Ask the Expert: Dr. Vivian Bykerk, Rheumatologist, Answers Your Questions on Psoriatic Arthritis

Q1. What’s the difference between psoriatic arthritis and rheumatoid arthritis?

Both are forms of inflammatory arthritis and often are treated with similar medications. Patients with psoriatic arthritis often have a rash of psoriasis present at the same time but blood tests are negative. Patients with psoriatic arthritis often have complete swelling of a finger or toe (called dactylitis).

Q2. Is there anything to help with psoriatic arthritis flares?

Non-steroidal anti-inflammatory drugs help to manage the pain. Disease modifying drugs such as sulfasalazine, methotrexate and leflunomide and biologic therapies that block TNF (etanercept, adalimumab, infliximab, golimumab and likely certolizumab) are all proven to help this. Talk with your physician about treatment.

Q3. I have deformed nails from psoriatic arthritis where it’s thickened and discolored. Is there a treatment that will help my nails grow normally again?

Often treating the psoriatic arthritis helps the nails grow normally again.

Q4. I have psoriatic arthritis and get extremely fatigued. What can I do for my fatigue?

Treating the psoriatic arthritis with effective medication can help. It is also important to control weight and eat a balanced diet. Consult with your physician.

Q5. I’m newly diagnosed with psoriatic arthritis and have a swollen finger. Will the psoriatic arthritis affect more fingers?

Left untreated it can go on to affect other joints and fingers. It is important to see a rheumatologist to help you with the right treatment strategy.

Bykerk Vivian1Dr. Vivian Bykerk is a Rheumatologist at Hospital for Special Surgery. She has an active clinical practice and works with patients with autoimmune diseases causing joint and spine inflammation including rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies. She is also the director of a team of specialists at the Inflammatory Arthritis Center of Excellence at Hospital for Special Surgery.


Next week Dr. Scott Ellis, Foot and Ankle Surgeon, will answer questions on toe and foot deformities. Write your questions below or email


The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. Age 67, psoriatic rheumatoid spondylitis, positive for HLA-B27 1973. Meds: methotrexate, prednisone, Plaquenil, indomethacin up till July 26, 2013 when I stopped methotrexate & indocin cause of kidney malfunction; count was 2.03. 3rd incident & worse since first time in 2009. Taking only prednisone & Plaquenil since July. I changed life style, exercise, veggies, fruit, fish & lost over 20lbs. But now in great pain but still active & maintaining weight @ 150 or so. Try to walk 3 miles daily, right foot severely joint damaged, swelling. I cook, food shop, clean house & work garden trying all while balancing activity, rest, meditation, hydrocodone dosage. Noticing spurs on finger tips, joint spacing & loss of joints. Pain, fatigue, depression, insecurity increasing. But still manage to get enjoyment in my life. Problem-don’t know what to do now. Last creatinine level was 1.41. Can’t go back & should not take biologics. What can I expect? I’m with Kaiser, they’re not very candid.

    1. Hi Douglas, thanks for reaching out. Dr. Susan Goodman, Rheumatologist, says: “It seems that you have an overlap of inflammatory arthritis. Although the indomethacin and methotrexate are contraindicated in the setting of renal damage, there are other agents to consider. Part of the decision would hinge on whether your symptoms are caused by active inflammation or existing joint damage. It would also be important to know why you cannot take biologics. If your disease is very active with lots of joint swelling and stiffness, then a new drug which is approved for use in psoriatic arthritis, called apremilast, might be useful. You should specifically discuss your depression with your physician before beginning apremilast, as depression can be a problem with the drug. Although the dose needs adjustment in patients with renal disease, it is not contraindicated. In addition, if there is significant damage to your joints, consultation with a surgeon who has experience with inflammatory arthritis patients can be helpful as well. You are absolutely correct that diet and exercise can play a role, and its great you’ve been so successful there.” For more information on arthritis, click here: If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance. For more information, visit

  2. In plaque psoriasis, skin rapidly accumulates at these sites, which gives it a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area, including the scalp, palms of hands and soles of feet, and genitals. In contrast to eczema, psoriasis is more likely to be found on the outer side of the joint.

  3. There is no definitive test to diagnose psoriatic arthritis. Symptoms of psoriatic arthritis may closely resemble other diseases, including rheumatoid arthritis. A rheumatologist (a doctor specializing in diseases affecting the joints) may use physical examinations, health history, blood tests and x-rays to accurately diagnose psoriatic arthritis.

  4. I had ask about my son with psoriatic arthritis. He just had his prostate removed from cancer. Can i get him on herbs that might help him because the other medicines like humeria, embrel destroy his body. He now has such pain from the arthritis he can hardly move. Is there anything I can do

    1. Hi Jolyn, We’re sorry to hear about your son’s pain. Rheumatologist Dr. Vivian Bykerk says, “Herbs have not been shown to effectively control psoriatic arthritis. If he is in pain, it may be because his psoriatic arthritis is flaring. He likely needs to restart a treatment that is effective in this disease. TNF inhibitors such as humera, Enbrel, etc. are very commonly used and are now known to have a good safety profile. Your concern may be that these can?t be used in someone who has been diagnosed with cancer. Prostate cancer is a ‘solid’ tumor. Long-term studies have not demonstrated any increase in the risk of solid tumors in patients on TNF inhibitors, and some have also investigated whether patients who do have a history of solid tumors can restart or initiate TNF inhibitors. Studies have addressed this question in large registries of patients and do not show an increased risk when restarting or initiating these therapies in people who have had a solid tumor.” It is best to consult with your physician on these questions and any others you may have.

  5. Hi I have been diagnosed with Psoriatic arthritis since 2005 with failed treatment with Enbrel and Humira. I am currently on
    Remicade infusions as well as my other meds I started with including Methotrexate, leukovorin and Tylenol and Advil. The disease is very aggressive and progressing toward diabling symptoms. I am wondering is a second opinion would be advantageous or if I am reaching for something that is not going to help. It would take considerable resources to make it happen and would like your opinion as to whether it would be a useful way to go. Thank you for any answer you may offer. Julia

    1. Dr. Bykerk says, “If TNF inhibitors such as Enbrel, Humira and Remicade do not seem to be working, even with methotrexate, a second opinion is warranted. New agents are being tested in clinical trials.” If you would like to make an appointment to see a physician at HSS, please contact Physician Referral Service at 877-606-1555 or visit them online at

  6. I have a son 44 yrs old son and he has Psoriatic Arthritis for 5 yrs. He was on enbel, humeria methatroxate. He has just started with his whole body the nerves just jump throughout his body. He knows one of the side effects is MS, Lupus,etc. He has no insurance so he can only go to one hospital. He can’t get another opinion from any other doctor. I’m very upset that when you disabled you can’t get any help. He only gets social security to live on. It is a shame you have to which your son getting worse and can’t help him or find help. If you have any ideas that will help I would appreciate it very much.
    Thank you from a desperate mother

    1. I don’t no what I can say except is there something my son has not done to help his Psoriatic Arthritis. Can you be contacted at the hospital you are or can you contact me by email.

      Thank You

    2. Hi Jolyn, thank you for your question. Please contact our Insurance Advisory Service at 212-774-2607 or our Financial Assistance Program at 212-606-1505 for assistance.

  7. I was diagnosed with several types of osteoarthritis and fibromyalgia for 25 years before getting the Dx of severe psoriatic arthritis about 18 months ago. I am on Enbrel, but am continuing to get deformed joints with osteophytes, dissolved joints throughout hands, hips, knees, spine. Can my damage be reversed? Stopped? Cannot tolerate any DMARDS.

    1. Hi Rachel, Dr. Susan Goodman, Rheumatologist, says, “Psoriatic arthritis can be extremely aggressive, as you describe, and very difficult to control. Patients who have been on Enbrel, without significant benefit, or have lost the initial beneficial response, may want to consult with their physician about trying a second anti-TNF biologic. Although not as well studied as in RA, it has been shown that switching to a second anti-TNF may help control psoriatic arthritis. Once a joint has become badly damaged, it can’t be reversed, although the right regimen may stop further damage. It is important to consult with your treating physician regarding treatment options.”

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