Psoriatic Arthritis Treatment
Joint inflammation linked to psoriasis — diagnosis and treatment at Arthritis Care of Texas.
Some people with psoriasis — a skin condition that causes scaly patches — also develop arthritis. Joints become painful, stiff, and swollen. Treatment calms the immune system to help both the skin and the joints.
There is no cure yet — the goal is control of both halves of the disease: joints and skin. Success looks like few or no swollen joints, skin that is clear or nearly clear, pain-free heels and tendons, and no new joint damage on imaging. Reaching ‘minimal disease activity’ is a realistic target for many patients on modern treatment.
Psoriasis is a disease in which scaly red and white patches develop on the skin, caused by the body's immune system going into overdrive to attack the skin. Some people with psoriasis can also develop psoriatic arthritis, manifested by painful, stiff and swollen joints. Like psoriasis, psoriatic arthritis symptoms flare and subside, vary from person to person, and even change locations in the same person over time.
Psoriatic arthritis can affect any joint in the body — just one joint, several joints, or many. Affected fingers and toes can resemble swollen sausages, a condition called dactylitis, and finger and toenails may also be affected. Psoriatic arthritis in the spine, called spondylitis, causes stiffness in the back or neck and difficulty bending. It can also cause tender spots where tendons and ligaments join onto bones — enthesitis — resulting in pain at the back of the heel, the sole of the foot, around the elbows, or in other areas. Enthesitis is one of the characteristic features of psoriatic arthritis.
Recent research suggests that persistent inflammation from psoriatic arthritis causes joint damage later, so early, accurate diagnosis is essential. Fortunately, treatments are available and effective for most people.
What causes psoriatic arthritis?
The exact cause is not known. Of those with psoriatic arthritis, 40% have a family member with psoriasis or arthritis, suggesting heredity may play a role. It can also result from an infection that activates the immune system. While psoriasis itself is not infectious, it might be triggered by a streptococcal throat infection (strep throat).
How is psoriatic arthritis diagnosed?
Rheumatologists look for swollen and painful joints, certain patterns of arthritis, and skin and nail changes typical of psoriasis. X-rays are often taken to look for joint damage, and MRI, ultrasound or CT scans can look at the joints in more detail. Blood tests may rule out other types of arthritis with similar signs — gout, osteoarthritis, and rheumatoid arthritis — and may reveal high levels of inflammation and mild anemia, though labs may also be normal. Occasionally, skin biopsies are needed to confirm the psoriasis.
How is psoriatic arthritis treated?
Treatment varies depending on the level of pain, swelling, and stiffness. Those with very mild arthritis may require treatment only when their joints are painful. Non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin or Advil) or naproxen (Aleve) are used as initial treatment. Please make an appointment with Dr. Chiang for treatment.
Did you know?
- Psoriatic arthritis can swell a whole finger or toe so evenly that it looks like a little sausage — doctors call it dactylitis, from daktylos, the Greek word for finger.
- For some people the joint trouble arrives first: psoriatic arthritis can show up years before any psoriasis appears on the skin.
- It can even leave a mark on the fingernails — tiny dents called pitting are one of its classic calling cards.
Common worries
Why do both my skin and joints need treating?
They are one disease with two faces, driven by the same inflammation. Untreated joint inflammation causes permanent damage even when pain feels modest, and skin severity does not predict joint severity — each is assessed and treated in its own right.
Will my children get it?
Genes play a part — psoriatic arthritis is more common in families — but most children of patients never develop it. There is no test or treatment needed for them unless symptoms appear; knowing the family history simply speeds up diagnosis if they ever do.
Why blood tests and screening before treatment?
Baseline bloods give us your starting counts, liver and kidney values, so later results are easy to interpret. Screening for hidden infections such as TB is required before immune-calming medicines, because they can let a dormant infection wake up — finding it first keeps treatment safe.
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What counts as a flare: joint pain and swelling clearly worse than usual for more than 2–3 days, often with skin plaques worsening at the same time, new heel or tendon pain, or a whole finger or toe swelling (‘sausage digit’).
What to do: call us at (361) 400-7700 rather than waiting it out — joint flares left running cause damage. Keep taking your regular medicines and note whether skin and joints flared together; that pattern guides treatment.
Do not adjust steroids on your own: do not start or increase steroid tablets without calling — steroid changes can rebound psoriasis skin badly, so the plan needs to be made with us.
What isn’t a flare: a dry skin patch without joint symptoms, one sore joint after activity that settles in a day, or morning stiffness under 30 minutes.
Ready to be seen? New patients are seen within 2–4 weeks.