Psoriatic Arthritis: Combining Skin and Joint Management
Psoriatic arthritis (PsA) is a type of inflammatory arthritis that affects some people with psoriasis — a skin condition causing red, scaly patches. PsA can affect any joint and causes pain, stiffness, swelling, and fatigue. Like other forms of inflammatory arthritis, it requires a combination of medical treatment and physiotherapy for optimal management.
PsA typically develops in people aged thirty to fifty who already have psoriasis, though joint symptoms can precede skin symptoms. The pattern of joint involvement varies — it can affect large joints, small joints of the hands and feet, the spine, or combinations of these. A characteristic feature is dactylitis ("sausage digits" — swelling of an entire finger or toe) and enthesitis (inflammation where tendons attach to bone, particularly at the heel).
Medical management is the cornerstone of PsA treatment, typically involving disease-modifying anti-rheumatic drugs (DMARDs) and biologic medications that target specific inflammatory pathways. These are prescribed by a rheumatologist and can be very effective at controlling disease activity.
Physiotherapy complements medical treatment by addressing the secondary effects of PsA — muscle weakness, joint stiffness, reduced fitness, and impaired function. The approach shares principles with other forms of inflammatory arthritis: during flares, focus on gentle range-of-motion and joint protection; during remission, progress to strengthening, aerobic exercise, and functional training.
Exercise considerations specific to PsA include: addressing enthesitis (heel pain from Achilles tendon insertion inflammation is common — appropriate footwear and gentle stretching help), managing dactylitis (gentle hand exercises during and after flare-ups), and addressing spinal involvement (similar to ankylosing spondylitis management).
Skin management requires coordination with dermatology — some PsA medications also improve psoriasis, and physiotherapy treatment should be adapted to avoid aggravating skin lesions (for example, adjusting the placement of resistance bands or exercise equipment).
Fatigue is a common and often debilitating symptom in PsA — energy management strategies (pacing, prioritising, planning) are essential.
Our home visit physiotherapy service provides PsA management at home. Our elderly physiotherapy service supports older adults with PsA, while our back pain physiotherapy service addresses spinal involvement when present.