Which Doctors Treat Psoriatic Arthritis?

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Updated on May 05, 2020

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Psoriatic arthritis is a complicated disease that is often mistaken for other conditions, including osteoarthritis ("wear-and-tear arthritis"), gout, and rheumatoid arthritis. It is caused when the inflammation associated with psoriasis extends beyond the skin to the joints of the hands, feet, knee, or ankle. 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.

The question is: which kind of specialist should you see? Because of its two distinct symptoms—psoriasis plaques on the skin and arthritis-related pain in the joints—you will probably need to see more than one doctor.

Psoriatic Arthritis Doctor Discussion Guide

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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:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen), Aleve (naproxen), and Celebrex (celecoxib)
Intra-articular corticosteroid injections delivered directly into a joint space
Disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and cyclosporine which temper the immune system as a whole
Biologic drugs like Humira (adalimumab), Enbrel (etanercept), Cimzia (certolizumab), and Remicade (infliximab) that temper specific facets of the immune system

woman patient talking with doctor — David P. Hall/Getty Images

Dermatologists

As a field of practice, dermatology involves more than 3,000 different medical conditions, both infectious and non-infectious. To that end, you'll want to make sure any dermatologist you seek out actually has experience treating psoriasis. According to the National Psoriasis Foundation, if the office offers phototherapy or excimer laser, you're likely in the right place.

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, most 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 (including biologics). 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.

Do Dermatologists and Rheumatologists Ever Work Together?

Combined rheumatology-dermatology clinics are a newer frontier in the treatment of psoriatic arthritis, with just over 20 clinics in the United States
Depending on the clinic, some rheumatologists and dermatologists may see a patient at the same time in the same room. Sometimes, separate back-to-back visits are required
Studies show this combined care approach could achieve better outcomes for both skin and musculoskeletal symptoms
A survey from the Psoriasis and Psoriatic Arthritis Clinic Multicenter Advancement Network (PPACMAN) found over 80% of doctors thought a combined clinic accelerated an accurate diagnosis
Challenges are largely related to scheduling and billing

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 try 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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