Q: I am a 57 years old male with mild psoriasis and suffering from pain in my fingers. There is swelling in the middle fingers and knuckles, which comes and goes. Is it psoriatic arthritis? How can it be managed?

A:Psoriatic arthritis is a condition of joint damage that occurs in patients with psoriasis. The involvement of the joints may be in the small joints of the hand, especially the peripheral most joints in the fingers (distal inter-phalangeal joints) or may involve other joints in the body. The involvement may be symmetric or asymmetric. If you have painful joints of the fingers along with psoriasis, the chances are that you have psoriatic arthritis. The diagnosis may sometimes become easier with X-ray changes but these are not always seen and the diagnosis is more often clinical.

The treatment of psoriatic arthritis is similar to that of other similar inflammatory arthritis, very much like the common rheumatoid arthritis. Patients benefit by a combination of methotrexate (drug given for cancers) and sulphasalazine (a sulpha drug). Treatment should be done by a doctor experienced in the use of these drugs who has an understanding of the possible side effects. The physician has to use a judicious combination of these drugs along with pain killers. Leflunomide is another drug which has been shown promise in psoriatic arthritis. There is a recent interest in use of anti-TNF alfa agents with remarkable results. But this is very expensive and the rheumatologist has to make decision on the use of this drug.

I do recommend that instead of making independent decisions based on answers to queries such as this, you get in touch with an experienced rheumatologist (physicians who are specially trained in caring for arthritic conditions of joints).