Rheum Rundown: Psoriatic Arthritis (PsA)

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1. What Is Psoriatic Arthritis?

Psoriatic arthritis (PsA) is a chronic, immune-mediated inflammatory arthritis associated with psoriasis, a skin disease characterized by erythematous, scaly plaques. PsA affects peripheral joints, entheses, and in some patients, the axial skeleton, leading to pain, swelling, stiffness, and progressive joint damage. Approximately 20–30% of individuals with psoriasis develop PsA. Early recognition and treatment are essential to prevent disability.

2. Key Signs and Symptoms

• Joint pain, swelling, stiffness, and tenderness
• asymmetric oligoarthritis (≤4 joints) or symmetric polyarthritis (≥5 joints)
• Distal interphalangeal (DIP) joint involvement
• Morning stiffness
• Fatigue
• Dactylitis (“sausage” fingers or toes)
• Enthesitis
• Axial involvement (spondylitis)
• Nail pitting and onycholysis
• Associated conditions: uveitis, inflammatory bowel disease

3. Risk Factors

Genetic:

• Family history of psoriasis or PsA
• HLA-B27 and other HLA alleles

Environmental:

• Infections
• Trauma

Lifestyle:

• Smoking
• Obesity
• Psychological stress

Demographic:

• Affects men and women equally

4. Diagnosis

Clinical assessment including history and physical exam of joints, skin, and nails. Laboratory testing includes RF (to exclude RA) and ESR/CRP. Imaging may include X-ray, MRI, or ultrasound. Classification is often guided by CASPAR criteria.

5. Treatment Goals

• Early diagnosis
• Control inflammation and pain
• Prevent joint damage
• Improve function and quality of life
• Achieve remission or low disease activity

6. Medications

Symptom Relief:

• NSAIDs- Ibuprofen, Naproxen etc
• Short-term corticosteroids-Prednisone

Conventional / Foundational:

• Methotrexate
• Sulfasalazine
• Leflunomide

Biologic Therapies:

• TNF inhibitors- Infliximabs, certolizumab pegol (Cimzia), golimumab (Simponi Aria) , adalimumab (Humira), etanercept (Enbrel)
• IL-17 inhibitors – secukinumab (Cosentyx), bimekizumab-bkzx (Bimzelx), ixekizumab (Taltz)
• IL-23 inhibitors – risankizumab-rzaa (Skyrizi), guselkumab (Tremfaya), ustekinumab (Stelara)

Targeted Synthetic Therapies:

• JAK inhibitors- tofacitinib (Xeljanz), upadacitinib (Rinvoq)
• PDE-4 inhibitors-apremilast (Otezla)
• TYK2 inhibitors- deucravacitinib (Sotyktu)

7. Management & Nursing Considerations

• Monitor disease activity and medication adverse effects
• Educate patients on disease process and treatments
• Encourage exercise, weight management, and smoking cessation
• Provide emotional support and coordinate interdisciplinary care

8. Definitions & Key Terms

• Psoriasis – chronic inflammatory skin disease
• Dactylitis – swelling of an entire finger or toe
• Enthesitis – inflammation at tendon or ligament insertion
• DMARDs – disease-modifying antirheumatic drugs
• Onycholysis – separation of the nail from the nail bed

9. Documentation Essentials

• Presenting symptoms
• Disease severity scores (PASI, BSA)
• Medication history and adherence
• Comorbidities
• Functional assessments (HAQ)

10. Triage Questions

• What joints are affected?
• Are there skin or nail changes?
• Is there morning stiffness or fatigue?
• Recent infections or medication changes?
• Impact on daily activities?

11. Nurses Role

Rheumatology nurses support early identification, patient education, medication monitoring, and interdisciplinary care to optimize outcomes.

12. References

• Gossec L, Kerschbaumer A, Ferreira RJO, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis. 2024;83:706–719.
• Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Care Res. 2019;71(1):2–29.

Sponsored Content:

The following content is sponsored by Bristol Myers Squibb

PsA might be more complex than you think.

Explore videos and podcasts on the diagnosis and management of psoriatic arthritis (PsA) — including expert perspectives on emerging topics in this complex disease at Understanding PsA | Inside the Science

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