Which Doctors Treat Psoriatic Arthritis?

Meet your healthcare team

Psoriatic arthritis is a chronic autoimmune disorder integrally linked to psoriasis. It is caused when the inflammation associated with psoriasis extends beyond the skin to the joints of the hands, feet, knee, or ankle. Although psoriatic arthritis tends to develop after psoriasis, it can sometimes be the first symptom.

Psoriatic arthritis is a complicated disease that is often mistaken for other conditions, including osteoarthritis ("wear-and-tear arthritis"), gout, and rheumatoid arthritis. While a primary care doctor may have the skills to help manage the condition, other specialists would be needed to deliver disease-specific care and treatment.

About Psoriatic Arthritis

Psoriatic arthritis affects as many as 40 percent of people with psoriasis to varying degrees, according to a 2014 study from the University of Washington. The mechanisms of the disease are poorly understood but are believed caused by a combination of genetic and environmental factors.

Psoriatic arthritis, while distinctive in its symptoms, is essentially a consequence of psoriasis. With psoriasis, the immune system will inexplicably attack normal cells in the outer layer of skin known as the epidermis. The ensuing inflammation will cause the cells to divide rapidly, leading to the formation of skin lesions called plaques.

Because psoriasis is chronic (meaning that it persists over long periods of time), the inflammation can begin to affect the whole body. Psoriatic psoriasis is the prime example of this, wherein inflammation triggers chronic pain, swelling, and stiffness in one or more joints.

Common sites include the distal joints (those closest to the nail) of the fingers or toes. The lower back, wrists, knees, or ankles also may be affected.

Because there are no tests to definitively diagnose psoriatic arthritis, expert insight is needed to evaluate the symptoms and other factors used to render a diagnosis.

No less complicated are the treatments used the manage the disease, which can span over-the-counter medications and physical therapy to next-generation biologic drugs and surgery.

Considering how complex psoriasis and psoriatic arthritis are, it is important to know which doctors are best qualified to treat the various manifestations of the diseases. Oftentimes, you need more than one.

Psoriatic Arthritis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Rheumatologists

Rheumatologists treat diseases of the bones, joints, and muscles. This includes both autoimmune and non-autoimmune forms of arthritis. With regards to psoriatic arthritis specifically, a rheumatologist will treat the underlying inflammation that contributes to joint injury.

Rather than treating the disease symptomatically, a rheumatologist will inhibit the inflammatory processes that cause the symptoms.

The tools commonly used in rheumatology include:

Dermatologists

Dermatologists are specialists who treat conditions affecting the skin, hair, and nails. As a field of practice, dermatology involves more than 3,000 different medical conditions, both infectious and non-infectious.

As opposed to rheumatologists, dermatologists diagnose and treat conditions affecting the skin, nails, and hair rather than the joints. That doesn't mean that there aren't overlaps in the types of treatments used by both specialists or the way in which psoriatic diseases are diagnosed.

With psoriatic arthritis specifically, more than 85 percent of those affected will have psoriasis as well. Because of this, a dermatologist is considered central to the team.

To temper the pain and swelling associated with arthritis, the dermatologist may prescribe topical corticosteroids or NSAIDs to alleviate inflammation. Other treatments specific to dermatology, such as phototherapy, may be used to support drug therapies.

Although a dermatologist may refer you to a rheumatologist if a drug like methotrexate is needed, many are highly skilled in the use of DMARDs. They even have the acumen to recognize psoriatic arthritis symptoms in the early stages of the disease.

It is at that stage, however, that a rheumatologist would likely be sought. Not only do rheumatologists have the tools and training to accurately diagnose joint disorders, but they also have the experience to manage the side effects and complications of treatment.

Primary Care Doctors

Even if you are seeing a rheumatologist and dermatologist, your primary care doctor plays just as important a role in managing your condition.

A primary care doctor is vital to coordinating care and ensuring that treatments delivered by one specialist don't interfere with treatments from another. This is especially true if you have other chronic conditions like diabetes or kidney disease.

Moreover, psoriatic arthritis is associated with an increased risk of heart disease and stroke. Neither of these are conditions that rheumatologists or dermatologists routinely screen.

In the end, psoriatic arthritis benefits from a multidisciplinary approach, integrating it as part of primary care rather than treating it in isolation.

Pain Specialists

Pain management doctors are typically sought when arthritis pain persists despite treatment. These specialists are medical doctors (MDs) or doctors of osteopathy (DOs) who have undergone fellowships to specialize in pain medicine.

Treatment will vary based on the cause and nature of the pain. The diagnosis may involve physical exams, imaging studies, blood tests, and evaluative questionnaires (including the quality of pain scale). Depending on the results, the doctor may endeavor to block the pain and help you manage it. 

Treatment for arthritis pain may include prescription NSAIDs, painkillers like Ultram (tramadol), permanent or temporary nerve blocks, corticosteroid shots, physical therapy, or surgery.

Pain specialists will often use complementary therapies, such as meditation, acupuncture, or biofeedback to alter your mind-body response to pain.

A Word From Verywell

Ongoing medical care and treatment are key to managing psoriatic arthritis. As a chronic disorder without a cure, psoriatic arthritis needs to be managed consistently to prevent disease progression and irreversible joint damage.

To this end, it makes sense to see both a rheumatologist and dermatologist and to ensure that your primary care doctor provides the necessary oversight.

The relationship with your medical team is important. It should be a genuine partnership with an unobstructed flow of information. In this way, you can optimize your health as well as that of your joints.

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