ARTHRITIS, PSORIATIC

Psoriatic arthritis causes inflammation leading to pain, swelling, and warmth of certain joints and a rash. The joints most frequently affected are the fingers, neck and lower back. Although the psoriasis rash usually occurs before the joint pain, some individuals are unaware of this rash. Psoriasis may affect the nails, scalp, umbilicus (belly button), and genital areas. Fatigue may also occur in this disease. Less commonly, psoriatic arthritis may also cause inflammation of the eyes, nails, and heart.

Although certain hereditary and environmental factors may increase an individual's risk of developing psoriatic arthritis, the exact cause of this disease is unknown. Psoriatic arthritis is not an infectious illness. In other words you cannot "catch" it from another individual.

Psoriatic arthritis usually begins between the ages of 30 and 50 years. It occurs equally between men and women. To diagnose psoriatic arthritis, a physician obtains a medical history, performs an examination of the joints, skin, and nails, and orders laboratory tests and possibly x-rays of the joints, neck, and lower back. Laboratory tests may include an erythrocyte sedimentation rate (ESR), which measures inflammation in the body, and a complete blood cell count (CBC).

The joints most frequently affected are the fingers, neck, and low back. Psoriatic arthritis of the fingers can decrease your ability to write, open jars, and lift and carry items. If the back is affected, it can decrease your ability to bend or stand. If the neck is affected, it may affect your ability to look around. For some individuals, the rash of psoriasis causes embarrassment in social situations. There is no cure for psoriatic arthritis. However, with earlier detection, improved medications, and comprehensive treatment, individuals with psoriatic arthritis can lead a full life.

The best way to manage psoriatic arthritis is through a combination of medications, therapies, exercise, and education. Medications help to decrease the inflammation that causes pain and swelling. Nonsteroidal antiinflammatory drugs (NSAIDs) are often the first line of therapy. Potential side effects of NSAIDs include stomach upset, diarrhea, constipation, ulcers, headache, dizziness, difficulty hearing, and a rash. If these medications do not adequately control the pain and swelling, a physician may prescribe "disease modifying" medications that may slow down the disease process. These medications include hydroxychloroquine, sulfasalazine, and methotrexate. Hydroxychloroquine may cause nausea, diarrhea, and a rash, and rarely affect the eyes. Sulfasalazine and methotrexate may affect the blood and liver, and may cause a rash. A dermatologist (skin doctor) may prescribe medications to manage the psoriasis.

Learning about your arthritis is essential because you may have psoriatic arthritis for the rest of your life. Exercise is important to maintain joint movement and muscle strength. Alternating periods of rest and activity helps to manage fatigue.

• Take your medication as prescribed.
• Call your doctor if you are experiencing side effects from medications.
• Ask you doctor what over-the counter pain medications and skin products you may take with the prescription medications.
• Exercise, because this can help maintain joint range of motion and muscle strength.

• Wait and see if a medication's side effect will go away. Always call your doctor if you have any questions.
• Give up. If one medication does not work for you, discuss this with your physician until you find a medicine that helps decrease joint pain, stiffness, and the skin disorder.
• Go on a specific diet without the consent of your physician.
• Continue an exercise program that causes pain. If pain after exercise continues, it usually means the exercise needs to be modified specifically for you.

• You experience any of the side effects listed above from any of the medications.
• The medication is not helping the joint pain, stiffness, or swelling, or the skin disorder.
• You need a referral to a physical or occupational therapist for exercise or joint protection.

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