Psoriatic Arthritis
Patient Education

Doctors Who Treat Psoriatic Arthritis

As your psoriatic arthritis is diagnosed, treated and managed, you will encounter a team of health care professionals. They may include some or all of the following doctors and specialists listed below in the psoriatic arthritis patient education guide:

Dermatologists – doctors who specialize in the health, diagnosis, and treatment of the skin and its conditions; Treating psoriasis or skin inflammation can deter the harmful progressive effects of psoriatic arthritis.

Rheumatologists – doctors who specialize in the diagnosis and treatment of arthritis and other joint conditions

Physical Therapists – devise appropriate stretching and exercise routines to improve joint mobility

How to Prepare for Your Doctor Visit for Psoriatic Arthritis

There is no special preparation for diagnostic tests performed for psoriatic arthritis. However, prior to seeking a consultation with your physician, bring with you:

• List of symptoms and dates
• List of all medications taken, past and present. Include dosage.
• Record of past medical history including surgeries with dates
• List of questions to ask your physician

Questions to Ask Your Doctor About Psoriatic Arthritis

From your initial diagnosis throughout your treatment and care, you will have questions about your condition. Listed below in this psoriatic arthritic patient education guide are questions to discuss with the doctor so you can make informed decisions about your condition and care.

Questions About My Diagnosis

• How is psoriatic arthritis differentiated from other types of joint problems?
• What tests will confirm the diagnosis?
• How can I keep my joints from getting worse?
• How can I keep my condition confined to psoriasis without progressing to arthritis?
• Is this condition associated with other diseases?

Questions About My Treatment

• Is my condition curable?
• What medications or therapy do you advise? Are there supplements that work as well?
• What are the adverse reactions to these treatments?
• Are there clinical trials that I can participate in?
• Will I need surgery?
• Will I become disabled without the medication?

Questions About Lifestyle & Family

• What triggers my psoriasis or psoriatic symptoms?
• What diet should I follow? What foods should I avoid? Does drinking alcohol make it worse?
• What exercise do you advise? What activities should I avoid?
• What can my family do to avoid getting this condition?
• Are there alternative therapies that are helpful?

Common Tests or Labs to Diagnose Psoriatic Arthritis

The diagnostic examination of psoriatic arthritis is mainly one of exclusion for other joint pain conditions rather than a specific test.

Test	Why Test?	What Happens?	Normal Result
RF (Rheumatoid factor)	For the identification of an antibody seen in the blood of a patient with rheumatoid arthritis but missing in psoriatic arthritis patients	A tourniquet is placed around the arm and an antiseptic wipe is used over the area for needle insertion. The needle (attached to a syringe) is inserted into a vein and blood is withdrawn. The needle is removed and a bandage is placed over the insertion site. The blood is then sent to the laboratory.	No RF seen
Joint Fluid	Uric acid levels are measured to rule out gout as joint condition	Fluid is aspirated from the symptomatic joint with a long needle and uric acid is measured.	Uric acid level is less than 6 mg/dL
MRI (Magnetic resonance imaging)	To check the joints and soft tissues for inflammation or abnormalities	You are asked to lie on your back on a table with your head, torso, and arms strapped down to prevent movement. The table then slides into a tunnel-like space that contains a magnet. You may hear banging or tapping noises from the magnet movement but there is often piped in music to soothe you and mask the noise. Images are taken in body cross sections. The test usually takes 30-60 minutes and is painless.	No inflammation of joints, ligaments and tendons
X-rays	To detect abnormalities of joints that are only seen in psoriatic arthritis	Painless test whereby you are asked to lie on a table over a special plate. Electromagnetic rays are passed through your body to produce an image. Depending on the density of the various tissues, different shades appear on the plate.	No abnormalities of the joint are seen

Common Medications and Treatments for Psoriatic Arthritis

Psoriatic arthritis treatments center on symptomatic relief, targeting:

• Swelling reduction
• Pain relief
• Increased joint mobility
• Additional joint damage prevention

The type of therapy administered depends on the severity and type of psoriatic arthritis. In mild or localized cases, only one or two joints are affected and the patient may be symptom-free for long intervals. In more severe cases, three or more joints are affected, causing greater joint problems and disability.

If caught early, therapy can help maintain joint function and mobility. Restraining outbreaks of psoriasis may also help in the control of the associated arthritis. Read about treatments listed below in this psoriatic arthritis patient education guide:

Treatment	How/Why it Works
NSAIDS (Nonsteroidal anti-inflammatory drugs)	Block specific enzymes (Cox-1,Cox-2) from producing prostaglandins in order to decrease pain and swelling
Biological drugs	Suppress specific messenger cells that trigger inflammation, providing symptom relief and preventing future joint damage
DMARDs (Disease-modifying anti rheumatic drugs)	Very selective drugs that directly affect specific cell events that are the cause of psoriasis and psoriatic arthritis
Immunosuppressants (Traditional systemic drugs)	Decrease painful symptoms by binding to the enzyme responsible for rapid growth of cells and inhibiting its action, thus slowing skin cell growth in psoriasis *Given only in severe cases of psoriasis
Antimalarial drugs	Occasionally used to treat psoriatic arthritis; a potent anti-inflammatory agent
Alternative/holistic therapies	Certain dietary supplements have shown promise in symptomatic relief of joint problems. Stretching and isometric exercise is crucial to maintain range of motion and strength of joints. Aqua therapy, which is exercise done in a pool, can decrease pressure on the joints while flexing and stretching. Heat and cold packs also relieve pain of joints.
Corticosteroids (Steroids)	Potent anti-inflammatory agents that can be injected into joint spaces to decrease swelling
Synovectomy (Surgery)	Artificial joint replacement (to restore movement) or joint fusions may be performed when medical protocols are ineffective.

Written by Barbara Hales, M.D.