Doctor's reflections: Lessons learned from treating psoriatic arthritis in a young patient

By David Ozeri, MD, FACP, FACR
Published February 27, 2023

Key Takeaways

One day a young man came to my clinic. He had been experiencing joint pain and stiffness, especially in his hands, feet and back. On examination, he had tender, swollen joints and showed evidence of enthesitis, or inflammation, at the sites where ligaments and tendons attach to bones. He also had a history of psoriasis. We discussed the probable diagnosis of psoriatic arthritis.

This was difficult to discuss with my patient. He was in his 30s, otherwise healthy and had a young family. Psoriatic arthritis is a chronic condition that can cause joint damage and disability; there is no cure. I explained that we needed to start treatment early to prevent joint damage and control his symptoms.

Over the next few months, we tried different medications, including non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and biologic agents. We also discussed lifestyle changes, such as exercise, weight loss and stress management, that could help manage his symptoms.

After several months, my patient reported significant improvement in his joint pain and stiffness, and his physical examination showed reduced joint swelling and tenderness. He was able to resume his normal activities and return to work.

Here's how I diagnosed and found a treatment plan to help this patient.

Diagnosis

Questions I ask:

As a doctor, when I suspect a patient has psoriatic arthritis, I typically ask the following questions:

  • Do you have any joint pain or stiffness? This condition causes joint pain.

  • Do you have psoriasis, or have you had it in the past? This is often associated with psoriatic arthritis.

  • Have you had any injuries or infections that may have triggered joint pain? Imaging tests, such as X-rays and MRI scans, can also help identify joint damage and inflammation.

  • Do you have any family history of psoriasis or psoriatic arthritis?

  • What is your medical history and testing history? Blood tests can also be useful in identifying inflammation markers, which can suggest an autoimmune disorder like psoriatic arthritis.

Diagnosing psoriatic arthritis can be challenging because the symptoms can vary widely between patients. Symptoms may also be similar to other types of arthritis, making it difficult to distinguish psoriatic arthritis from other conditions. Imaging tests and blood tests can help support a diagnosis, but the final diagnosis may require a combination of tests, imaging and clinical judgment.

Outcomes for patients with psoriatic arthritis vary depending on the condition's severity, treatment effectiveness, and the degree of joint damage. With appropriate treatment and lifestyle changes, many patients with psoriatic arthritis can manage their symptoms and maintain a good quality of life.

Treatment approaches

The goal of treatment for psoriatic arthritis is to reduce inflammation, manage symptoms and prevent joint damage. Depending on the severity of the condition, treatment may involve a combination of medications, lifestyle changes and surgery.

NSAIDs, DMARDs, and biologic drugs are some of the most commonly prescribed medications for psoriatic arthritis. NSAIDs or corticosteroids can help relieve pain and inflammation.

  • DMARDs or biologics may be prescribed to slow joint damage and improve symptoms.

  • Physical therapy or occupational therapy may be recommended to improve joint mobility and function.

  • In severe cases, joint replacement surgery may be necessary to repair damaged joints.

Related: Resources for physicians who treat psoriatic arthritis

Living with psoriatic arthritis

Patients living with psoriatic arthritis should make certain behavioral modifications, including:

  • Avoiding tobacco use and limiting alcohol consumption, as they can increase inflammation and worsen symptoms.

  • Maintaining a healthy weight can help reduce stress on joints.

  • Exercising regularly, including low-impact activities such as walking, swimming, or yoga, can help improve joint flexibility and reduce pain.

  • Eating a balanced diet rich in fruits, vegetables, whole grains, lean protein, and healthy fats can help reduce inflammation and promote overall health.

  • Practicing stress management techniques such as meditation, deep breathing, or relaxation exercises can help reduce stress and improve well-being.

Related: Psoriatic arthritis and diet: Can nutrition provide relief?

Reflections and takeaways

Psoriatic arthritis can be a challenging condition to diagnose and manage. Patients may experience a wide range of symptoms that can vary in severity over time.

The condition can be difficult to distinguish from other types of arthritis, making accurate diagnosis essential.

Effective treatment requires a comprehensive approach that addresses joint inflammation and the underlying autoimmune disorder. Lifestyle changes, such as exercise and stress management, can also play a critical role in managing symptoms and maintaining joint health.

Reflecting on treating this young man, I am reminded of the importance of early diagnosis and treatment of psoriatic arthritis. It can be a challenging condition to manage. Still, with the right combination of medication and lifestyle changes, many patients can achieve good symptom control and maintain their quality of life.

This article is part of Room for Better Rheum Care, where physicians and patients share the latest research, tips, and strategies for raising treatment expectations and delivering improved care in RA, PsA, and nr-AxSpA.

Read Next: Adopt a treat-to-target approach to psoriatic arthritis

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