The current status of psoriatic arthritis and the urgency of its treatment.

Urgent Warning: These signals indicate a potential risk of psoriatic arthritis!

The symptoms of psoriatic arthritis are complex and varied, with significant individual differences. Early identification and diagnosis are crucial to preventing joint deformities. The following are the core symptoms and classification characteristics:

1. Core Symptoms (Warning Signs to Watch Out For)

Joint symptoms: Joint pain, swelling, and stiffness, with stiffness improving after activity (this typically lasts more than 30 minutes, a characteristic feature of inflammatory arthritis, differentiating it from osteoarthritis where symptoms worsen after activity);

Skin symptoms: Accompanied by psoriatic skin lesions (red patches, silvery-white scales, Koebner phenomenon, pinpoint bleeding), skin symptoms may appear before, after, or simultaneously with joint symptoms;

Nail changes: Approximately 80% of patients with psoriatic arthritis experience nail abnormalities, which are important diagnostic clues, including nail pitting (thimble-like changes), thickened nails, cloudy nails, brittle nails, subungual debris, or nail separation from the nail bed;

Other accompanying symptoms: Some patients may experience systemic symptoms such as fatigue, low-grade fever, and weight loss. In severe cases, it may be accompanied by eye inflammation (such as conjunctivitis, uveitis), and intestinal inflammation.

2. Common Subtypes and Typical Manifestations

Psoriatic arthritis presents with diverse patterns of joint involvement, and the prognosis varies significantly among different subtypes. Clinically, it is often classified into 5 types:

Asymmetrical oligoarthritis: The most common type (40%-50%), characterized by asymmetrical involvement of a few joints (usually ≤4), mainly affecting the fingers, toes, wrists, knees, and ankles. "Sausage fingers/toes" (swelling of the entire finger or toe, resembling a sausage) may occur. Symptoms are relatively mild, and progression is slow;

Symmetrical polyarthritis: Accounts for approximately 30%, characterized by symmetrical involvement of joints such as the hands, wrists, knees, and ankles. Symptoms are similar to rheumatoid arthritis, and may be accompanied by morning stiffness and joint deformities. If left untreated, there is a higher risk of bone destruction;

Distal interphalangeal arthritis: Accounts for approximately 10%, mainly affecting the distal interphalangeal joints of the fingers and toes (the joints closest to the nails). It is often accompanied by nail abnormalities, with significant pain and stiffness, and is easily misdiagnosed as osteoarthritis;

Spondyloarthritis: Accounts for approximately 5%-10%, mainly affecting the spine and sacroiliac joints. It manifests as lower back pain and stiffness, which worsens at night or in the morning and improves with activity. In severe cases, it may lead to spinal ankylosis and limited mobility;

Arthritis mutilans: The most severe type (less than 5%), characterized by severe inflammation and bone destruction in multiple joints, leading to joint deformities, dislocations, and even mutilation. Hand joint involvement is most common, requiring urgent and intensive treatment.

3. "Danger Signs" Requiring Urgent Medical Attention

No intervention within 6 months of the onset of joint symptoms, or symptoms that continue to worsen;

Presence of "sausage fingers/toes," joint deformities, or limited range of motion;

Accompanied by systemic symptoms such as eye inflammation (eye pain, photophobia, blurred vision), fever, etc.;

Rapid expansion of skin lesions accompanied by worsening joint inflammation.

If any of the above symptoms occur, especially in individuals with a history of psoriasis or a family history of the disease, it is necessary to seek timely medical attention from a rheumatologist. Diagnosis should be confirmed through joint imaging (X-ray, ultrasound, MRI), blood tests (ESR, C-reactive protein, rheumatoid factor, etc.), and skin/nail examinations to avoid delayed treatment.

Core treatment principles: Four "synchronizations," addressing both the skin and joints.

The treatment goals for psoriatic arthritis are to "simultaneously control skin lesions and joint inflammation, protect joint function, prevent bone destruction and deformity, and improve quality of life." Treatment should follow the following four core principles, avoiding unilateral treatment:

1. Simultaneous treatment of skin and joints: It is crucial not to focus solely on skin lesions while neglecting joint inflammation, nor to treat only the joints while ignoring skin symptoms. A treatment plan targeting both "skin + joints" should be developed to ensure simultaneous remission of both.

2. Early intervention and priority to achieving treatment goals: The first six months after onset are the "golden period" for treatment. At this stage, joint and bone damage is relatively mild, and timely intervention can significantly reduce the risk of deformity. Treatment should aim for "clinical remission" or "low disease activity" (absence of joint pain and swelling, normal inflammatory indicators, and resolution of skin lesions), avoiding "partial control."

3. Individualized stratified treatment: Treatment should be stratified based on factors such as the number of affected joints, presence of bone destruction, severity of skin symptoms, and comorbidities: Mild patients (≤4 affected joints, no bone destruction) should primarily receive local treatment + physical therapy; moderate patients (5-10 affected joints, or mild bone destruction) should use conventional synthetic DMARDs; severe patients (≥10 affected joints, or significant bone destruction) should use biologics or targeted drugs as early as possible.

4. Long-term comprehensive management: Psoriatic arthritis is a chronic disease requiring long-term maintenance treatment; medication should not be stopped without consulting a doctor. Treatment should also include rehabilitation exercises, lifestyle adjustments, and psychological counseling to avoid triggering factors and reduce the risk of recurrence.

Scientific treatment plan: from local to systemic, with layered coverage.

Treatment methods for psoriatic arthritis include topical treatments, conventional synthetic DMARDs, biologics, targeted therapies, and physical therapy. Clinical treatment should be tailored to the patient's condition, and combination therapy may be necessary:

1. Topical Treatment (for mild cases or as adjunctive therapy)

Suitable for patients with few affected joints (≤4) and mild symptoms, or as adjunctive therapy for moderate to severe cases. These treatments act directly on the affected joints and skin with minimal side effects:

Joint-specific topical medications:

Corticosteroid injections: For single or a few severely inflamed joints, local corticosteroid injections (such as triamcinolone) can quickly relieve pain and swelling. Injections should be spaced at least 3 months apart to avoid frequent injections that can damage articular cartilage;

Topical anti-inflammatory creams: Non-steroidal anti-inflammatory drug gels (such as diclofenac diethylamine gel) can be applied to the skin around the joints to relieve local pain and inflammation without systemic side effects.

Skin-specific topical medications:

Refer to topical medications for psoriasis (corticosteroids, vitamin D3 derivatives, calcineurin inhibitors, etc.), prioritizing creams that have minimal impact on joint movement (such as ointments and gels), and avoiding thick creams that may hinder joint mobility.

2. Traditional Synthetic DMARDs (First-line treatment for moderate patients, combination therapy for moderate to severe patients)

Traditional synthetic disease-modifying antirheumatic drugs (DMARDs) can inhibit systemic inflammation and slow down joint and bone destruction. They are the core treatment drugs for moderate psoriatic arthritis. Commonly used drugs include:

Methotrexate (MTX): A classic first-line drug, effective for both skin lesions and joint inflammation, and can slow down bone destruction. The usual adult dose is 10-25 mg per week, orally or by injection. Regular monitoring of blood count, liver and kidney function is required (it may cause bone marrow suppression and liver damage). It is contraindicated in pregnant women;

Sulfasalazine (SASP): Effective for psoriatic arthritis associated with intestinal inflammation, and also suitable for symmetrical polyarthritis. The adult dose is 2-3 g per day, taken orally in 2-3 divided doses. Side effects include gastrointestinal reactions (nausea, diarrhea) and rash. Blood count and liver and kidney function should be monitored during medication;

Leflunomide (LEF): Significantly effective in controlling joint inflammation, especially suitable for patients intolerant to methotrexate. The adult dose is 20 mg per day, taken orally. Side effects include hair loss, rash, and liver damage. It is contraindicated in pregnant women, and liver and kidney function should be monitored during medication;

Sulfasalazine: Similar in action to sulfasalazine, suitable for mild to moderate patients, with similar dosage and side effects.

Traditional synthetic DMARDs have a slow onset of action (usually 1-3 months). When used alone, the effect may not be sufficient, and they can be combined with biologics or targeted drugs.

3. Biologics (First-line treatment for moderate to severe patients, or for those unresponsive to traditional DMARDs)

Biologics are targeted drugs that act on specific cytokines (such as TNF-α, IL-17, IL-23). ​​They have a rapid onset of action (2-4 weeks), significant efficacy, and can quickly control skin and joint symptoms and delay bone destruction. They are currently the core drugs for treating moderate to severe psoriatic arthritis:

Anti-TNF-α inhibitors:

Representative drugs: Etanercept, Infliximab, Adalimumab, Golimumab;

Indications: All types of moderate to severe psoriatic arthritis, especially suitable for patients with severe skin lesions and spinal involvement;

Dosage: Etanercept once a week, subcutaneous injection; Adalimumab once every two weeks, subcutaneous injection; Infliximab once every 6-8 weeks, intravenous injection;

Precautions: Screening for tuberculosis, hepatitis, and other infections is required before medication (may increase the risk of infection). Avoid live vaccines during medication, and regularly monitor infection indicators.

Anti-IL-17 inhibitors:

Representative drugs: Secukinumab, Ixekizumab, Brodalumab;

Indications: Patients who are ineffective or intolerant to TNF-α inhibitors, especially suitable for psoriatic arthritis with severe skin lesions;

Dosage: Secukinumab: second injection at week 4 after the first injection, then once every 8 weeks; Ixekizumab: once every 4 weeks;

Precautions: May increase the risk of fungal infections (such as candidiasis). Pay attention to skin and oral hygiene during medication, and treat infections promptly if they occur. Anti-IL-23 Inhibitors:

Representative drugs: Guselkumab, risankizumab;

Suitable for: Patients with moderate to severe disease, with particularly significant improvement in skin lesions and stable control of joint inflammation;

Dosage: Guselkumab is administered subcutaneously every 8 weeks;

Precautions: The risk of infection is lower than with TNF-α inhibitors, but infection screening is still required before treatment.

Biologic agents are relatively expensive, but they are highly effective and can effectively prevent joint deformities. Some patients may be able to reduce the financial burden through medical insurance reimbursement.

4. Targeted Synthetic DMARDs (tsDMARDs, alternative or combination therapy)

Targeted synthetic DMARDs are oral small-molecule targeted drugs suitable for patients who are intolerant to biologics or for whom biologics are too expensive. Commonly used medications include:

Tofacitinib: Inhibits the JAK signaling pathway and is effective for both joint inflammation and skin lesions. The adult dose is 10 mg daily (taken in two divided doses) or 11 mg daily (extended-release tablet). Side effects include infection, elevated blood lipids, and liver damage. Blood counts, lipid levels, and liver and kidney function should be monitored during treatment;

Baricitinib: A JAK1/2 inhibitor, suitable for moderate to severe patients. The adult dose is 2 mg daily, taken orally. Side effects are similar to tofacitinib, and relevant indicators should be monitored regularly;

Upadacitinib: A JAK1 inhibitor, which is significantly effective in controlling joint inflammation. The adult dose is 15 mg daily, taken orally. Precautions are the same as for other JAK inhibitors.

5. Non-steroidal anti-inflammatory drugs (NSAIDs, symptomatic treatment)

NSAIDs are mainly used to relieve joint pain, swelling, and stiffness. As adjunctive therapy, they do not slow down bone destruction:

Representative drugs: Ibuprofen, diclofenac sodium, celecoxib, etoricoxib, etc.;

Dosage: Choose the appropriate dose according to the degree of pain, oral or topical administration, avoid long-term high-dose use (which may lead to gastrointestinal damage and kidney damage);

Precautions: Use with caution in patients with gastric ulcers or renal insufficiency, and use gastric mucosal protective agents under the guidance of a doctor if necessary.

6. Physical therapy and rehabilitation training (adjunctive treatment throughout)

Physical therapy can improve joint blood circulation, reduce inflammation, relieve pain, and maintain joint function, and is an important part of the treatment of psoriatic arthritis:

Common Physical Therapy Treatments:

Hot/Cold Compress: During the acute inflammatory phase (joint redness, swelling, heat, and pain), use cold compresses (15-20 minutes each time, 2-3 times a day) to reduce inflammation; during the remission phase, use hot compresses to promote blood circulation;

Ultrasound Therapy: Uses ultrasound to improve joint synovial inflammation and reduce pain;

Ultraviolet Irradiation: Has a relieving effect on skin lesions and inflammation around the joints, and should be performed under the guidance of a professional doctor;

Rehabilitation Training:

Joint Mobility Training: Perform joint flexion, extension, and rotation exercises without aggravating pain to maintain joint range of motion and prevent stiffness and adhesion;

Muscle Strength Training: Perform muscle training (such as quadriceps and biceps training) using dumbbells, resistance bands, etc., to enhance joint stability;

Posture Training: For patients with spinal involvement, perform exercises such as chest expansion, head lifting, and torso rotation to prevent spinal rigidity;

Note: Training should be gradual, avoiding overexertion or strenuous exercise. During the acute inflammatory phase, rest is paramount, and the intensity of training should be gradually increased during the remission phase.

Rehabilitation care and joint protection: preventing deformities and maintaining function.

The core of rehabilitation care for psoriatic arthritis is "protecting the joints, preventing injury, and promoting recovery," which requires a multi-faceted approach including daily care, diet, exercise, and psychological support:

1. Joint Protection Techniques (reducing joint burden and avoiding injury)

Avoid maintaining the same posture for extended periods: Move your joints every 30 minutes when sitting or standing for long periods to prevent joint stiffness;

Use proper force and avoid heavy lifting: Use your arms instead of your fingers to lift heavy objects, and use your legs instead of your waist to move things, avoiding excessive pressure on individual joints;

Choose appropriate joint postures: Maintain good posture with your chest out and abdomen in when standing; choose a chair with lumbar support when sitting, and avoid crossing your legs; use a firm mattress when sleeping, and patients with spinal involvement can place a pillow under their knees to reduce pressure on the lower back;

Keep joints warm: Avoid exposing joints to cold (cold can trigger and worsen inflammation), add extra clothing when the weather changes, and wear warm protective gear such as knee pads and wrist supports when necessary.

2. Skin and Nail Care (simultaneously improving skin symptoms)

Skin care: Keep the skin clean and moisturized, avoid scratching lesions (to prevent infection), and apply a gentle, non-irritating moisturizer (such as petroleum jelly or medical-grade moisturizer) to the entire body, especially the affected areas; avoid using harsh soaps and shower gels, keep bath water temperature moderate (around 37°C), and limit bathing time to within 15 minutes;

Nail care: Avoid having nails that are too long, too short, or excessively trimmed, to prevent nail damage from triggering inflammation; apply hand cream after washing hands to keep the skin around the nails moisturized; if nail thickening or scaling occurs, use topical medications (such as urea ointment) under the guidance of a doctor to soften the nails.

3. Dietary Management (Assisting in controlling inflammation and strengthening the body)

Anti-inflammatory diet: Increase intake of foods rich in Omega-3 fatty acids (such as deep-sea fish, flaxseed, walnuts), foods rich in vitamin D (such as sun exposure, egg yolks, milk), and fresh vegetables and fruits (rich in antioxidants), which can help reduce inflammation;

Avoid trigger foods: Some patients are sensitive to spicy and irritating foods, alcohol, tobacco, and high-sugar foods, which may trigger worsening inflammation. Avoid these based on individual circumstances;

Weight control: Obesity increases the burden on joints (especially the knee and hip joints), leading to increased inflammation. Maintain a healthy weight through a balanced diet and exercise.

4. Psychological Care (Relieving stress and avoiding emotional triggers)

Patients with psoriatic arthritis are prone to anxiety and depression due to joint pain and changes in skin appearance. Mental stress is a significant trigger for disease recurrence, so psychological adjustment is crucial;

Seek support: Communicate with family and friends, or join patient communities to share experiences and encourage each other, avoiding feelings of loneliness;

Emotional management: Relieve stress through activities such as listening to music, meditation, and traveling. Seek help from a psychologist if necessary to avoid prolonged emotional suppression.

5. Regular Follow-up and Medication Management

Regular follow-up: Mild patients should have follow-up examinations every 3-6 months, and moderate to severe patients every 1-3 months. Follow-up items include joint imaging examinations, inflammatory indicators (ESR, C-reactive protein), liver and kidney function tests, and complete blood count. Treatment plans should be adjusted according to the condition;

Standardized medication: Strictly follow the doctor's instructions for medication. Do not stop, reduce, or change medications without consulting a doctor (especially biologics and DMARDs, as sudden discontinuation may lead to a relapse);

Side effect monitoring: Be familiar with the common side effects of the medications used. If you experience discomfort such as rash, fever, fatigue, nausea, or vomiting, seek medical attention promptly.

Preventing relapse: Avoid triggers and maintain long-term stable condition.

The recurrence of psoriatic arthritis is closely related to environmental factors. By scientifically avoiding triggers, the risk of recurrence can be significantly reduced:

1. Control infections: Infections (such as streptococcal infections, respiratory infections, and skin infections) are common triggers. Pay attention to personal hygiene, avoid colds and tonsillitis, and seek timely treatment for any infections;

2. Avoid trauma and skin damage: Skin trauma (such as scratches, burns, and insect bites) and joint trauma (such as sprains and impacts) may induce the "Koebner phenomenon" (new skin lesions or joint inflammation appearing at the site of injury). Protect your skin and joints to avoid injury;

3. Manage mental stress: Long-term mental stress, anxiety, lack of sleep, and overwork can lead to decreased immunity and trigger disease recurrence. Maintain a regular sleep schedule (7-8 hours of sleep per day), avoid staying up late, and relieve stress through appropriate methods;

4. Quit smoking and limit alcohol consumption: Smoking increases the risk of developing and recurring psoriatic arthritis and reduces treatment effectiveness; alcohol can worsen joint inflammation and skin irritation. Strictly quit smoking and limit or avoid alcohol consumption;

5. Avoid drug-induced triggers: Some medications may induce or worsen the condition, such as beta-blockers, lithium, and certain non-steroidal anti-inflammatory drugs. Before using other medications, patients should inform their doctor of their history of psoriatic arthritis to avoid using contraindicated drugs;

6. Adhere to maintenance treatment: After complete remission of skin lesions and joint symptoms, maintenance treatment (such as low-dose topical medications, maintenance injections of biologics) should be continued under the guidance of a doctor. Do not stop medication without authorization to prevent recurrence.

Conclusion

Psoriatic arthritis is a chronic inflammatory disease affecting both the skin and joints. The core of its treatment is "early intervention, simultaneous control, and long-term management"—early identification of symptoms and timely medical attention can significantly reduce the risk of joint deformity; individualized, stratified treatment plans that address both skin lesions and joint inflammation can achieve "clinical remission"; and through rehabilitation, joint protection, and avoidance of triggers, recurrence can be effectively prevented and joint function maintained.

It is important to emphasize that psoriatic arthritis cannot be "cured," but with scientific and standardized treatment and long-term comprehensive management, the vast majority of patients can live, work, and socialize normally without excessive worry. Patients should abandon the misconception of "miracle cures" and trust the professional diagnosis and treatment of rheumatologists and dermatologists in reputable hospitals, avoiding delays in treatment; at the same time, society should give patients with psoriatic arthritis more understanding and tolerance, eliminating discrimination against "skin disease + joint disease," and providing patients with more psychological support.

We hope this guide will help patients fully understand the key points of treatment and management of psoriatic arthritis, overcome misconceptions about diagnosis and treatment, and protect joint function and improve quality of life through scientific intervention. If you experience related symptoms, be sure to seek medical attention promptly; early diagnosis and treatment are key to preventing disability!