How Is the Severity of Psoriatic Arthritis Determined?

Reviewed by: HU Medical Review Board | Last reviewed: June 2022

Psoriatic arthritis (PsA) is a form of chronic arthritis that is often linked to the skin condition psoriasis. The severity of PsA is defined by the number of joints it affects and how it impacts the quality of life.1,2

Defining mild, moderate, and severe PsA

PsA is a chronic condition that can get worse over time for some people. The symptoms can ebb and flow as well as vary in severity. They include joint pain, inflammation, and swelling. The joints involved also can change over time.1,2

At first, people with PsA may experience only stiffness and pain without any other symptoms. Symptoms might appear to go away but later may flare up again.1-3

PsA often begins in the distal joints. These are the joints farthest from the core of the body, such as joints in the fingers and toes. PsA can progress from mild to moderate to severe depending on the number of joints it affects, their location, and its impact on quality of life.1-3

Mild PsA

In mild forms of PsA, 4 or fewer joints are affected. It usually has very little impact on the person's quality of life.1-3

Moderate PsA

Moderate PsA may affect 4 or more joints. It can impact daily tasks and physical functions. Moderate PsA may also affect your mental well-being. It may fail to respond to mild treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.1-3

Severe PsA

Severe PsA affects 5 or more joints throughout the body (polyarticular disease). Affected joints can be all on 1 side of your body or on both sides (symmetrical distribution). Many people with severe PsA cannot perform daily tasks without pain or dysfunction. Severe disease can impact physical health, mental health, and quality of life.1-3

Determining the severity of PsA

PsA is a challenging disease to diagnose, in part because its diverse set of symptoms can vary from person to person. The severity of PsA is based on several factors:1-4

  • Joint pain
  • Joint inflammation
  • Level of disease activity
  • Fatigue
  • Person’s assessment of their general health
  • Doctor’s assessment of the person’s general health
  • Physical function
  • Quality of life

These factors are measured through a physical exam given by a doctor as well as other criteria. One such criteria developed in recent years is the Psoriatic Arthritis Response Criteria (PsARC). The PsARC exam is a tool used to evaluate and monitor PsA.4,5

Severe signs and symptoms

If left untreated, PsA can get worse over time. It can lead to permanent joint damage and deformities. More severe symptoms include:1-3

  • Nail changes (pitting)
  • Pain and inflammation of the tendons and ligaments (enthesitis)
  • Swelling of the fingers and toes (dactylitis)
  • Inflammation between the spine and pelvis (sacroiliitis)
  • Eye inflammation (uveitis)

PsA’s most severe form: Arthritis mutilans

The most severe form of PsA is called arthritis mutilans. It is rare but very painful and disabling. In arthritis mutilans, the bones in the fingers and toes degrade, causing permanent deformity and disability.1

Treatment options for mild, moderate, and severe PsA

The severity of PsA determines the treatment approach. For mild disease, NSAIDs like ibuprofen or steroid injections can help manage pain and inflammation.5,6

For moderate to severe PsA, treatments that target joint disease can reduce symptoms and prevent disease progression. Disease-modifying anti-rheumatic drugs (DMARDs) as well as biologics are often recommended for moderate to severe PsA.5,6

DMARDS are medicines that work to suppress the immune system and/or inflammation. Biologics are treatments that target specific parts of the immune system. These medicines can help slow and stop inflammation and help with skin and joint pain.6

There are some non-medicine options as well. Physical therapy can be helpful for people in all stages of PsA and should be started early. If joints are severely affected, surgery may be an option. Talk with your doctor to learn the right treatment options for you.5,6

Do not delay treatment

PsA is a lifelong condition. Early diagnosis is key. If it is caught early, you can avoid severe disease progression. Work with your rheumatologist to monitor your PsA and make sure you are getting the right treatment to control inflammation, reduce pain, and improve mobility.

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