Psoriatic Arthritis (PsA)

What is it?

Psoriatic arthritis (PsA) is a type of arthritis linked to psoriasis, a skin condition that causes red, scaly patches. It happens when the immune system causes inflammation in the joints as well as the skin. About one in three people with psoriasis may develop PsA.

What are the symptoms?

PsA can cause joint pain, swelling, and stiffness. Symptoms often affect the feet, ankles, knees, hands and/or spine. You will probably feel stiff in the morning or after resting, and this usually improves with movement. Some people notice pain where tendons attach to bone, such as at the heel. Nail changes, including pitting or lifting, are also common.

How is it diagnosed?

There is no single test for PsA. Your doctor will look at your symptoms, examine your joints, skin, and nails, and ask about your medical and family history. Scans such as  an ultrasound, or MRI can help show inflammation and an X-rays is useful to rule out joint damage.

Blood tests

Blood tests cannot confirm PsA but are often used to rule out other types of arthritis e.g. Rheumatoid Arthritis. They may show raised levels of inflammation, such as CRP, which support the diagnosis. Some people are HLA-B27 positive.

How is it treated?

Treatment aims to reduce pain, control inflammation, and protect your joints.

Simple pain relief and long acting anti-inflammatory medicines e.g. Naproxen can help.

Sometimes a short course of low dose steroids (Prednisolone) can settle the joint pain, swelling and stiffness quite quickly but this needs to be handled carefully.

Disease-modifying drugs (DMARDs) such as methotrexate are often used to help settle the inflammation which in turn settles the joint pain, swelling and stiffness (and also improves the Psoriasis).  These take some months to work but can put the joints and skin into ‘remission’ i.e. fully control the inflammation.

If these are not enough, biologic medicines that target specific parts of the immune system may be offered. There are many types of biologic therapies available now. Prescribing has to be done by a specialist and there are national guidelines available for us to follow (NICE technology appraisals).

Physiotherapy and gentle exercise help to keep joints flexible and muscles strong. Lifestyle changes such as maintaining a healthy weight and stopping smoking can also make a difference.

How do I know if my PsA is severe?

PsA is considered more severe if it affects many joints, causes ongoing pain and stiffness, or limits daily activities. Scans showing a lot of inflammation and/or joint damage can also suggest more advanced disease.

Living with PsA

Living with PsA can be challenging, but many people find their symptoms improve with the right treatment and support. Staying active, protecting your joints, and eating a balanced diet can help as can weight loss and stopping smoking. Regular reviews with your healthcare team are important to keep your condition under control.

Final thoughts

Psoriatic arthritis varies from person to person. Getting an early diagnosis and starting treatment quickly can make a big difference in preventing long-term joint problems. With modern treatments, most people live full and active lives.

Psoriatic Arthritis and Comorbidities: What You Need to Know

Psoriatic arthritis (PsA) is more than just a joint and skin condition. Research shows that people with PsA are more likely to develop other health problems, known as comorbidities. Understanding these risks—and acting early—can make a big difference to your long-term health.

1. Heart and blood vessel health
   PsA increases the risk of heart disease, high blood pressure, and stroke. This is partly due to ongoing inflammation and partly related to lifestyle factors.
   What to do:Have regular blood pressure and cholesterol checks, keep active, eat a balanced diet, and avoid smoking.
2. Metabolic conditions
   Conditions such as type 2 diabetes, obesity, and fatty liver diseaseare more common in PsA. These can worsen inflammation and make joint pain harder to control.
   What to do:Ask your doctor to check blood sugar and liver health. Keeping to a healthy weight, regular exercise, and limiting alcohol can all help.
3. Mental health
   Living with PsA can affect mood. Anxiety and depressionare common but often overlooked.
   What to do:Speak openly with your healthcare team if you feel low. Support groups, counselling, and sometimes medication can make a big difference.
4. Bone and joint issues
   PsA can also increase the risk of osteoporosisand other musculoskeletal problems.
   What to do:Maintain bone health with vitamin D, calcium, exercise, and fall prevention strategies.

Take-home message

Comorbidities are common in PsA, but many can be prevented or well-managed. Regular check-ups, a healthy lifestyle, and open communication with your healthcare team are key to protecting both your joints and overall health.

Treatments for Psoriatic Oligoarthritis

Psoriatic oligoarthritis means only a small number of joints (usually fewer than five) are affected. Treatment aims to reduce pain, protect the joints, and improve quality of life. Care is usually tailored step-by-step, depending on your symptoms and how you respond.

1. First steps – simple medicines and lifestyle
   Doctors often begin with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to help reduce pain and stiffness. Local steroid injectionsinto swollen joints can also give fast relief. At this stage, gentle exercise, weight management, and physiotherapy are encouraged to keep joints mobile.
2. Disease-modifying drugs (DMARDs)
   If symptoms don’t settle, the next option is a DMARDsuch as methotrexate, sulfasalazine, or leflunomide. These medicines work by calming the immune system, helping to prevent further joint damage. Regular blood tests are needed to monitor safety.
3. Biologic therapies
   If DMARDs are not enough, newer biologic medicinesmay be offered. These are injections that target specific parts of the immune system—such as TNF inhibitors, IL-17 blockers, or IL-23 blockers. They can be very effective for both joint and skin symptoms.
4. Targeted oral treatments
   Some people may benefit from oral targeted drugssuch as JAK inhibitorsor PDE4 inhibitors (apremilast). These work in different ways to reduce inflammation and can be taken as tablets.

Key message

Treatment usually starts with simpler medicines and moves step-by-step to stronger options if needed. With the right approach, most people can keep psoriatic oligoarthritis under good control and protect their joints long-term.