Understanding Psoriatic Arthritis of the Elbow

How does psoriatic arthritis affect the elbow?

If you have PsA in your elbow, you may notice that one or both of your elbow joints:

• are tender or painful
• appear swollen
• are stiff, particularly in the morning
• have a decreased range of motion
• feel warm to the touch

Some people with PsA also experience enthesitis, inflammation in the area where tendons and ligaments connect to bone. Enthesitis can cause pain and may occur in the heel of the elbow.

In addition to having symptoms in the area of your elbow, you may also experience additional symptoms in other areas of your body. These can include:

• skin symptoms of psoriasis, which can affect your elbows but may also be present in other areas
• nail changes, such as pitting, cracking, or separation from the nail bed (onycholysis)
• painful swelling in the fingers or toes (dactylitis)
• fatigue

Learn more about psoriatic arthritis (PsA).

What causes psoriatic arthritis of the elbow?

In PsA, the immune system mistakenly attacks the tissues of the joints. This leads to PsA symptoms like pain and swelling. It’s not known what exactly causes the immune system to behave in this way. Researchers believe that a combination of genetic and environmental factors can contribute to the development of PsA.

PsA can run in families. In fact, about 33% to 50% of people with PsA have at least one close family member who has psoriasis or PsA. Additionally, researchers have been able to identify genes associated with PsA.

Several environmental factors may also lead to the development of PsA in people who are genetically predisposed to the condition. These may include injuries, certain infections, and physical or psychological stress.

In addition to genetic and environmental factors, other things also increase an individual’s risk of developing PsA. These include:

• having psoriasis
• having psoriasis that:
  • is severe
  • affects the scalp or buttocks
  • occurs along with nail changes like pitting or cracking
  • happens with eye inflammation (uveitis)
• having obesity
• smoking

How is psoriatic arthritis of the elbow diagnosed?

When diagnosing PsA of the elbow, a doctor will need to rule out other conditions that can cause similar pain, swelling, or stiffness. These include:

• injuries like dislocations or fractures
• overuse injuries, such as tennis elbow or golfer’s elbow
• tendinitis
• bursitis
• osteoarthritis
• other types of inflammatory arthritis, such as:
  • rheumatoid arthritis
  • juvenile idiopathic arthritis
  • arthritis due to lupus

Medical history

Your doctor will typically begin their diagnosis of your condition with a review of your medical history. They’ll ask questions about things like:

• your symptoms, their severity, and when they started
• any underlying health conditions that you may have
• if you have a family history of any health conditions
• which medications or supplements you’re taking

Physical exam

After completing a review of your medical history, your doctor will examine your elbow for signs of injury or symptoms like swelling, discoloration, redness, or decreased range of motion.

If they suspect PsA, they’ll also check for other PsA symptoms like itchy skin patches, nail changes, or dactylitis (a painful swelling of the fingers).

Diagnostic tests

Your doctor may also run some tests to help with their diagnosis, including:

• blood tests that check for signs of inflammation, such as a C-reactive protein test and erythrocyte sedimentation rate test
• blood tests for rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies, which are associated with rheumatoid arthritis and are absent in most people with PsA
• imaging tests, such as X-rays, ultrasound, or MRI, to check your elbow joint for signs of inflammation or damage

How is psoriatic arthritis of the elbow treated?

Prompt treatment of PsA is important to prevent it from progressing and causing additional joint damage. Other goals of PsA treatment include:

• lowering inflammation levels
• easing pain and tenderness
• boosting range of motion
• improving quality of life

There are several potential treatment options for PsA, from medications and physical therapy to surgery and lifestyle changes.

Medications

A variety of medications can be used to treat PsA, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs can be taken by mouth and may help with PsA that’s mild. Some examples of NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). Topical forms are also available.
• Corticosteroids: Corticosteroids can reduce inflammation and can be injected into the area of your elbow. However, due to potential side effects, they’re typically only used sparingly.
• Disease-modifying antirheumatic drugs (DMARDs): Traditional DMARDs work to suppress the activity of the immune system. They’re often taken by mouth. Examples are methotrexate (Trexall).
• Biologics: Biologics target certain molecules in the inflammatory process. As such, they’re more specific than DMARDs. Biologics are given by injection. Examples of biologics for PsA are adalimumab (Humira) and secukinumab (Cosentyx).
• Targeted DMARDs: Similar to biologics, targeted DMARDs focus on specific parts of the inflammatory process. They’re taken by mouth. Apremilast (Otezla) is an example of a targeted DMARD for PsA.

Physical therapy

Physical therapy can improve strength, flexibility, and range of motion in the elbow and other affected joints and may also reduce pain.

Surgery

Surgery isn’t typically used for PsA. However, if joint damage has become severe, your doctor may recommend a surgical procedure to repair it.

Lifestyle changes

In addition to the treatments discussed above, several lifestyle changes may also help with PsA:

• Harnessing hot and cold: A warm compress may improve circulation in your elbow and help with stiffness. A cool compress has the opposite effect on circulation and can work to reduce swelling.
• Exercising: Getting regular exercise can help to improve joint health as well as things like flexibility and range of motion. Be sure to ask your doctor about exercises that are appropriate for you.
• Focusing on anti-inflammatory foods: Try to implement more anti-inflammatory foods into your diet. A few examples include:
  • berries
  • avocados
  • broccoli
  • fatty fish
  • spices like turmeric or ginger
• Avoiding inflammatory foods: Avoid consuming foods that can cause inflammation. These can include processed foods, trans fats, and refined carbohydrates.
• Cutting down on alcohol: Consuming alcohol heavily or frequently may affect the way your PsA medications work, so try to drink in moderation.
• Reducing stress: Stress can cause PsA to flare up, making your symptoms worse. Because of this, try to find ways to lower your stress levels. Some examples of things to try out are:
  • yoga
  • meditation
  • breathing exercises
  • taking a walk outside
  • listening to soothing music
• Protecting your skin: Skin damage or injury can cause PsA flare-ups as well. Care for your skin by:
  • regularly moisturizing
  • applying sunscreen when you’re going outside
  • promptly treating any cuts, scrapes, or bug bites
• Not smoking: Smoking is a risk factor for many autoimmune conditions. It may also lead to a PsA flare-up.

Takeaway

PsA can affect any joint in your body, including your elbows. If you have PsA in your elbow, you may notice that your elbow is swollen, tender, or warm. You may also find that it feels stiff or has a reduced range of motion.

PsA of the elbow may resemble several other conditions that can affect the elbow, such as rheumatoid arthritis, osteoarthritis, or overuse injuries. Your doctor will work to rule these out when making a diagnosis.

There are many treatment options available for PsA. It’s important to start treatment as soon as possible to prevent the condition from progressing, so be sure to see your doctor if you’re concerned that you may have PsA.