The following medications are approved by the FDA in the US for the treatment of psoriatic arthritis: anti-TNF inhibitors, ustekinumab and apremilast. Of these, the latter is an oral medication. Your doctor may indicate other treatment options depending on the specifics of your own diagnosis.
Psoriatic Arthritis Q & A
Psoriatic arthritis manifests with joint swelling and pain and can lead to permanent joint damage. There are a few patterns of joint involvement in psoriatic arthritis and in some cases it can present similarly to rheumatoid arthritis (about 15%). Spinal joint involvement (spondyloarthropathy) is common in psoriatic arthritis (about 20% people with psoriatic arthritis are affected by spondyloarthropathy).
Skin: Psoriasis is usually present in people with psoriatic arthritis but sometimes history of psoriasis or psoriasis in a first degree relative are sufficient to make a diagnosis; if other typical features are present.
Nails: Nail psoriasis is frequent in psoriatic arthritis compared to psoriasis; nail involvement also counts as a criterion when a diagnosis of psoriatic arthritis is considered. There are different kinds of nail involvement. It is important to keep in mind that nail changes are nonspecific and can be caused by other common things (like fungus and nutrient deficiencies). A dermatologist or rheumatologist can best diagnose psoriatic nail disease.
Tendons/Bones: tendons are affected in psoriatic arthritis especially at their site of insertion on bone (enthesitis). This condition can be recognized on ultrasound or MRI. When enthesitis is advanced it can lead to inflammatory reaction of the bone and new bone growth (that is different than simple spurs) at the tendon insertion site. At this stage reactive bone formation may be seen on plain X-rays.
Laboratory tests: currently, there are no antibodies to confirm a diagnosis of psoriatic arthritis. Doctors usually test for rheumatoid arthritis antibodies to rule out rheumatoid arthritis before making a diagnosis of psoriatic arthritis.
It would be highly unlikely to have all 3. There is always one entity which explains most of your symptoms. Psoriatic arthritis can have a rheumatoid arthritis like presentation in 15% of the cases. Ankylosing spondylitis can also be accompanied by arthritis of the small joints. While psoriasis does have great weight when making a diagnosis of psoriatic arthritis it is not an absolutely necessary criterion.
Drugs from the class of anti-TNF inhibitors are FDA approved and work well for all these 3 diseases.
Is there plaque present at the site of the arthritis?
In psoriatic arthritis skin disease and joint disease do not have to be present at the same time and in the same body location.
Can X-rays be used to confirm diagnosis of psoriatic arthritis?
X-rays can provide useful information. Ultrasound is another useful tool especially in early disease.
Psoriatic arthritis is associated with tendon inflammation which in turn can cause trigger finger. Trigger finger may benefit from medical evaluation to exclude inflammatory arthritis and other diseases.
It is a good idea to be thoroughly evaluated by your primary care doctor for other causes of chest pain and possibly a rheumatologist for spondyloarthropathy. Psoriatic arthritis is a spondyloarthropathy. Sometimes people with spondyloarthropathy can have a decrease in the amount their chest expands with deep breath. It is important that you follow up on this problem.