Psoriatic Arthritis

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Definition/Description[edit | edit source]

Psoritic arthritis is a chronic progressive inflammatory joint disease often associated with psoriasis. The condition may affect both peripheral joints and the axial skeleton causing pain, stiffness, and swelling.

Prevalence[edit | edit source]

  • Occurs in 6%-42% of persons that have psoriasis
  • Approximately 2% of general population has psoriasis 
  • Psoriatic arthritis is estimated to have a prevalence of 0.1%-0.25% in the US
  • Equal prevalence in both males and females [1]
  • Can occur at any age but typically occurs between ages of 30-50 years old 

Characteristics/Clinical Presentation[edit | edit source]


Associated Co-morbidities

  • Psoriasis
  • Presence of HLA-B27


It is a seronegative spondyloarthopathy that often coincides with psoriasis. In around 70% of cases, psoriasis precedes the arthritis. For the majority, joint symptoms do not apear until approximately ten years after the first signs of psoriasis. Both occur simultaneously in 15% of cases. Arthrits occassionally will appear first in around 15% of cases. Expression of the disease varies greatly from one person to the next. Its course is unpredictable and can range from mild to severe and destructive. The DIP joints are often involved bilaterally. Psoriatic arthritis causes inflammation, pain, stiffness, and swelling in joints as well as ligaments and tendons at their insertion site into bone. Bone, tendons, enthesis, cartilage, synovial membrane, skin, and nails may all be affected by the condition. During initial stages it is the tendons, synovia, and articular capsule that are primarily affected. As the condition progresses, tendons and bone often become altered. Marked joint destruction may occur in some individuals. After two years joint damage will commonly appear on radiographs and may include bone erosion, narrowing of joint space, periostitis, osteolysis, acro-osteolysis, ankylosis, spur formation, and spondylitis. Diagnosis of this condition may often be delayed since there are no identified biomarkers at this time. If left untreated psoriatic arthritis may lead to severe physical limitations and disability. Early diagnosis is critical to slow the progression of the disease with medications.

Medications[edit | edit source]

  • NSAIDS
  • Local Corticosteroid Injections

Aggressive Cases

  • DMARD Therapy with MTX, SSZ, and TNF-Beta Antagonists [1]

Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]

  • There is no definitive test. Diagnosis is made by ruling out other conditions.
  • X-rays are the current gold standard. However, signs of psoriatic arthritis often do not appear on radiographs until later stages of the disease when bone erosion has occured.[2]
  • Contrast enhanced ultra sound is starting to play a leading role since it can detect changes in bone and soft tissue much sooner than X-rays.[2]
  • Early studies have demonstrated that ultrasound and MRI are both highly sensitive to early inflammatory joint changes that occur in psoriatic arthritis. [2]
  • DIP erosive changes on X-rays may support the diagnosis.
  • Blood work will be done to detect for the HLA-B27 since it is a common histocompatibility complex marker in people with psoriatic arthritis.
  • A blood test for rheumatoid factor should be done to rule out rheumatoid arthritis

Causes[edit | edit source]

Psoriatic arthritis seems to have a genetic cause although the exact marker genes have not been identified. Having a first-degree realtive with psoriatic arthritis increases the likihood of contracting the disease by 80-90%.[1]Immunological and environmental factors also play a role in the disease. There are currently genome studies being done to determine the biomarkers associated with psoriatic arthritis. [3]

  Medical Management[edit | edit source]

  • Narrowband UVB light therapy can be very effective in clearing skin lesions. Bulbs with a narrow emission between 311 and 313 nm have been shown in studies to be superior to broadband UVB light. Treatment can be done in an outpatient setting or at home. Both small handheld devices are available as well as larger full body light units. UV light lamps designed specifically for psoriasis are more effective than commercial tanning beds or sunlight since they give of narrowband UVB light. Commercial tanning beds often give off much higher levels of UVA radiation that has been proven to be less effective in treating psoriasis. Exact ratios of UVA and UVB are very difficult to determine with both sunlight and tanning beds. Generally light treatments should be done 2-3 times per week for a total of around twenty-five treatments. Skin will be exposed to UVB light from 20 seconds up to around 2 minutes during each treatment based on the Fitzpatrick skin type or minimal erythema dose.  [4]

Physical Therapy Management (current best evidence)[edit | edit source]

This patient should be referred to a rheumatologist immediately if undiagnosed psoriatic arthritis is suspected.

Alternative/Holistic Management (current best evidence)[edit | edit source]

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Differential Diagnosis[edit | edit source]

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Reactive Arthritis
  • Gaut
  • Mallet finger due to traumatic injury

Case Reports[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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[1][5][3][6][7][8]References [9][10][edit | edit source]

see adding references tutorial.

  1. ↑ 1.0 1.1 1.2 1.3 Fuller KS. Pathology: Implications for the Physical Therapist. Third Edition. St.Louis: Saunders Elsevier; 2009.
  2. ↑ 2.0 2.1 2.2 Cite error: Invalid <ref> tag; no text was provided for refs named Solivetti FM, et al
  3. ↑ 3.0 3.1 Castelino M, Barton Anne. Genetic susceptibility factors for psoriatic arthritis. Curr Opin Rheumatol 2010;22:152-156.
  4. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Menter A, et al
  5. ↑ Langley R. Psoriasis: Everything You Need to Know. New York: Firefly Books; 2005.
  6. ↑ Solivetti FM, et al. Role of contrast-enhanced ultrasound in early diagnosis of psoriatic arthritis. Dermatology 2010;220:25-31.
  7. ↑ Anandarajah AP, Ritchlin CT. The diagnosis and treatment of early psoriatic arthritis. Nat. Rev. Rheumatol. 2009;5:634-641.
  8. ↑ Menter A, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 5. Guidelines of care for the treament of psoriasis with phototherapy and photochemotherapy. Journal of the American Academy of Dermatology. 2010;62(1):114-135.
  9. ↑ Goodman CC, Snyder TEK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th Edition. St.Louis: Saunders Elsevier; 2007.
  10. ↑ Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010;69:48-53.


[1][edit | edit source]


  1. ↑ Gottlieb A, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 2. Psoriatic arthritis:overview and guidelines of care for treatment with an emphasis on biologics. Journal of the American Academy of Dermatology. 2008;58:851-864.
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