What is psoriatic arthritis?

Psoriatic arthritis (PsA) is a condition that causes inflammation of the joints. It usually only affects people who have a skin disease called psoriasis, which causes dry scaly skin rashes. Only one or two out of every 10 people with psoriasis will develop psoriatic arthritis. Symptoms can vary from person to person but the most common symptoms are listed below.

Symptoms of PsA

The symptoms of PsA vary from person to person, however the most common symptoms may include:

• Pain and stiffness in and around your joints, swollen fingers or toes (dactylitis), caused by inflammation both in joints and tendons
• Pain and stiffness in the buttocks, lower back or neck, which is caused by inflammation in your spine (spondylitis)
• Pain and swelling in your heels, caused by inflammation where the Achilles tendon attaches to the bone or pain in other areas where tendons attach to bone (enthesitis), such as your knee, hip and chest
• Pitting, discolouration and thickening of your nails

How will my doctor diagnose psoriatic arthritis?

Your doctor will diagnose psoriatic arthritis from your symptoms and a physical examination. Your skin will be examined for signs of psoriasis, if you have not been diagnosed with this already. There is no specific test for psoriatic arthritis. However your doctor may order blood tests for inflammation, such as the erythrocyte sedimentation rate (ESR) test. Blood tests may also help to rule out other types of arthritis. If your doctor suspects you have psoriatic arthritis you should be referred to a rheumatologist, a doctor who specialises in arthritis.

With the right treatment, most people with psoriatic arthritis can lead full and active lives. However the course of psoriatic arthritis is variable and no two cases are the same. Many people find their symptoms worsen at times (known as a ‘flare’) and then settle down for a period of time. About one in 20 people with psoriatic arthritis will develop a more severe, destructive form which can cause deformity to the joints in the hands and/or feet. Most people with psoriatic arthritis will need some ongoing treatment to control their symptoms and prevent damage to the joints. This is usually managed by a rheumatologist.

Living with psoriatic arthritis

Once your diagnosis is confirmed, living with psoriatic arthritis can be challenging at times, however there are many useful tools and resources that can assist you in managing your range of movement and capability. It is also important that you maintain a strong relationship with your rheumatologist, rheumatology nurse and GP as this team will make every effort to provide the necessary support and information for you.

To help you in your arthritis journey, there are many useful tools and resources that can assist you, with some key guiding principles;

1. Take control by knowing your disease.
2. Don’t delay, see your doctor.
3. Work with your healthcare team and be an important part of it.
4. Know about your treatment options.
5. Find new ways to stay active.
6. Learn techniques to help manage your pain.
7. Acknowledge your feelings and seek support.
8. Make food choices that count.
9. Balance your life.
10. Call your local State or Territory Arthritis Office.

Will medicine cure my psoriatic arthritis?

At present, there is no ‘cure’ for psoriatic arthritis. However, early use of the right medicines can slow down any damage caused by the disease, relieve pain and stiffness, and reduce the possibility of long-term disability. The aim of treatment is to achieve remission — the absence of any symptoms and a return to normal function of your joints.

What is the right medicine for me?

All medicines have risks and benefits, so before you start treatment talk to you doctor and pharmacist about how each medicine should be helping you and what risks it might have. Make sure your doctor knows about any other health problems that you or your family members have, as this can help them choose the best medicine for you, and be sure to act early, as early use of the right medicines can slow down the damage caused by the disease, relieve pain and stiffness, and reduce long-term disability.

You should also make sure that you understand what side effects the medicine might have, including what to do or who to speak to if you experience any unwanted effects from your medication.

Many medicines need to be taken regularly to work properly and should not be stopped suddenly — talk to your doctor if you have concerns about side effects, safety or cost. As you may have heard in our speaker interviews, each person responds differently to medicines, which means that you will need to work with your specialist and GP to find the best medications and doses for you. This can take time, but by finding the most effective medicines with the least side effects, you can hope to really make a difference in controlling your condition.

Your disease may also change over time, including which joints are affected, how much pain or disability you experience and whether you have symptom-free periods. This means that you may need to change or add medicines over the course of your treatment — you may not be on the same medicine forever.

Some medicines can only be used once other medicines are no longer effective in controlling your arthritis, do speak to your doctor about any concerns you may have.

The following medicines may be used at various points in your journey;

• Painkillers such as paracetamol are often very helpful. They can be taken regularly and are particularly useful just before activity to keep your pain to a minimum. It’s best not to wait until you’re in severe pain before taking them. They don’t need to be taken with a meal, though some water and a small snack are advised.
• There’s a wide range of non-steroidal anti-inflammatory drugs (NSAIDs) that can reduce pain so you can get on with your daily activities and your exercise routine. You’ll probably need to take these during bad patches, and some people may need them over a longer period. Some tablets are made in a slow-release formulation, which can help with night-time pain and morning stiffness. Some NSAIDs are also available as gels, which you can apply to the painful area. Like all drugs, NSAIDs can sometimes have side-effects, but your doctor will take precautions to reduce the risk of these, for example by prescribing the lowest possible dose for the shortest possible period of time.
• Steroids can be used as a short-term treatment for flare-ups. They’re usually given as an injection into a swollen joint or as a slow-release injection into a muscle. They can also be used for painful tendons, for example at the heel, although they won’t be repeated very often as this may lead to tendon weakness. Occasionally, you may be given a course of steroid tablets. While these treatments can be very effective at improving pain and stiffness, you may develop side-effects if you use them for long periods, for example, weight gain, bruising or thinning of the skin, high blood pressure, high blood sugar or osteoporosis. If you develop eye inflammation, it will usually be treated with steroid eye drops. In more severe cases, steroids may be given as tablets or as an injection into the eye.
• Disease-modifying anti-inflammatory drugs (DMARDs) are designed to reduce damage to the joints rather than just ease your symptoms. They’re slow-acting so you won’t notice an immediate impact, but they’re very effective over a period of time. Drugs such as these can be helpful for arthritis in the joints of your arms and legs, although they’re not usually effective for spinal symptoms. When taking DMARDs, you’ll need regular check-ups and blood tests to monitor their effect.
• Biological therapies are relatively new treatments that can be very effective for psoriatic arthritis. A number of drugs are currently available for psoriatic arthritis. These biological therapies are currently only available to patients with more severe forms of the condition if it can’t be controlled with anti-inflammatory drugs and they may not be suitable for everyone. The effect of these drugs will be monitored, and you’ll need to complete questionnaires regularly which assess how active your disease is and how well it’s responding to treatment.

Exercise and activity information

Physical activity protects joints by strengthening the muscles around them. Strong muscles and tissues support those joints that have been weakened and damaged by arthritis. A properly designed program of physical activity reduces pain and fatigue, improves mobility and overall fitness, and alleviates depression. Physical activity allows someone with arthritis to have a more productive, enjoyable life. There are different types of exercises that you can do to lessen your pain and stiffness;

• Range of motion exercises reduce pain and stiffness and keep your joints moving. To achieve the most benefit, these exercises should be done daily.
• Strengthening exercises maintain or increase muscle tone and protect your joints.
• Moderate stretching exercises help to relieve the pain and keep the muscles and tendons around an affected joint flexible.
• Endurance exercises strengthen your heart, give you energy, control your weight and help you feel better overall. These exercises include things like walking, swimming and cycling. It is best to avoid high-impact exercises like step aerobics, jogging or kickboxing.

Inflammation in your muscles, tendons and other tissues may make it harder for you to stand up straight, turn and bend, or take a deep breath. Your physiotherapist or exercise physiologist can suggest suitable exercises to stretch and strengthen your muscles. These exercises will improve your posture and help to maintain flexibility. You should aim to do this stretching program every day, or at least five times per week. If you experience early morning stiffness, gentle stretching exercises under a warm shower will also help.

In addition to your stretching exercises, it is important to do at least 30 minutes of moderate exercise on most days of the week for your general fitness. You can do this either in one go or break your exercise into smaller efforts (for instance, three 10-minute or two 15-minute blocks per day).

Activities that are likely to be good for your fitness include walking, swimming, water exercise, low-impact aerobics and riding a bicycle or exercise bike. Your physio or exercise physiologist can also suggest specific exercises and stretches that are appropriate for your situation.

Ask your physio or exercise physiologist to create a special exercise program you can do at home or at the local gym or swimming pool.

Protecting your joints

You should always use your joints in ways that avoid excess stress. This allows you to experience less pain, perform tasks more easily and protect your joints from damage. Techniques to protect your joints include:

• Pacing by alternating heavy or repeated tasks with lighter tasks. Taking a break reduces the stress on painful joints and conserves energy by allowing weakened muscles to rest.
• Positioning joints wisely promotes proper alignment and decrease excess stress. For example, squatting and kneeling may put extra stress on your hips or knees. When lifting or carrying heavy items, keep items at waist height and avoid carrying them up and down stairs.
• Talk to your doctor about seeing an occupational therapist or physiotherapist, who may prescribe splints, braces or orthotics (shoe inserts) to help align and support your joints.
• Using assistive devices conserves energy and makes daily tasks easier. Raise seat levels to decrease stress on hip and knee joints. Use a reacher to pick up items from the ground. Use a cane to decrease stress on hip and knee joints. Enlarge grips on utensils, such as spoons or peelers, to decrease stress on delicate hand joints. Other devices to consider include carts for carrying objects and jar/tap openers.

For additional information on living at home with arthritis, review Arthritis Australia’s ‘At home with arthritis’ which outlines a range of simple steps for managing in the home.

Pregnancy and psoriatic arthritis

It is possible for women with psoriatic arthritis to have children. Some arthritis medicines can still be used during pregnancy if necessary, but many can harm the foetus and should not be taken while trying to conceive, when pregnant, or during breastfeeding.

Whether you are male or female, discuss your pregnancy and parenting plans with your doctor so that your medications can be reviewed. Talk to your doctor for more advice on psoriatic arthritis and pregnancy.

‘Arthritis, Pregnancy and the Path to Parenthood’, published by Suzie May, details Suzie’s experience as a young Australian woman with psoriatic arthritis, along with the experiences of other men and women from around the world as they fulfil their goal of becoming parents, despite their arthritis. This practical guide can help you understand the potential challenges you may face and give you strategies to overcome these challenges. The book is available here.

What other assistance is available?

There are many resources available to help people with psoriatic arthritis. Your doctor may put you in touch with a social worker, who can help explain the financial and health services that are available to you. These can include any pensions or allowances that you might be entitled to, plus any financial assistance such as Health Care Concession Cards or low-cost treatment programs. Your local council, community health centre, community group or religious organisation may also offer programs that include practical advice, activities, social networks or just someone to talk to. Arthritis Australia is always here to help too.

 

Contact your State/Territory Arthritis Office (on the details outlined below) to find out about their wide range of resources, management programs and support groups – call 1800 011 041 or visit www.arthritisaustralia.com.au.

In addition, there are Independent Living Centres in each state that provide advice on products and services, including aids and devices, that can help with day-to-day activities. Visit www.ilcaustralia.org.au or call 1300 885 886 for your closest centre or more information.

Who can help?

There are many people who can help you deal with both the functional and emotional side of psoriatic arthritis. Your first step is to try to talk honestly with your partner, parents or children about how you feel. Give them a chance to talk too – they might have worries or feel that they don’t know enough about your disease and how it is affecting you.

Visit your GP if you are worried about how well you are coping, as your GP may be able to suggest additional ways of coping, or may prescribe medicines if you are especially worried or depressed. Many people with psoriatic arthritis will also visit a physiotherapist (physio). These practitioners can use various treatments, including exercise therapy and hydrotherapy (water exercise), to keep your joints as flexible, strong and pain-free as possible. They will also show you exercises and pain-relief techniques to use at home.

Your GP may also refer you to a counsellor or psychologist, who can talk to you about your worries, feelings and moods, then suggest practical ways to work through them. If you want to contact a psychologist directly, call the Australian Psychological Society on 1800 333 497 or visit www.psychology.org.au. Beyondblue also provides information and advice about depression, anxiety, available treatments and where to get help. Visit www.beyondblue.org.au or call 1300 22 4636. Lifeline provides a 24hr confidential telephone crisis support service for anyone across Australia experiencing a personal crisis. Call 13 11 14.

Arthritis Infoline: 1800 011 041

Please call our toll free national Arthritis Infoline number for information about arthritis and other musculoskeletal conditions including self-management, community programs, seminars, support groups, resources etc. The infoline is staffed by health professionals and specially trained volunteers who are able to answer most questions about living with arthritis. Alternatively, contact Arthritis Australia, or your local state or territory using the details below.

Arthritis Australia

Phone: (02) 9518 4441

Fax: (02) 9518 4011

Email: [email protected]

Website: www.arthritisaustralia.com.au

Freecall: 1800 111 101

State and Territory Support

Australian Capital Territory

Phone: (02) 6251 2055

Fax: (02) 6251 2066

Email: [email protected]

Web site: www.arthritisact.org.au

Infoline: 1800 011 041

New South Wales

Phone: (02) 9857 3300

Fax: (02) 9857 3399

Email: [email protected]

Web site: www.arthritisnsw.org.au

Infoline: 1800 011 041

Northern Territory

Phone: (08) 8948 5232

Fax: (08) 8948 5234

Email: [email protected]

Web site: www.aont.org.au

Infoline: 1800 011 041

Queensland

Phone: (07) 3857 4200

Fax: (07) 3857 4099

Email: [email protected]

Web site: www.arthritis.org.au

Infoline: 1800 011 041

South Australia

Phone: (08) 8379 5711

Fax: (08) 8379 5707

Email: [email protected]

Web site: www.arthritissa.org.au

Infoline: 1800 011 041

Tasmania

Phone: (03) 6228 4824

Email: [email protected]

Website: www.arthritistas.org.au

Infoline: 1800 011 041

Victoria

Infoline: 1800 011 041

Western Australia

Phone: (08) 9388 2199

Fax: (08) 9388 4488

Email: [email protected]

Website: www.arthritiswa.org.au

Infoline: 1800 011 041

Additional resources in Australia:

For access to quality online information about psoriatic arthritis, start at Health Direct www.healthdirect.gov.au

For advice on healthy eating and appropriate exercise, visit Healthy Active www.healthyactive.gov.au 

For advice on quitting smoking, contact the Quitline www.quitnow.gov.au
Ph: 13 78 48

To find a rheumatologist, contact the Australian Rheumatology Association www.rheumatology.org.au
Ph: (02) 9252 2356

To find a dermatologist, contact the Australasian College of Dermatologists www.dermcoll.edu.au
Ph: (02) 8741 4101

To find a physiotherapist, contact the Australian Physiotherapy Association www.physiotherapy.asn.au
Ph: 1300 306 622

To find an occupational therapist, contact Occupational Therapy Australia www.otaus.com.au
Ph: 1300 682 878

To find a podiatrist, contact the Australasian Podiatry Council www.apodc.com.au
Ph: (03) 9416 3111

To find an exercise physiologist, contact Exercise and Sports Science Australia www.essa.org.au
Ph: (07) 3171 3335

To find a dietitian, contact the Dietitians Association of Australia www.daa.asn.au
Ph: 1800 812 942

To find a psychologist, contact the Australian Psychological Society www.psychology.org.au
Ph: 1800 333 497

Psoriasis resources

Psoriasis Australia is based in Melbourne and can assist with information and links to support groups www.psoriasisaustralia.org.au
Ph: 0481 346 160

International resources

The public area on the website of the American College of Rheumatology contains many useful resources www.rheumatology.org

Arthritis Research UK also provides a wide variety of information for people with arthritis www.arthritisresearchuk.org

Thank you to Arthritis Society (Canada) and Arthritis Research UK for contribution of content and materials the above overview.