Helping Doctors Diagnose and Treat Psoriatic Arthritis

Despite decades of research on psoriatic arthritis (PsA), diagnosing this debilitating inflammatory joint and skin disease is often delayed. Because the disease varies so much from patient to patient, researchers have not been able to hone in on a clear set of clinical criteria to diagnose it. URMC researchers provide some guidance to help doctors recognize signs of PsA and treat the disease earlier in a review recently published in the New England Journal of Medicine.

PsA is essentially a grab bag of mixed and matched symptoms. While PsA always occurs alongside psoriasis, an immune skin disorder characterized by painful, red, scaly patches of skin, other symptoms are less reliable.  PsA patients may have inflamed, swollen fingers or toes referred to as “sausage fingers”, or may experience any combination of inflammation in tendons, ligaments, the lower spine, and/or peripheral joints (any joint other than the spine). One distinguishing characteristic of PsA is its penchant for destruction of cartilage and bone and harmful creation of new bone, which is unparalleled by other forms of arthritis.

These symptoms can also come and go – flaring up in response to emotional or immune stress. Patients’ daily living can be significantly impacted during flare ups, making it hard for them to maintain productivity and often causing them to miss work.

Christopher Ritchlin, M.D., M.P.H., professor and chief of Allergy, Immunology, and Rheumatology at the University of Rochester Medical Center and author the review, has studied PsA for over 25 years and has treated many PsA patients in the clinic. He and review co-authors Dafna Gladman, M.D., of Toronto Western Hospital and Robtert Colbert, M.D., Ph.D., of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, offer their collective expertise on testing for PsA and differentiating it from similar forms of arthritis. 

The group recommends assessing a litany of joints for tenderness and soft swelling due to inflammation, occurring in a unique “ray pattern”; each joint of a single finger may be affected, while neighboring fingers are entirely spared. Physicians should also evaluate spinal range of motion and back pain as well as the severity of psoriasis, indicated by the amount of skin that appears inflamed and signs of nail pitting or separation from the nail bed.

Because PsA varies so much from patient to patient, the review authors suggest physicians tailor treatment strategies to specific, dominant features of the disease in each patient. Non-steroidal anti-inflammatory drugs (NSAID) may be sufficient for some, while others may need one of the many disease modifying anti-rheumatic drugs (DMARDS) now available.

All PsA patients, however, can benefit from lifestyle modifications that keep inflammation at bay. Quitting smoking, maintaining a healthy body weight, staying physically active, managing stress, and protecting joints are some vital changes that PsA patients can make to help manage their disease.

For more advice on diagnosing and treating PsA, read the full review article.

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