How do I manage joint pain along with swelling in fingers?

Question

Hi doctor,

I have had thick, scaly psoriasis plaques on my elbows, knees, scalp, and lower back for nine years, and now I am developing severe joint pain, swelling, and stiffness in my fingers, toes, wrists, and lower back. My fingernails show pitting, ridges, and separation from the nail beds. My morning stiffness lasts for more than 90 minutes. I also have sausage-like swelling (dactylitis) in two fingers and one toe, along with severe heel pain (enthesitis).

The joint pain is affecting my ability to work and perform daily tasks. My recent lab results showed an elevated CRP of 25 mg/L.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I am really sorry to hear how much these long-standing psoriasis plaques and severe joint symptoms are affecting your daily life.

Based on your history, you have developed psoriatic arthritis and need to start systemic or oral therapy to prevent joint deformities and to manage your symptoms effectively.

There are several good treatment options, including Methotrexate, Apremilast, and Biologics.

It is important to get your blood work done and start oral therapy to manage both your psoriasis and the complications you are developing.

If you want, I can guide you in choosing the best option, but I will need to know a few things, such as your previous medication history, budget, and comorbidities like diabetes, liver disease, anemia, or any past tuberculosis infection. If possible, a picture of your plaques would help me calculate the PASI (psoriasis area and severity index) score.

For skin psoriasis, I would suggest starting topical medications:

Body plaques: Apply Clobetasol propionate once daily for two to three weeks, along with regular emollients such as Mix It gel, Vaseline, or coconut oil for hydration.
Scalp: Use Provate-S lotion (Clobetasol propionate and Salicylic acid) at night to reduce scales for two weeks.
Nails: Apply Clobetasol ointment carefully to the nail folds.
Moisturizer: Apply twice daily.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.