Still's disease: Causes, symptoms, and treatment
What Are The Symptoms Of A Psoriatic Arthritis Flare?
The symptoms of a psoriatic arthritis (PsA) flare include stiff, swollen, and painful joints. PsA is linked to psoriasis, so many people with PsA also have psoriatic skin lesions.
Psoriatic arthritis (PsA) is a chronic inflammatory condition that stems from a problem in the immune system. It affects the joints and causes them to become swollen, stiff, and painful. Some people may also experience changes in their nails and general fatigue.
The National Psoriasis Foundation estimates that up to 30% of people with psoriatic skin changes will develop PsA. The American College of Rheumatology suggests the figure may be lower, at 15%.
Treatment can help a person manage PsA. Without treatment, symptoms can worsen over time. Persistent inflammation can result in permanent damage and deformation in the affected joints.
A 2014 study on diagnostic delay found that people who do not receive treatment within the first 2 years of onset will have more severe problems.
A flare-up, flare, or relapse occurs when the symptoms get worse. It is difficult to know when a flare-up will occur, but avoiding some triggers may help prevent them.
Treatment can help manage inflammation and the symptoms it causes. Newer medications, known as biologics, reduce both the risk of a flare and the severity of symptoms if one does occur.
Early signs of a flare include:
Symptoms and severity can vary widely between individuals. They can be mild and develop slowly, or they can be quick and severe.
Experts do not know what causes PsA to appear, but as with psoriasis, it is a type of psoriatic disease.
The link between psoriasis and PsAPsoriasis and PsA are not the same conditions, but scientists have found close links between them, and they can occur together.
Many people with psoriatic disease have only skin involvement or only joint problems. Among those who experience both, 70% of people have skin changes first, 15% develop skin symptoms after PsA appears, and for 15% both symptoms appear at the same time.
Genetic factorsResearch shows that people with psoriatic disease often have similar genetic features. Specific genetic changes appear to underlie different types of PsA and psoriasis. At least 10% of people may have genes that can lead to psoriasis.
These features can run in families. If a person's close relative has psoriatic disease, there is a chance they may also develop it. However, not everyone in this situation will develop the condition.
This is because environmental factors also play a role. If a person has the genetic features but no exposure to certain triggers, they are unlikely to develop psoriasis or PsA.
Triggers for initial onset include strep throat or another infectious disease, which may cause an overreaction in the immune system in those who are susceptible.
Triggers for onset and a flare include:
A person who already has PsA may find that symptoms worsen when they change their medication. Other individual triggers might include a lack of sleep, overexertion, or a poor diet.
Avoiding these triggers may help prevent PsA or a flare from starting.
A person should see a doctor if they have:
Early treatment of initial symptoms or a flare can help:
Depression is a common complication of psoriatic disease. Learn more here.
Treatment can help manage symptoms during a flare and improve the overall outlook of psoriasis and PsA. Following a treatment plan can also help reduce the risk of a flare.
Biologics and alternativesGuidelines published in 2019 recommend prescribing a tumor necrosis factor inhibitor, which is a type of biologic drug, as first-line therapy for most people with a new diagnosis of PsA.
Long-term use of biologics can help:
They work by targeting specific parts of the immune system.
However, biologics are not suitable for everyone, especially those who are prone to frequent infections.
In these cases, a doctor may prescribe methotrexate, or apremilast (Otezla), which a person can take by mouth. These types of medication are known as oral small molecule drugs.
Another option is tofacitinib (Xeljanz).
NSAIDsNonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, reduce inflammation, pain, and swelling. A person can apply them to the skin or take them by mouth.
If this is not effective, a doctor can prescribe a stronger pain relief medication.
People with PsA should always ask their doctor before taking NSAIDs or other over-the-counter drugs, as there may be adverse effects or interactions with other medications.
CorticosteroidsSteroid treatment can help reduce inflammation, swelling, and pain during a flare. They are available as a topical treatment to apply on the skin, in tablet form, or a doctor may inject the drug directly into the joint.
Long-term use can lead to adverse effects, so a doctor will only prescribe steroids during a flare and when symptoms are severe.
DMARDsDisease-modifying antirheumatic drugs (DMARDs) suppress substances in the body that cause inflammation. They can help to limit joint damage, reduce pain, and slow the progression of PsA.
Adverse effects include:
Long-term side effects include:
DMARDs are a long-term option that can help manage PsA overall.
During a flare, a person may benefit from:
Smoking can make symptoms worse and increase the risk of long-term problems. Guidelines published in 2018 strongly recommend that people with PsA who smoke join a smoking cessation program.
These strategies can also help reduce the risk of cardiovascular disease, high blood pressure, diabetes, and other health conditions that can occur alongside PsA.
Learning as much as possible about PsA, its effects, and the treatment options available can help a person feel in control of their situation and equip them to take an active role in staying as well as possible.
A 2018 systematic review concluded that the following natural remedies might help people with psoriasis:
Physical therapy may also help.
In 2018, some experts noted that vitamin D supplementation may help some people with psoriasis and PsA, as long as they work with a doctor and incorporate it as part of an overall treatment plan. However, more research is needed.
What natural remedies might help with PsA? Find out here.
Here are some questions people often ask about PsA.
What does a PsA flare feel like?Early signs of a PsA flare include fatigue together with throbbing pain, swelling, and stiffness in the joints. The tendons may also be painful. In addition, a person may notice swelling in the fingers and toes and worsening skin symptoms.
What aggravates PsA?Triggers for a flare include smoking, mental or physical stress, injury, some medications, illness, and infection.
How do you calm a PsA flare?Ways of reducing inflammation and pain include the use of NSAIDs such as ibuprofen and corticosteroids. A doctor may prescribe the long-term use of DMARDs or biologics to reduce the risk of a flare and lessen the symptoms if they occur.
PsA is a type of psoriatic disease that can lead to joint problems, fatigue, and other symptoms. Symptoms can worsen during a flare.
Getting an early diagnosis, starting treatment as soon as possible, and knowing and avoiding triggers can help reduce the number of flares and the severity of symptoms.
A doctor can help manage a flare by prescribing or adjusting medication. Following the doctor's instructions about medication and lifestyle measures can also help an individual manage a flare.
In the long term, new biologic drugs and other therapies are showing promise for reducing flares, managing symptoms, and possibly slowing the progress of PsA.
How Does Psoriatic Arthritis Affect The Nails?
Psoriatic arthritis (PsA) is a type of arthritis that commonly develops in people with psoriasis. Psoriatic arthritis nail changes can include pitting, splitting, discoloration, and more.
Both psoriasis and PsA commonly cause changes in the nails. However, PsA does not present the same way in everyone, and symptoms can vary from person to person.
This article discusses how PsA may affect the nails and some medical and at-home treatment options to try.
Finally, we answer some common questions about the condition.
People with PsA commonly experience changes in their nails. In fact, researchers suggest that around 80% of people with PsA experience nail symptoms.
Many people may notice changes in their nails as an early symptom of PsA. Changes can affect any part of the nail structure and areas surrounding the fingers, including:
PsA can cause many visible symptoms in the nails.
Possible changes include the following:
When do nail symptoms occur?Psoriatic disease varies widely in the way it presents and the order in which features appear.
Typically, PsA develops in stages.
In its preclinical stage, psoriatic inflammation may lead to:
At this point, doctors may not yet be able to identify the condition as PsA.
In time, nail changes can begin to occur, such as:
Dactylitis may also develop. This is when the toes or fingers swell and take on a "sausage" shape.
As the condition progresses, symptoms may become more severe, and damage can affect the bones, tendons, and joints.
However, around 68% of people who receive a diagnosis of psoriatic arthritis already have a history of psoriasis. This can affect the skin, nails, or both. Another 15% develop skin or nail symptoms after PsA appears.
The incidence of nail psoriasis is higher in people with PsA than in those with psoriasis. Between 80% and 90% of people with PsA also have nail psoriasis, while 10–55% of those with psoriasis have nail involvement.
Around 20% of people with psoriasis develop PsA at some point.
Treatments for psoriatic nail problems will focus on managing the underlying condition and relieving any pain. These treatments may include the following:
Topical creamsMedicated creams can help alleviate symptoms in the nail and nail bed. The type of medication in the cream can vary, depending on the problem.
Some creams contain medications to slow the growth of cells, which may help with hyperkeratosis. Others contain steroids to reduce inflammation and damage.
A doctor may also recommend applying topical vitamin D cream.
Steroid injectionsDoctors sometimes recommend corticosteroid injections to help relieve inflammation. However, steroids can have severe adverse effects, and doctors prefer to limit their use.
Steroid injections to treat nail symptoms can be painful. Also, the surrounding nail or matrix may become weak after a person stops receiving the injections.
PhototherapyIn some cases, shining UV rays on the nails may help slow the growth of skin cells and stop some symptoms from affecting the nails.
Doctors can carry out this procedure in a clinic, or they may recommend specialty equipment for home use.
General PsA treatmentsVarious medications may help reduce the severity and frequency of flare-ups by targeting the underlying condition rather than the symptoms.
They include:
What are the latest drugs for treating PsA?
Some home remedies may help alleviate the symptoms of PsA in the nails and fingers. These include the following:
Over-the-counter (OTC) optionsSome OTC medicated creams may help if the nails are at risk of infection. They typically include two main ingredients: Salicylic acid and tar.
A person may wish to talk with a doctor before using any additional creams or medicated ointments on nails with psoriasis.
DietPsoriatic disease is an inflammatory condition.
For this reason, people may wish to consider eating an anti-inflammatory diet, such as the Mediterranean diet. These diets focus on fish, vegetables, and olive oil.
In contrast, highly processed foods may worsen inflammation.
Nail careGeneral nail care is essential for people with nail psoriasis. Sustaining new injuries to the nail may trigger a symptom flare-up, so people should try to avoid activities that can damage their hands or nails.
People should be sure to follow a doctor or dermatologist's instructions on daily nail care. This may include carefully washing underneath the nail each day and keeping the nails short to prevent breaks.
Some other nail care tips include:
People should avoid:
A person with PsA who is experiencing new nail symptoms may wish to contact a doctor. Likewise, if they are unsure about whether their treatment is working, they can ask a doctor about other treatment options.
The nails grow slowly, so results from any treatment can take time to show up. Attending all appointments and staying in touch with the healthcare team can help make treatment more effective.
Nail psoriasis is a long-term condition that can improve for a while and then worsen again, as with other forms of psoriatic disease.
Complications include psychological distress, difficulty using the hands for certain tasks, and a higher risk of infection due to nail damage.
Treatment can help manage nail psoriasis, but it can have adverse effects.
Here are some questions people often ask about nail psoriasis and psoriatic arthritis.
Can nail psoriasis lead to psoriatic arthritis?Nail psoriasis does not cause psoriatic arthritis, but both are manifestations of psoriatic disease. Nail psoriasis affects 80–90% of people with psoriatic arthritis, but it can appear before, with, or after joint psoriasis starts. Nail involvement can be a predictive factor for psoriatic arthritis.
What do nails look like with psoriatic arthritis?Not everyone with psoriatic arthritis will develop nail symptoms. If symptoms do occur, they include:
Yes, a person can have nail psoriasis as a sole symptom. Also, psoriatic arthritis does not always involve the nails.
PsA with nail psoriasis can affect the nails in various ways. It can cause pitting, discoloration, and brittleness. The more severe the condition, the worse its impact on the nails may be.
There is currently no cure for PsA or nail psoriasis, but medical and natural treatments can help manage these conditions and reduce flare-ups.
What Is Psoriatic Arthritis?
© Provided by Verywell Health Jacques Hugo / Getty Images Psoriatic arthritis (PsA) is a progressive inflammatory disease that affects the joints and entheses, the areas where tendons and ligaments attach to bones. PsA occurs because the immune system malfunctions and starts affecting healthy tissues. Many people with PsA also have psoriasis, an autoimmune skin condition that causes skin cell overgrowth.
There is no cure for PsA, but the condition is treatable, and treatments can slow disease progression, improve pain and other symptoms, and prevent joint damage.
This article covers psoriatic arthritis symptoms, types, causes, flares, treatment, and more.
© Provided by Verywell Health Jacques Hugo / Getty Images Psoriatic Arthritis Symptoms The symptoms of PsA range from mild to severe. PsA primarily affects the peripheral joints (the joints located in the arms and legs), but it can also affect the axial skeleton, which includes the spine, hips, and shoulders.
Symptoms of PsA can affect the joints, entheses, nails, and skin and may include the following:
© Provided by Verywell Health Reproduced with permission from ©DermNet NZ www.Dermnetnz.Org 2022 
© Provided by Verywell Health Reproduced with permission from ©DermNet NZ www.Dermnetnz.Org 2023 Types of Psoriatic Arthritis There are five types of psoriatic arthritis. It is possible to have more than one of the following types:
PsA prevalence in the United States ranges from 0.06% to 0.25% of the population. While it has a low prevalence in the general population, it is common among people with psoriasis.
PsA occurs when the immune system malfunctions and attacks healthy tissues. The overactive immune responses cause inflammation of the joints and entheses. It might also cause the overproduction of skin cells.
Genetic and environmental factors in PsA are believed to trigger the immune system's overactive response. Many people with PsA have a family history of psoriasis or PsA or a personal history of psoriasis.
PsA is also associated with specific genetic markers that, with environmental factors, can cause the disease to develop. Such factors include smoking, certain medications, physical trauma, illness, or infection.
Risk Factors for PsARisk factors that might increase your risk of developing PsA include:
PsA is characterized by flare-ups (worsening symptoms) and periods of remission (few or no symptoms). Triggers typically cause flare-ups.
PsA triggers can vary from person to person. Common triggers include:
An accurate and timely diagnosis of PsA can help you to avoid joint damage and other disease complications.
No single test can confirm PsA, but your healthcare provider can make a diagnosis based on the following:
Related:Psoriatic Arthritis Differential Diagnosis: Diseases That Mimic PsA
Stages of Psoriatic ArthritisPsA is a disease that progresses over time. Progression varies from person to person.
Early StagesSigns and symptoms may differ from what you would see with long-established PsA and will change over time.
In its early stages, PsA causes pain and swelling in a few joints, often on one side of the body. It will cause inflammation of the smaller joints of the hands and feet, usually the fingers and toes. Most people with early PsA will experience nail and skin symptoms, while around 10% will not.
As the disease progresses, you will notice symptoms in larger joints, including the knees. Over time, you may experience dactylitis and enthesitis.
Later StagesAs PsA progresses, it may affect your daily life. You might experience severe fatigue and frequent and painful flares.
Severe PsA can cause permanent damage to bones and joints. Ongoing inflammation, which might be the case for people with severe PsA, can cause bone erosion and narrowing joint space.
Living with more severe symptoms of PsA can make working or maintaining a social life harder. These symptoms can also lead to depression, and research shows the prevalence of depression is significantly higher for people with PsA than for the general population.
Psoriatic Arthritis TreatmentPsA is treated with a combination of medication, therapies, lifestyle changes, and, as a last result, surgery.
MedicationDifferent classes of drugs used to treat PsA include:
Many people with PsA can benefit from physical and occupational therapies to manage joint symptoms. Your healthcare provider might prescribe light therapy if you experience skin symptoms of the disease.
If you are experiencing depression or anxiety, your healthcare provider might recommend mental health therapy options to help you better cope with the effects of PsA.
Related:Physical Therapy for Psoriatic Arthritis
SurgerySurgery is a last resort for people with PsA. It is often recommended for people who experience severe pain due to a damaged joint. Surgery aims to improve joint function, reduce pain, and prevent additional joint damage.
Related:Everything You Need to Know About Psoriatic Arthritis Surgery
Lifestyle ChangesAs part of your treatment plan, your healthcare provider might recommend lifestyle changes to help you better manage PsA.
Lifestyle changes that might better help manage PsA include:
Related:Smoking Cessation: How to Quit and What to Expect
Diet for Psoriatic ArthritisThere is no specific diet for PsA, but eating a healthy and nutritious diet can help to control inflammation and relieve PsA symptoms.
Some foods might increase inflammation, while others might help reduce it. Foods that cause inflammation might include sugars, fried foods, refined carbs, red meats, and alcohol. Foods that might reduce inflammation include fatty fish, nuts, olive oil, leafy green vegetables, and some fruits.
Complications of Psoriatic ArthritisIf PsA is not adequately treated, it can lead to complications.
Complications and comorbidities linked to PsA include:
Related:What You Need to Know About Comorbidities in Psoriatic Arthritis
Outlook for Psoriatic ArthritisThe outlook for PsA varies from person to person. For some people, PsA causes mild disease and a few flare-ups a year. PsA can be painful for others, leading to disability and severe joint damage.
Fortunately, PsA can be managed with appropriate treatment, and most people with the condition can manage pain and will not experience significant joint damage or disease complications.
Let your healthcare provider know if you have questions or concerns about your outlook. They can advise on ways to improve your outlook and the best ways to manage your disease.
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