Why are my joints getting worse despite stable psoriasis?

Hello,

Welcome to icliniq.com.

I understand your concern.

There is actually no correlation between skin disease and joint pain in psoriasis. You can get arthritis without flaring of skin lesions and vice versa. We usually try to stratify the management according to the domain most affected. In your case, it seems to be the joints.

You should get a thorough assessment of your joints by an expert rheumatologist to determine the cause of pain and whether it is due to arthritis or other musculoskeletal disorders, such as tendinitis or secondary fibromyalgia.

If it is indeed arthritis, adding Methotrexate can help with your joint pain, as it is a cornerstone in managing arthritis and is also useful in managing skin lesions in psoriasis.

In case of no improvement after three months of Methotrexate, the next step will be adding biological therapy, most preferably anti-tumour necrosis factor (anti-TNF), to control joint pain.

Investigations needed for biological therapy:

• Complete blood count (CBC).

• Erythrocyte sedimentation rate (ESR).

• C-reactive protein (CRP).

• Alanine aminotransferase (ALT).

• Aspartate aminotransferase (AST).

• Serum creatinine (Sr Creatinine).

• Hepatitis C virus antibody (HCV AB).

• Hepatitis B surface antigen (HBsAg).

• Human immunodeficiency virus antibody (HIV AB).

• Tuberculin test.

• Chest X-ray.

• Hand X-ray.

Methotrexate 25 milligrams weekly, Folic acid 5 milligrams weekly, and biological therapy in case of no response. Follow-up after three months of Methotrexate. Rest and physical therapy.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.