FITNESS & NUTRITION Bones/Joints/Muscles • Juvenile rheumatoid arthritis • Osteoarthritis • Rheumatoid arthritis • Bursitis • Fibromyalgia • Gout • Lupus • Osteoporosis • Sjogren's syndrome • Tendinitis • Trigger finger • Achilles tendon rupture • Back pain • Hip fracture • Rotator cuff injury • Scoliosis • Muscular dystrophy • Dislocation • Shin splints • Bunions • Muscle cramp • Polymyositis • Dermatomyositis • Sprains and strains • TMJ disorders • Scleroderma • Osgood-Schlatter disease • Frozen shoulder • Polymyalgia rheumatica • Baker's cyst • Flatfeet • Morton's neuroma • Tennis elbow • Psoriatic arthritis • Hammertoe and mallet toe • Ankylosing spondylitis • Paget's disease of bone • Reactive arthritis • Metatarsalgia • Plantar fasciitis • Spinal stenosis • Sciatica • Marfan syndrome • Neck pain • Septic arthritis • Knee pain • Stress fractures • CREST syndrome • Dislocated shoulder • Patellar tendinitis • Costochondritis • Bone spurs • Avascular necrosis • Legg-Calve-Perthes disease • Water on the knee • Mixed connective tissue disease • Kyphosis • De Quervain's tenosynovitis • Cervical spondylosis • Thumb arthritis • Ehlers-Danlos syndrome • Golfer's elbow • Pseudogout • Sacroiliitis • Dupuytren's contracture • Achilles tendinitis • Diffuse idiopathic skeletal hyperostosis (DISH) • Osteochondritis dissecans • Osteomyelitis • Ganglion cysts • Chondromalacia patella • Chronic exertional compartment syndrome • Adult Still's disease • Rickets • Growth plate fractures • Greenstick fractures

Note: All links within content go to MayoClinic.com

Tens of millions of Americans experience the pain and physical limitations of arthritis. Yet arthritis isn't a single medical problem but a group of more than 100 conditions that can cause inflammation in your joints, muscles, tendons, ligaments and bones.

One of these conditions is psoriatic arthritis, which may affect as many as 1 million of the approximately 6 million Americans who have psoriasis. Most are adults in their 30s, 40s and 50s, but children also can develop a form of the disease.

In addition to the inflamed, scaly skin that's typical of psoriasis, people with psoriatic arthritis have swollen, painful joints — especially in their fingers and toes — and pitted, discolored nails. They may also develop inflammatory eye conditions such as conjunctivitis.

There are several types of psoriatic arthritis, with symptoms that range from mild to severe. In general, the disease isn't as crippling as other forms of arthritis, but if left untreated it can cause discomfort, disability and deformity. Although no cure exists for psoriatic arthritis, medication, physical therapy and lifestyle changes often can relieve pain and slow the progression of joint damage.

Although psoriatic arthritis normally affects only people with psoriasis, skin and joint problems usually don't develop simultaneously. Many people have psoriasis long before they develop arthritic symptoms, and a few have joint pain for decades before skin symptoms appear. But to receive a diagnosis of psoriatic arthritis, you must have signs and symptoms of both conditions:

• Patches of thick, red skin covered with silvery scales, especially on your elbows, knees, scalp or the lower end of your spine. These patches (plaques) often itch or burn, and the skin at your joints may crack.
• Pain, redness, swelling and reduced motion in your joints — especially the small joints at the ends of your fingers and toes. The joints in your spine and your sacroiliac joints — the two large joints that connect your pelvis and the triangular bone at the end of your spine (sacrum) — also may be affected.
• Stiffness and fatigue in the morning.
• Pitted, discolored nails that may separate from the nail beds.
• Eye inflammations such as conjunctivitis or iritis.

In addition to general arthritic symptoms, there are five distinct types of psoriatic arthritis, each with its own characteristics:

• Asymmetric arthritis. The mildest form of psoriatic arthritis, asymmetric arthritis usually affects joints on only one side of your body or different joints on each side — including those in your hip, knee, ankle or wrist. One to three joints are generally involved, and they're often tender and red. When asymmetric arthritis occurs in your hands and feet, swelling and inflammation in the tendons can cause your fingers and toes to resemble small sausages (dactylitis).
• Symmetric arthritis. Unlike asymmetric arthritis, symmetric arthritis usually affects four or more of the same joints on both sides of your body. It's similar to rheumatoid arthritis, one of the most common and debilitating of the many arthritic conditions. Although symmetric arthritis is generally milder than rheumatoid arthritis, it can cause progressively disabling joint damage. More women than men have symmetric arthritis, and psoriasis associated with this condition tends to be severe.
• Distal interphalangeal joint predominant (DIP). A small percentage of people with psoriatic arthritis — most of them men — have DIP, which affects the small joints closest to the nails (distal joints) in the fingers and toes. DIP is sometimes misdiagnosed as osteoarthritis, a type of arthritis that results from the destruction of cartilage on the ends of the bones. But psoriatic arthritis usually causes nail problems that don't occur with osteoarthritis.
• Spondylitis. This form of psoriatic arthritis can cause inflammation in your spine as well as stiffness and inflammation in your neck, lower back or sacroiliac joints. Inflammation can also occur where ligaments and tendons attach to your spine. As the disease progresses, movement tends to become increasingly painful and difficult. Psoriatic spondylitis isn't the same as ankylosing spondylitis, another arthritic condition. Ankylosing spondylitis doesn't occur with psoriasis and usually affects the entire spine, whereas psoriatic spondylitis may affect only your neck or low back.
• Arthritis mutilans. A small percentage of people with psoriatic arthritis have arthritis mutilans — a severe, painful and crippling form of the disease. Over time, arthritis mutilans destroys the small bones in the hands, especially the fingers, leading to permanent deformity and disability.

The symptoms of psoriatic arthritis are likely to be better at some times and worse at others. But because skin and joint problems frequently flare up and go into remission at different times, you may have severe psoriasis when your joints are relatively pain-free and aching joints when your skin clears.

Juvenile psoriatic arthritis
Children with psoriatic arthritis usually develop signs and symptoms of the disease around age 9 or 10. Symptoms are often mild, although some children may have severe and debilitating problems that last into adulthood.

In general, children have many of the same signs and symptoms that adults do, but they're more likely to develop skin and joint problems simultaneously. And because children's bones are still forming, abnormal bone development can affect growth.

Psoriasis is a skin condition marked by a rapid buildup of rough, dry, dead skin cells that form thick scales. Arthritis causes pain and stiffness in your joints. Both are autoimmune problems — disorders that occur when your body's immune system, which normally fights harmful organisms such as viruses and bacteria, begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as the overproduction of skin cells.

It's not entirely clear why the immune system turns on itself, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a close relative, such as a parent or sibling, with the disease, and researchers have discovered certain gene mutations that appear to be associated with psoriatic arthritis.

Having a genetic mutation doesn't necessarily mean you'll develop the disease, but it does mean you have a greater tendency to do so than other people do. Something in the environment — such as a viral or bacterial infection or even physical trauma — may eventually trigger psoriatic arthritis in people who have an inherited tendency.

A number of other factors may trigger psoriatic arthritis, including:

• Injury to your skin
• Reaction to a medication or vaccine
• Infection, especially streptococcal
• Stress
• Alcohol and poor nutrition
• Overexposure to the sun or prolonged exposure to irritating chemicals such as disinfectants and paint thinners

Having psoriasis is the single greatest risk factor for psoriatic arthritis. Other risk factors include:

• Heredity. Nearly half of people with psoriatic arthritis have a close relative with the disease.
• Age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.
• Race. Caucasians are more likely to develop psoriatic arthritis than are people of other races.
• Sex. In general, psoriatic arthritis affects men and women equally, but DIP and spondylitis are more likely to affect men, whereas symmetric arthritis occurs more often in women.
• HIV infection. Psoriatic arthritis seems to occur more often among people who are HIV-positive than among those who are HIV-negative. HIV infection may also exacerbate existing psoriasis.

For some people, psoriasis is a minor nuisance. For others, it can be extremely disabling. Talk to your doctor if any skin condition causes you discomfort and pain, makes performing routine tasks difficult or makes you self-conscious about your appearance.

Joint pain and stiffness can be mild or crippling. In general, if you have persistent discomfort and swelling in multiple joints, see your doctor. He or she can work with you to develop a pain management and treatment plan.

Diagnosing psoriatic arthritis can be difficult for several reasons. One problem is that you're considered to have psoriatic arthritis only when you have symptoms of both psoriasis and arthritis. Yet in adults, skin and joint problems rarely occur at the same time. You may have psoriasis long before arthritic symptoms appear, or you may have arthritis and not develop psoriasis for decades. It's even possible to havejoint pain — from osteoarthritis, for example — with psoriasis and not have psoriatic arthritis.

Psoriatic arthritis also mimics other conditions, which further complicates diagnosis. These conditions include:

• Rheumatoid arthritis. One of the most debilitating forms of arthritis, rheumatoid arthritis occurs when an autoimmune response causes inflammation in the lining of your joints, especially those in your hands and feet. Over time, the affected joints may be damaged as your ligaments, muscles and bones weaken. Eventually, inflammation that isn't treated can destroy joints and cause permanent pain and disability.
• Gout. This type of arthritis is characterized by sudden, severe attacks of pain, redness and tenderness in a single joint, usually the joint at the base of the big toe. Unlike rheumatoid arthritis, gout isn't an autoimmune disorder. Instead, it's caused by excessive blood levels of uric acid — a waste product formed when naturally occurring substances called purines are broken down by your body.
• Reiter's syndrome. This form of reactive arthritis can cause inflammation in your joints, eyes, genitals, and urinary or digestive tract. Often, a bacterial infection triggers Reiter's syndrome in people who have inherited a tendency to develop the disease.

Finally, no single test can confirm a diagnosis of psoriatic arthritis, although you may have tests to help distinguish psoriatic arthritis from other conditions:

• X-rays. These can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
• Joint fluid test. In this test, your doctor removes a small sample of fluid from one of your joints — often the knee joint — for analysis in a laboratory. If no uric acid crystals are present, it's likely you don't have gout.
• Sed rate. This blood test checks your erythrocyte sedimentation rate (ESR), commonly known as the sed rate, by measuring how far from the top of a glass tube your red blood cells fall in a given time. Generally, the blood cells fall farther — that is, the sed rate increases — when inflammation is present. But because many conditions can cause inflammation in the body, including many forms of arthritis and other rheumatic diseases, an elevated sed rate alone can't confirm the presence of psoriatic arthritis.
• Rheumatoid factor (RF). RF is an antibody — a protein made by the immune system — that's often present in the blood of people with rheumatoid arthritis, but not in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.
• Other blood tests. Because many people with psoriatic arthritis have anemia, your doctor may check the number of red blood cells in your blood.

You may experience complications from both psoriasis and arthritis and sometimes from treatments you receive for these conditions.

Psoriasis
Even mild psoriasis can cause itching, burning and bleeding skin as well as psychological distress. In some cases, these signs and symptoms can be debilitating. The British author Dennis Potter, who created the British TV series "The Singing Detective," suffered from severe psoriatic arthritis. He described his psoriasis this way: "Your pores, your whole face, your eyelids, everything is caked and cracked and bleeding."

Severe psoriasis may also lead to the following problems:

• Folate deficiency. This B vitamin is important for proper functioning of your nervous system. Folate also plays a major role in preventing birth defects and in keeping homocysteine levels low — a critical factor in the prevention of heart disease.
• Poor temperature regulation. One of your skin's many jobs is to help regulate body temperature. Psoriasis that affects large sections of skin may interfere with this function due to the large numbers of dilated blood vessels in the affected areas.
• Generalized pustular psoriasis (von Zumbusch's psoriasis). This potentially life-threatening condition can cause protein loss, fluid retention and electrolyte imbalances. Older adults with severe forms of psoriasis are especially at risk.

Arthritis
Although many people have mild symptoms of psoriatic arthritis, the most severe form of the disease — arthritis mutilans — can cause crippling deformities of the small joints in the hands and feet.

In addition, having arthritis, especially psoriatic spondylitis, increases your risk of developing osteoporosis. This condition can cause bones to become so thin and brittle that even minor stresses like bending over or coughing can lead to a fracture. Getting regular exercise and including plenty of calcium and vitamin D in your diet can help keep your bones strong. When that's not enough, your doctor may prescribe prescription drugs that slow bone loss.

Whether your symptoms are mild or severe, the goal of treatment for psoriatic arthritis is the same: to reduce joint pain and swelling, slow or prevent joint damage, and relieve dry, scaling skin. To help achieve these aims, your doctor is likely to prescribe a combination of medications, exercise and other types of physical therapy, and sometimes surgery.

Medications for arthritis
If you have mild psoriatic arthritis, your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), to help control pain, swelling and morning stiffness. Prescription NSAIDs provide higher potencies than do over-the-counter drugs. But all NSAIDs can irritate your stomach and intestine, and long-term use can lead to ulcers and gastrointestinal bleeding.

Other potential side effects include damage to your kidneys, fluid retention and heart failure. In addition, NSAIDs generally don't help psoriasis, and some may even make skin problems worse. Still, these medications may be a good option for people with minor joint pain and stiffness.

Be sure to talk to your doctor before taking any NSAID — even aspirin — to relieve arthritis pain. Because the effects of over-the-counter NSAIDs wear off quickly, it's easy to take too much, leading to dangerous levels of the drug in your body.

When NSAIDs don't control pain and inflammation or aren't appropriate in your case, your doctor may prescribe other drugs, such as:

• COX-2 inhibitors. This class of drugs is similar to NSAIDs, but because they work differently, they're supposed to be less damaging to your stomach. Like NSAIDs, COX-2 inhibitors — such as celecoxib (Celebrex) — suppress an enzyme called cyclooxygenase (COX) that's active in joint inflammation. But regular NSAIDs, such as aspirin, work against two versions of COX that are present in your body: COX-1 and COX-2. Suppressing COX-1 may cause stomach and other problems because COX-1 is the enzyme that protects your stomach lining. COX-2 inhibitors suppress only COX-2, the enzyme involved in inflammation. Still, whether COX-2 inhibitors actually have fewer gastrointestinal side effects than do other NSAIDs is a matter of debate. Furthermore, this class of drugs has been linked to an increased risk of heart attack and stroke.

• Disease-modifying antirheumatic drugs (DMARDs). Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic and rheumatoid arthritis. But because DMARDs act slowly, you may not notice the effects for weeks or even months. For that reason, your doctor may prescribe a pain reliever such as aspirin in addition to a DMARD. Examples of DMARDs include sulfasalazine (Azulfidine), gold salts, the antimalarial drug hydroxychloroquine (Plaquenil), and methotrexate.

  Sulfasalazine was originally developed to treat inflammatory bowel disease, but it's now widely used to treat rheumatoid and psoriatic arthritis as well. Potential side effects of sulfasalazine — including nausea, vomiting and loss of appetite — often can be alleviated by reducing the dosage or by taking enteric-coated tablets.

  Gold salts — which are not the same as the metal gold used in jewelry — are used to treat rheumatoid arthritis and sometimes psoriatic arthritis, although they may make psoriasis worse in some people. What's more, the side effects of gold treatment, such as kidney and bone marrow damage, can be extremely serious. For these reasons, gold is used less often than it once was.

  Antimalarial drugs are frequently used to treat rheumatoid arthritis, but may cause severe psoriasis flares in people with psoriatic arthritis. Hydroxychloroquine is less likely to have this effect than are other antimalarials. It's also considered one of the safest DMARDs.

  Methotrexate, taken orally or given by injection, can reduce skin and joint symptoms and slow the progression of arthritis in some people. Taken orally, it also helps symptoms of psoriasis by decreasing the production of skin cells, suppressing inflammation and inhibiting the release of histamine — a substance involved in allergic reactions. Methotrexate is generally well tolerated in low doses, but when used for long periods it can cause a number of serious side effects, including severe liver damage. Taking 1 milligram daily of the B vitamin folic acid can reduce the risk of methotrexate-induced mouth sores or enlarged red blood cells (macrocytosis), but folic acid won't help other potential side effects such as nausea, dizziness, diarrhea and fatigue.

• Immunosuppressant medications. These medications act to suppress the immune system, which normally protects the body from harmful organisms, but which attacks healthy tissue in people with psoriatic arthritis. Commonly used immunosuppressants include azathioprine (Imuran) and cyclosporine (Sandimmune, Neoral).

  Immunosuppressants can have potentially dangerous side effects and usually are used in only the most severe cases of psoriatic arthritis. Because they suppress the immune system, all such drugs can lead to anemia and an increased likelihood of serious infection. And many of them can cause liver and kidney problems.

  Azathioprine is a potent anti-inflammatory drug used to prevent organ rejection after transplants. But it also may be used in severe cases of rheumatoid and psoriatic arthritis. Taken long-term, azathioprine increases the risk of developing cancerous or noncancerous growths (neoplasias) and certain blood disorders. Other potential side effects include nausea and vomiting, bruising more easily than normal and fatigue.

  Used primarily to prevent rejection of transplanted organs, cyclosporine can improve joint and skin inflammation in people with psoriatic arthritis. But like other immunosuppressant drugs, cyclosporine increases your risk of infections and other health problems, including cancer. Cyclosporine also makes you more susceptible to kidney problems and high blood pressure — the risk increases with higher dosages and long-term therapy.

• Tumor necrosis factor (TNF) blockers. These biological response modifiers block an immune system protein called tumor necrosis factor, which acts as an inflammatory agent in some types of arthritis. By targeting the protein, TNFs can help reduce pain, morning stiffness and swollen joints — usually within one to two weeks after treatment begins. Two TNF blockers approved for treating psoriatic arthritis are etanercept (Enbrel) and infliximab (Remicade) — a drug commonly used to treat inflammatory bowel disease. Enbrel has also been approved for use in people with severe psoriasis without arthritis symptoms. Side effects of entanercept may include abdominal pain, dizziness, headache and respiratory problems. A more serious side effect is reduced resistance to infection. Serious, even fatal, infections may occur, especially in people whose immune systems are already weakened. Both entanercept and infliximab have been linked to an increased risk of tuberculosis and to leukocytoclastic vasculitis, an inflammatory blood vessel disorder. Nevertheless, a growing number of doctors are using entanercept instead of COX-2 inhibitors, especially in combination with other therapies such as ultraviolet B radiation.
• Corticosteroids. These medications can reduce inflammation and slow joint damage, but they're not usually recommended for long-term treatment of psoriatic arthritis. When used for many months or years, they may become less effective and cause serious side effects, including easy bruising, thinning bones (osteoporosis), cataracts, diabetes, high blood pressure and decreased resistance to infection. What's more, stopping therapy can aggravate skin symptoms and even trigger pustular psoriasis, a severe form of the disease. For these reasons doctors usually prescribe oral corticosteroids only to relieve acute symptoms, with the goal of gradually tapering off the medication (steroid taper). Injecting cortisone directly into aching joints can provide almost immediate relief and improve range of motion — sometimes for months. But because injected steroids can cause damage, their use is usually limited.

Medications and other treatments for psoriasis
Treatments for psoriasis include oral medications (systemic therapy), ointments and creams (topical medications), and the use of ultraviolet light or sunlight (phototherapy). Because different types of psoriasis respond differently to treatment, your doctor may use a combination of therapies tailored to your particular condition. These therapies may include:

• Oral medications. In addition to methotrexate and cyclosporine, a group of drugs related to vitamin A (retinoids) may be used to treat severe cases of psoriasis. Retinoids such as acitretin (Soriatane) and isotretinoin (Accutane, Amnesteem) can curb the proliferation of skin cells, but they may also have a number of side effects, including eye and lip inflammation, sun sensitivity, bone thinning and liver toxicity. And because retinoids can cause severe birth defects, you should never take them if you're pregnant or might become pregnant while taking the drug.

• Creams and ointments. Used alone, these can effectively treat mild to moderate cases of psoriasis. When skin disease is more severe, creams are likely to be combined with systemic drugs or phototherapy. Topical medications include anthralin, coal tar, retinoids, vitamin D analogues, steroids and moisturizers.

  Anthralin is believed to normalize DNA activity in skin cells and to reduce inflammation. Originally derived from the dried stems and branches of a Brazilian tree, anthralin (Drithocreme) is now synthesized in laboratories. Its primary drawback is that it can irritate healthy skin as well as stain virtually anything it touches, including skin, clothing and bedding. For that reason doctors often recommend short-contact treatment — allowing the cream to stay on your skin for a brief time before washing it off. Anthralin is sometimes used in combination with UV light.

  Coal tar — a thick, black byproduct of the manufacture of gas and coke — is probably the oldest treatment for psoriasis. It's effective for all forms of the disease except the severe generalized pustular types. Exactly how it works isn't known. Coal tar is available with or without a prescription and has few known side effects. It's often used in combination with light therapy (Goeckerman treatment).

  Topical retinoids are commonly used to treat acne and sun-damaged skin, but tazarotene (Tazorac) was developed specifically for the treatment of psoriasis. Like other vitamin A derivatives, it normalizes DNA activity in skin cells. The most common side effect is skin irritation. Although the risk of birth defects is far lower for topical retinoids than for oral retinoids, your doctor needs to know if you're pregnant or intend to become pregnant while using tazarotene.

  Vitamin D analogues are synthetic forms of vitamin D that reduce skin inflammation and help prevent skin cells from proliferating. Calcipotriene (Dovonex) is a prescription cream or solution containing a vitamin D analogue that may be used alone to treat mild to moderate psoriasis or in combination with other topical medications or phototherapy. The main side effect is skin irritation, but because vitamin D can affect growing bone, special care is needed when using these creams on children.

  Topical steroids, like those you take orally, are powerful medications that reduce inflammation and suppress the immune system. When used for long periods, steroid creams can have serious side effects, not just on your skin but also throughout your body. Because withdrawal from corticosteroids can cause a flare of psoriasis, or in the worst cases, induce generalized pustular psoriasis, steroid creams are likely to be used with caution and for brief periods of time.

  In addition to prescription ointments, your doctor is likely to recommend using regular moisturizing creams to prevent the skin dryness that often results from psoriasis therapy.

• Phototherapy. This therapy uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to moderate amounts of natural sunlight. Other traditional forms of therapy include the use of broadband ultraviolet B (UVB) light either alone or in combination with coal tar.

  A more aggressive treatment — psoralen UVA (PUVA) therapy — involves taking a light-sensitizing medication (psoralen) before exposure to ultraviolet A light. You usually have two or three treatments a week for a prescribed number of weeks. PUVA is effective in suppressing the growth of skin cells in severe psoriasis, but long-term treatment may increase your risk of skin cancer, including melanoma, the most serious form of the disease. The risk of skin cancer depends on a number of factors, among them skin pigmentation, family history, total dosage of UVA over time, the concurrent use of therapies that suppress the immune system, and the amount of protection given to your face and genital areas while undergoing PUVA therapy. There may be a long delay of up to 15 years after the first treatment before any cancer is detected.

  A newer form of phototherapy — narrow-band UVB (NBUVB) — doesn't require oral medications before each treatment and so may be less likely to cause cancer. It's usually administered two or three times a week. Many people who would have been treated with PUVA are now being treated with NBUVB. Sometimes your doctor may also use phototherapy and oral medications such as retinoids, methotrexate or the newer TNF drugs in rotation to minimize the side effects of both.

Exercise and physical therapy
Physical activity plays a key role in the treatment of many arthritic conditions, including psoriatic arthritis. In addition to helping maintain muscle strength, joint mobility and flexibility, exercise can reduce pain, improve sleep and help you maintain a healthy weight.

The challenge is finding a good balance between staying active and not overusing your joints. Your doctor may recommend that you work with a physical therapist to find an exercise program that's right for you. A positive attitude, patience and persistence can help you get the greatest benefit from therapy. A therapeutic program for arthritic joints might include:

• Range-of-motion exercises. Gently moving your joints through their normal range of motion can help relieve stiffness and increase flexibility.
• Strengthening exercises. These help preserve or increase your muscle strength. If your joints are very painful, your physical therapist may recommend isometric exercises, which can strengthen muscles without joint movement. Otherwise, you're likely to lift weights or use exercise bands to challenge your muscles.
• Water exercises. These can be especially beneficial because warm water helps relieve pain and relaxes muscles while reducing strain on your joints. You don't have to know how to swim to participate in water exercises — you usually perform them while standing or sitting in shallow water.
• Recreational exercise. Supplementing therapeutic exercise with activities such as walking, swimming or biking can help relieve pain, combat depression and improve your overall health. Swimming is particularly good for people with psoriatic arthritis because the natural buoyancy of water reduces strain on your joints. But any activity you enjoy — from tennis to tai chi — can be beneficial. A physical therapist or an exercise physiologist can help you learn how to get a good cardiovascular workout without harming your ligaments and joints.

Other therapies
A number of other treatments may help relieve arthritis pain, such as:

• Splints. These can relieve pain and help joints maintain their normal position. Mainly used on knee, wrist and finger joints, plastic splints are usually custom designed by an occupational or physical therapist. But although splints can be effective in the short term, constant use can actually weaken your joints and decrease flexibility.
• Heat treatments. Heat can ease pain, relax tense, painful muscles and increase blood flow. For that reason, it's frequently used during physical therapy treatments. Therapists often apply deep heat using ultrasound or a procedure called short-wave diathermy, which uses oscillating electrical fields to produce warmth in tissues.
• Massage. This can improve your circulation, decrease pain and reduce swelling. Look for a massage therapist who is trained in treating people with arthritis.
• Transcutaneous electrical nerve stimulation (TENS). During TENS therapy, a painless electrical current is delivered to your arthritic joints through an electrode taped to your skin. The current helps prevent pain signals from reaching your brain.
• Biofeedback. This relaxation method uses technology to teach you how to control certain body responses so that you can cope better with pain. During a biofeedback session, you're attached to monitors that give you information on your heart rate, breathing patterns, body temperature and muscle activity. Eventually, you learn how to slow your heart rate and breathing and relax your muscles on your own.

Surgery
Although surgery is rarely performed for psoriatic arthritis, your doctor may recommend some form of joint operation when other treatments fail to relieve your symptoms. Surgeons use various procedures to ease pain and restore mobility. Because these operations pose some risks, be sure you thoroughly discuss your options with your doctor.

The strength of your bones and the ligaments supporting your joints, as well as your age, weight and ability to participate in rehabilitation can all affect the outcome of joint surgery.

Some of the most encouraging news about psoriatic arthritis is that you can do a great deal on your own to help manage the condition:

• Eat a nutritious diet. Researchers haven't found any specific food or nutrient that consistently helps prevent or control arthritis, but several show great promise. For example, antioxidants such as vitamins C, E and A can help prevent the cell damage that may contribute to cancer and cardiovascular disease as well as to arthritis. Researchers have found that some people with rheumatoid arthritis had low levels of these vitamins before their disease developed.

  A diet high in olive oil and vegetables also has been shown to reduce the risk of rheumatoid arthritis. Olive oil is a rich source of vitamin E, and fresh vegetables contain both antioxidants and health-enhancing substances called phytochemicals. In addition, omega-3 fatty acids from cold-water fish — especially salmon, mackerel and herring — have helped reduce joint inflammation in some people.

  You may have heard that certain foods such as citrus fruits, red meat, and fruits and vegetables from the nightshade family — including potatoes, tomatoes, eggplant and peppers — aggravate arthritis. Studies haven't found that any one food increases joint pain or inflammation, but if a particular food seems to make your symptoms worse, try excluding it from your diet. And check with your doctor to see if you should limit the amount of alcohol you drink.

• Maintain a healthy weight. In addition to being important for overall health and playing a pivotal role in the prevention of many diseases, maintaining a healthy weight places less strain on your joints, leading to reduced pain and increased energy and mobility. The best way to increase nutrients while limiting calories is to eat more plant-based foods — fruits, vegetables and whole grains.
• Exercise regularly. Exercise is essential for everyone — and that includes people with arthritis. In fact, exercise alone can help relieve many of the symptoms of arthritic conditions, including pain and fatigue. In addition, a sensible exercise program can slow bone loss due to osteoporosis, increase flexibility, strengthen the muscles that stabilize your joints, reduce morning stiffness and maintain mobility. It can also control your weight and improve your mood. You're the best judge of how much you can do, but an appropriate activity level should make you feel the same or better afterward, not worse. Introduce new activities gradually and heed warning signs. If you experience new pain later in the day or fatigue the following day, you've probably done too much.

• Use cold and hot packs. Because cold has a numbing effect, it can dull the sensation of pain. Before using an ice pack, apply a thin layer of mineral oil to the painful joint. Place a damp towel over the mineral oil and then put the ice pack on the towel. You can apply cold several times a day for 20 or 30 minutes. Some people prefer to briefly massage the painful area with an ice cube. If you try this method, keep the ice moving to avoid frostbite.

  You can also use heat to relax tense muscles and relieve pain. Try an electric heating pad on the low setting — be sure to place a towel between your skin and the heating pad — a heat lamp, an inexpensive gel-filled pack found in most pharmacies, or a warm bath or shower.

• Experiment with relaxation techniques. Although stress may not cause psoriatic arthritis, it can make your symptoms worse. Deep relaxation, on the other hand, can lessen pain and improve your general sense of well-being. Fortunately, you have a wide range of options from which to choose, including meditation or prayer, yoga, tai chi, deep breathing, self-hypnosis, and visualization or guided imagery. All of these help counteract the harmful effects of stress. To get started, look for books, videos or classes on any techniques that interest you.
• Use proper body mechanics. Changing the way you carry out everyday tasks can make a tremendous difference in how you feel. For example, you can avoid straining your finger joints by using a can opener to twist the lids from jars, by lifting heavy pans or other objects with both hands and by pushing open doors with your whole body instead of with your fingers. It's also important to check your posture throughout the day. A healthy spine curves inward at your neck, outward at your upper back, inward at your lower back and outward at your pelvis. Maintaining these natural curves helps to protect your joints, muscles and ligaments.
• Pace yourself. Battling pain and inflammation can leave you feeling exhausted. You're also more likely to be anemic than other people are, and some arthritis medications can cause fatigue. The key isn't to stop being active, but to rest before you become too tired. Divide exercise or work activities into short segments. And find time to relax several times throughout the day.
• Take care of your skin. Daily bathing can help remove psoriasis scales, but avoid hot water and harsh soaps. Pat yourself dry after a shower or bath and apply a moisturizing cream while your skin is still damp. Avoid creams or lotions containing alcohol. Consider using a humidifier to help keep the air in your house moist.
• Expose your skin to moderate sunlight. Because sunlight slows down cell growth, it can help improve psoriasis. But too much sunlight can damage your skin, so be sure to avoid sunburn or exposure longer than about 20 minutes at a time. Some people with psoriatic arthritis have found that a combination of sunlight and bathing in water with a high concentration of minerals, such as the Dead Sea, helps both skin and joint problems.

Because psoriatic arthritis involves two conditions rather than one, even mild cases present challenges. Psoriatic arthritis can also be discouraging because skin and joint problems frequently don't flare and go into remission at the same time. Some of the following suggestions may help:

• Learn as much as you can about psoriatic arthritis. Find out how the disease progresses, your prognosis and your treatment options, including the newest information on diet and exercise. The more you know, the more active you can be in your own care.
• Think positive. Because your mind and body are integrally connected, your beliefs about yourself and your psoriatic arthritis have a powerful influence on your health. When you are optimistic, have confidence in yourself and believe you have control over your illness, you'll find it much easier to cope. Better coping skills, in turn, mean you'll function more effectively.
• Learn to manage stress. The chemicals your body releases when you're under stress can help you deal with demanding situations. But there's a downside: Those same chemicals can suppress your immune system and aggravate both psoriasis and arthritis. Trying to cope with worsening symptoms makes you feel even more stressed, setting up a destructive cycle. Although it's not possible to eliminate stress from your life, you can learn to manage it. One of the best ways is to use relaxation techniques such as yoga, deep breathing and meditation to calm yourself and break the stress cycle.
• Maintain a strong support system. The support of friends and family can make a tremendous difference when you're facing the physical and psychological challenges of psoriatic arthritis. Just having someone to talk to can make you feel less helpless and alone. Being with people who care about you also makes it more likely you'll take good care of yourself. And a strong support system can lower your stress levels. For some people, support groups can offer the same benefits — this may be especially important if you're worried about burdening your loved ones. Support groups aren't for everyone, but if you're interested in finding out more, talk to your doctor or contact your local Arthritis Foundation chapter.
• Simplify your life. One of the reactions to the excesses of modern life has been the growth of a movement called voluntary simplicity. Proponents seek to simplify their lives by focusing less on money and material things and more on happiness and fulfillment. This doesn't mean you have to retire to the country, but it does mean that you may want to rethink some of your priorities — how you spend your time and the things that you attach the most importance to in your life. Is your job more stressful than satisfying? Would you be able to get by on less money? Are you able to say no when you're overextended? Are you happy? These are important questions for everyone to consider — having psoriatic arthritis may make self-examination even more crucial.

Many people try nontraditional cures for arthritis and psoriasis. These therapies are compelling because conventional cures don't exist for many diseases and because traditional treatments often have serious side effects. Although many complementary and alternative therapies haven't been thoroughly studied by Western scientists, there's a growing body of evidence that they may play a role in treating and managing disease. Some treatments that have been tried for psoriatic arthritis include:

• Acupuncture. This medical treatment, originally developed in China, has been in use for more than 2,500 years. It involves inserting extremely fine needles in your skin to stimulate specific points that allow the free flow of energy in your body. Depending on the problem being treated and the type of acupuncture, a practitioner may use a number of needles or just a few. Typically, the needles remain in place for 15 to 40 minutes. During that time they may be moved or manipulated. Because the needles are hair-thin and flexible and are generally inserted superficially, most acupuncture treatments are relatively painless.
• Homeopathy. Developed by a German physician in the late 18th century, homeopathy is widely used in many parts of the world. It's based on an idea similar to that of vaccination: If a large amount of a substance causes disease, a small amount of that substance might stimulate the immune system to fight the same disease. Unlike most vaccines, however, homeopathic remedies don't contain inactivated viruses and bacteria but rather minute, highly diluted doses of minerals, plants and herbs. The remedies themselves are usually inexpensive and don't need to be taken often. Look for a homeopath who has graduated from an accredited homeopathic college.
• Dimethyl sulfoxide (DMSO). This industrial solvent, similar to turpentine, is sometimes sold as an arthritis treatment. The idea is that it can relieve pain and swelling when applied to the skin. Although some people claim to have been helped by DMSO, scientists are divided on the subject. The FDA hasn't approved DMSO for use in treating arthritis, and the industrial-grade DMSO sold in hardware stores may contain dangerous contaminants.
• Glucosamine and chondroitin. These dietary supplements have gotten a tremendous amount of press in the last few years and have been used extensively in Europe for at least a decade. Although evidence suggests that they can relieve joint pain and increase mobility, the benefits seem to apply only to osteoarthritis, which is caused by wear and tear on the joints, and not to inflammatory conditions such as rheumatoid arthritis and psoriatic arthritis. The same is true of S-adenosyl-methionine (SAM-e), another dietary supplement that has gotten a lot of attention as a treatment for both arthritis and depression. In clinical trials, SAM-e relieved the pain of osteoarthritis as effectively as NSAIDs did, but the effect on psoriatic arthritis isn't known.