the most common type.Distal arthritis: This type affects the small joints at the ends of the fingers and toes. It may cause changes to the nails, such as spotting, pitting, and separation of the nail from the nail bed. Most cases of DA occur alongside another type of PsA, with only around 20% of people experiencing DA alone.Arthritis mutilans (AM): This is the most severe and destructive type of PsA, and it primarily affects the joints of the fingers, hands, wrists, and feet. This type may shorten and fuse joints, leading to joint deformity, stiffness, and immobility. Less than 5% of people with PsA have the AM type.Spondyloarthritis: This type affects the joints of the lower back and the pelvis. The main symptoms are back pain and morning stiffness. CASPAR criteria for diagnosis Diagnosis of PsA can follow the CASPAR criteria, which stands for classification for psoriatic arthritis. The criteria state that to receive a diagnosis of PsA, a person must first have received a diagnosis of inflammatory articular disease. Such diseases typically cause symptoms such as joint pain, swelling, and stiffness. For a diagnosis of PsA using the CASPAR criteria, a person must also score at least three points from the options listed below:current active psoriasis: 2 pointspersonal history of psoriasis, unless current psoriasis is present: 1 pointfamily history of psoriasis, unless current psoriasis is present or there is a personal history of psoriasis: 1 pointcurrent or previous dactylitis, swelling of the fingers or toes: 1 pointX-ray evidence of a new bone growth near a joint: 1 pointrheumatoid factor (RF) negativity: 1 pointnail issues, such as nail pitting and separation of the nail from the nail bed: 1 point When to contact a doctor A person should consult a doctor if they have a personal or family history of psoriasis and begin to experience symptoms of PsA, such as persistent joint pain, swelling, or stiffness. A doctor will run tests to determine whether the person has PsA. A person should also talk with a doctor if they have already received a diagnosis of PsA and experiencing a particularly severe or persistent flare of the condition. Symptoms may include:general tiredness or fatiguejoint pain with swelling and stiffness, particularly in the morningsreduced range of joint movementtenderness, pain, and swelling over tendonsswollen fingers and toeseye pain and redness Treatment for psoriatic arthritis There are many treatment options for PsA. These treatments aim to:reduce symptomsslow the progression of the diseaseallow the joints to function as well as possibleimprove the person’s quality of lifeprevent or minimize complications In 2018, the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF) provided an evidence-based guideline for the treatment of PsA. Below are some of the treatments featured in these guidelines. Nonmedical treatments Nonmedical treatment options that may help to alleviate the symptoms of PsA include:physical therapyoccupational therapymassage therapyquitting smokinglosing excess weightperforming regular exercise Medical treatments The 2018 guidelines also list a range of medical treatments that may help alleviate the symptoms of PsA or help slow the progression of the disease. Examples are as follows. Nonsteroidal anti-inflammatory drugs NSAIDs NSAIDs block the production of prostaglandins that signal the body’s immune system to trigger an inflammatory response. Common over-the-counter NSAIDs are ibuprofen and naproxen. Glucocorticoids Glucocorticoids are steroid hormones that can help suppress the immune system and reduce inflammation and associated tissue damage. According to the Psoriasis and Psoriatic Arthritis Alliance (PAPAA), a person may take low dose steroid tablets to help alleviate PsA pain and stiffness. Doctors may also prescribe a temporary high dose to help a person recover from a PsA flare. In some cases, a person may receive an injection of steroids into the affected joints to reduce localized pain and inflammation. Disease-modifying antirheumatic drugs DMARDs DMARDs are medications that slow the biological processes responsible for causing chronic inflammation. In this way, DMARDs help slow the progression of PsA. Examples include:oral small molecules (OSMs), such as methotrexate, sulfasalazine, and cyclosporinetumor necrosis factor inhibitor (TNFi) biologics, such as etanercept and infliximabinterleukin-17 inhibitor (IL-17i) biologics, such as ustekinumab Outlook for psoriatic arthritis Psoriatic arthritis is a chronic condition that can worsen over time. Without treatment, severe cases may result in permanent joint damage and deformity. Such cases may require surgical treatment. However, diagnosing and treating PsA in its earlier stages can help slow the progression of the disease and reduce the risk of permanent joint damage. Psoriatic arthritis vs rheumatoid arthritis PsA and RA are both inflammatory forms of arthritis that occur due to the immune system attacking healthy body cells and tissues. The key difference between the two conditions is that PsA involves the skin as well as the joints. Other differences include:Disease symmetry: RA affects joints on both sides of the body, whereas PsA may affect joints on one side of the body.Joints affected: RA typically affects the middle joints of the fingers and toes, while PsA typically affects the joints closest to the fingernails and toenails.Diagnostic markers: Blood tests for RA will usually reveal a positive RF or CCP antibody, whereas blood tests for PsA will typically reveal a negative RF and CCP. Doctors may use such tests to help differentiate between the two diagnoses. Summary PsA is a chronic inflammatory skin condition associated with the skin disease psoriasis. Both conditions occur due to the immune system mistakenly attacking healthy body cells and tissues. A person should consult a doctor if they experience symptoms of PsA, especially if they have an existing diagnosis of psoriasis. Symptoms include joint pain, swelling, stiffness, and general fatigue. Early diagnosis and treatment of PsA can improve the outcome for people living with the disease. The diagnostic procedure for PsA typically involves a combination of imaging tests and blood tests. Treatment options are varied and include NSAIDs, glucocorticoids, and DMARDs. Last medically reviewed on June 28, 2022DermatologyPsoriasisPsoriatic ArthritisRheumatologyMedically reviewed by Nancy Carteron, M.D., FACR — By Goretti Cowley on June 28, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageWhat to know about psoriatic arthritis In this article, learn about the potential causes of psoriatic arthritis, as well as the possible symptoms and treatment options.READ MOREDiagnosis and treatment for ankylosing spondylitisMedically reviewed by Nancy Carteron, M.D., FACR Ankylosing spondylitis (AS) is a kind of arthritis that usually starts in the lower back. Here, find out what to expect when seeking a diagnosis for…READ MOREWhat are the symptoms of a psoriatic arthritis flare?Medically reviewed by Stella Bard, MD Psoriatic arthritis (PsA) is an inflammatory condition that causes swelling in the joints and other symptoms. Find out what triggers a flare and how…READ MOREHow does age of onset affect outcomes for psoriatic arthritis?Medically reviewed by Alana Biggers, M.D., MPH Psoriatic arthritis can develop at any age, and researchers are trying to determine how the age of onset affects the symptoms and treatment. Learn…READ MOREHow can a rheumatologist help with psoriatic arthritis?Medically reviewed by Stella Bard, MD Rheumatologists diagnose and treat conditions including psoriatic arthritis (PsA). Read about when to contact a rheumatologist, how they diagnose and…READ MORE