I am 36 and have psoriasis. Is it turning into arthritis?

Question

Hello doctor,

I am 36 years old and have been living with plaque psoriasis for the past five years. I have been using topical steroids and Calcipotriol for treatment. However, I am now experiencing painful joint stiffness, especially in the mornings. My recent blood tests showed an erythrocyte sedimentation rate (ESR) of 42 and a C-reactive protein (CRP) level of 15.2.

My dermatologist suspects psoriatic arthritis and is referring me to a rheumatologist. I am feeling nervous about the possibility of needing systemic treatment.

Could you please explain how psoriatic arthritis is definitively diagnosed?
Are biologic medications always required, or are there other effective treatment options available?
Also, do these medications help control both skin flares and joint symptoms, or only the joint-related symptoms?
Is starting treatment early important in preventing long-term joint damage in cases like mine?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Based on your history of plaque psoriasis and the recent onset of joint stiffness, especially in the morning, and elevated inflammatory markers (ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein)), your dermatologist's suspicion of psoriatic arthritis (PSA) is well-founded.

PsA (prostate-specific antigen) is typically diagnosed through a combination of clinical examination, medical history, imaging (such as X-rays or MRI (magnetic resonance imaging) to detect joint changes), and lab tests to rule out other causes like rheumatoid arthritis. To confirm the diagnosis, a rheumatologist will assess joint pattern, swelling, dactylitis, nail changes, and enthesitis.

Systemic treatment is often needed to control inflammation and prevent joint damage, but biologics are not the only option. For milder cases, nonsteroidal anti-inflammatory drugs (NSAIDs) or conventional DMARDs (disease-modifying antirheumatic drugs) like Methotrexate or Sulfasalazine can help. However, if there is significant joint involvement or inadequate response, biologics such as TNF (tumor necrosis factor) inhibitors or IL-17/IL-23 blockers are highly effective and can address both skin and joint symptoms.

While these medications can significantly reduce skin flares, they may not eliminate them in all patients. Early treatment is strongly recommended, as PsA can lead to irreversible joint damage if left uncontrolled. Prompt intervention improves long-term outcomes, reduces pain, preserves mobility, and helps prevent joint and skin disease progression.

After doing a physical examination by a rheumatologist, you can share the result so we can discuss a proper and safe plan for your treatment.

I hope I have answered your question. Let me know if I can assist you further.