Psoriatic Arthritis Treatment Brisbane

Psoriatic Arthritis: assessment and management in Brisbane

Written by Dr Joshua Hatch, Musculoskeletal GP, RACGP Fellow, Diploma in Musculoskeletal Medicine (FSEM UK).

Psoriatic arthritis is an inflammatory arthritis linked to psoriasis that can affect joints, fingers and toes, tendon attachments and the spine. It is controlled mainly with medicines directed by a rheumatologist, and early referral matters.

Psoriatic arthritis can look like many things: a swollen toe, heel pain, a stiff back, or ordinary joint pain. The skin may show psoriasis, or the joint symptoms may come first. Assessment focuses on the pattern of joints, fingers and toes, tendon attachments and spine, the skin and nails, and screening for related problems such as eye inflammation.

Diagnosis is clinical, supported by blood tests and imaging chosen to fit the pattern, and suspected cases are referred to a rheumatologist. Treatment is directed by the rheumatologist and follows a treat-to-target approach with regular review. Anti-inflammatory medicines and local corticosteroid injections can ease symptoms, but conventional or biologic disease-modifying medicines are what control the underlying inflammation.

The GP role is recognition, early referral, coordinating care and attention to weight, cardiovascular risk, mood and bone health. Physical activity and non-smoking are recommended supports. Procedures such as shockwave or needling do not treat psoriatic arthritis, and a separate mechanical problem would be assessed on its own terms. This page is educational information only. Anyone with psoriasis and new joint symptoms should see a GP promptly, and a painful red eye needs same-day review.

Common symptoms

Joint pain, swelling and stiffness that comes and goes
A swollen, sausage-like finger or toe
Heel or sole-of-foot pain at tendon attachments
Back or buttock stiffness, nail changes, or a painful red eye

Every treatment reviewed for this diagnosis

Evidence for twelve treatment options in psoriatic arthritis

This is not a fixed ladder or a package of treatments. Every option is assessed independently against this diagnosis, including treatments with limited direct research that may still be reasonable for a clearly defined tissue target. The evidence level, likely benefit, risks, cost and alternatives are weighed at consultation.

Foundation: diagnosis, education and rehabilitation

The part of care with the broadest relevance. For many people it is enough on its own; other options are judged against it, not automatically added after it.

Diagnosis, education and progressive rehabilitation Working out what is driving the pain, explaining what your imaging does and does not mean, and building a graded loading plan you can actually follow. Supportive, not disease-modifying

What it involves

Assessment to identify the likely pain source, an explanation of what the diagnosis means, adjustment of the loads that aggravate it, and a progressive strength and conditioning plan, with weight management where that is clinically relevant.

What the evidence shows

The sources reviewed for this page were EULAR 2023 (Gossec, Ann Rheum Dis 2024), the Australian 2024 recommendations (Nash, Intern Med J; abstract and headings only), the Arthritis Australia information sheet and the Alinaghi 2019 prevalence meta-analysis. EULAR describes PsA as sometimes needing multidisciplinary care and asks that comorbidities such as obesity, cardiovascular disease, depression and bone health be addressed; Arthritis Australia lists physical activity and pain management as supporting measures. Trial evidence for specific exercise programs in PsA was not reviewed.

Pairing reviewed 2026-10-17.

Where it fits

A supportive part of care alongside, never instead of, rheumatology-directed disease control: activity, weight, joint protection and a plan for any mechanical problem.

Muscle and symptom-modifying options

Useful only when the examination identifies the tissue they target or when short-term pain control creates a useful rehabilitation window.

Wet needling and trigger point injection (trigger point injection) A fine needle into a tender band of muscle, with a small volume of dilute glucose solution injected through it. Does not treat the disease

What it involves

The needle is placed into the tender muscle band and a small volume of 5% glucose with a very dilute local anaesthetic (0.02-0.08%) is injected. Often done in the same visit as your assessment, and usable where the tender area sits deeper. Dry needling (the same technique with nothing injected) is not offered here.

What the evidence shows

Pairing reviewed 2026-10-17.

Where it fits

Not offered for psoriatic arthritis. A separate mechanical problem would be assessed on its own page.

Ultrasound-guided injections Guidance means the needle can be seen reaching the target. What goes into the needle depends on the diagnosis. Adjunct per EULAR

What it involves

The injection is performed under ultrasound so the needle can be watched into the target structure. What is injected is decided by the diagnosis, and corticosteroid is used sparingly, for the reasons set out below.

What the evidence shows

The sources reviewed for this page were EULAR 2023 (Gossec, Ann Rheum Dis 2024), the Australian 2024 recommendations (Nash, Intern Med J; abstract and headings only), the Arthritis Australia information sheet and the Alinaghi 2019 prevalence meta-analysis. EULAR 2023 states that local glucocorticoid injections may be used as an adjunct for musculoskeletal symptoms, and mentions them for enthesitis before escalating to a biologic. They ease a joint or attachment but do not control the disease.

Pairing reviewed 2026-10-17.

Where it fits

Considered for a persistently inflamed joint, tendon sheath or enthesis alongside rheumatology care, not instead of disease-modifying treatment.

V-ACTOR vibration therapy (vibration therapy) Low-frequency vibration applied over tender muscle. Not a shockwave, despite sharing the machine. Does not treat the disease

What it involves

A vibration handpiece is moved over the tender muscle and fascia for a few minutes. It runs from the same STORZ MASTERPULS icon console as radial shockwave but is a separate handpiece delivering a different, gentler form of energy. No needles, no anaesthetic, no downtime.

What the evidence shows

Pairing reviewed 2026-10-17.

Where it fits

Not offered for psoriatic arthritis.

Energy-based treatment options

Radial pressure wave, focused shockwave and EMTT have different targets and different evidence. They are assessed separately rather than treated as one category.

Radial or focused shockwave? Read the overview

Radial shockwave (radial pressure wave) Broad treatment across tender muscle and fascia, close to the surface. Does not treat the disease

What it involves

A handpiece is moved over the tender tissue while ballistic pressure pulses are delivered, using a transmitter head chosen for the tissue, including heads shaped for fascia and for the muscle either side of the spine. The pulse is strongest at the skin and weakens with depth, so this is mainly a myofascial treatment, though it can reach deeper in some areas. No anaesthetic, no downtime, usually a course of sessions about a week apart.

What the evidence shows

Pairing reviewed 2026-10-17.

Where it fits

Not offered for psoriatic arthritis. A separate mechanical heel or tendon problem is assessed on its own page.

Biologic and joint injection options

Each injection is assessed independently for the named diagnosis. Cost, uncertainty, likely benefit, risks and alternatives are part of the decision.

Platelet-rich plasma (PRP) Your own blood, concentrated and injected under ultrasound guidance. Does not treat the disease

What it involves

Blood is taken from your arm, spun to concentrate the platelets, and injected into the target under ultrasound guidance in the same appointment.

What the evidence shows

Pairing reviewed 2026-10-17.

Where it fits

Not offered for psoriatic arthritis.

Prolotherapy (dextrose) A course of dextrose injections into and around the structure and its attachments. Does not treat the disease

What it involves

Hypertonic dextrose is injected at the tender ligament and tendon attachments, and into the joint where relevant, usually as a series of treatments a few weeks apart.

What the evidence shows

Pairing reviewed 2026-10-17.

Where it fits

Not offered for psoriatic arthritis.

Nerve-targeted options

Relevant when examination identifies a superficial neuropathic pattern or a compressed peripheral nerve, not simply because pain is present.

Lyftogt perineural therapy (perineural injection therapy) A series of small dilute dextrose injections just under the skin, over tender superficial nerves. Does not treat the disease

What it involves

Small injections of low-concentration dextrose, usually 5%, placed just beneath the skin along tender superficial nerves. Given as a series of short sessions.

What the evidence shows

Pairing reviewed 2026-10-17.

Where it fits

Not offered for psoriatic arthritis.

Ultrasound-guided nerve hydrodissection Fluid placed around a nerve to free it from the surrounding tissue. Does not treat the disease

What it involves

Under ultrasound, fluid is placed in the plane around the nerve to separate it from the tissue that is tethering or compressing it.

What the evidence shows

Pairing reviewed 2026-10-17.

Where it fits

Not offered for psoriatic arthritis.

This is general information only and suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of the uncertainty, the expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.

Every treatment above is described in full on the non-surgical treatments page, including what each one is used for and what the evidence supports. Ratings apply to the named diagnosis; an adjacent muscle, tendon, joint or nerve problem is assessed as a separate target. The method behind the ratings, and the treatments not offered, are set out on the evidence page.

A note on cortisone

Corticosteroid injection is reviewed separately for each diagnosis.

Cortisone reliably reduces pain in the short term, and that can be genuinely useful when pain is stopping you sleeping or moving enough to rehabilitate. Beyond that window the picture changes. A systematic review of 41 randomised trials and 2,672 participants found that corticosteroid injection reduced pain in the short term but that the effect reversed at intermediate and long term; in pooled analysis for lateral epicondylalgia the short-term effect was large (SMD 1.44, 95% CI 1.17 to 1.71) while no intervention was favoured at 26 weeks (-0.40, -0.67 to -0.14) and at 52 weeks (-0.31, -0.61 to -0.01) (Coombes, Lancet 2010). In a randomised trial in lateral epicondylalgia, 83 per cent of the corticosteroid group had completely recovered or much improved at one year against 96 per cent given a placebo injection, and recurrence ran at 54 per cent against 12 per cent; adding physiotherapy made no significant difference at one year (Coombes, JAMA 2013). In joints, repeated corticosteroid injections have been associated with cartilage loss. It does not repair anything.

So treatment plans are not built around it. Where an injection is the right call, the specific diagnosis and target are reviewed, what is being injected and why is discussed, the number is kept low, and it is paired with the loading work that changes the longer-term course.

When it might still be considered

Pain severe enough to block rehabilitation
A clear inflammatory or bursal target on imaging
A specific short-term goal: a trip, a procedure, a return to work
Diagnostic use, where the response shows where the pain is coming from

When a cortisone injection is worth doing, and when it is not

Other general conditions

Pain in the same area can come from more than one source, and the label matters less than what the examination and history point to. These are the other guides for this region.

Frequently asked questions

How common is it in people with psoriasis?

A 2019 meta-analysis of 266 studies estimated about 1 in 5 people with psoriasis have psoriatic arthritis, with wide variation between studies. Arthritis Australia describes it as 1 or 2 in 10. Joint symptoms can start before the skin disease is noticed.

How is it diagnosed?

From the symptoms and an examination of the joints, tendon attachments, skin and nails. There is no single confirming test; blood tests help exclude other types of arthritis. Suspected cases are referred to a rheumatologist.

Is anti-inflammatory medicine enough?

Usually not. European (EULAR 2023) guidance reserves anti-inflammatories alone for very mild or predominantly spinal or tendon-attachment disease, usually for about four weeks. Disease-modifying medicines are started promptly for most joint disease, aiming for remission or low disease activity. A painful red eye needs same-day review.

Ready for a clearer plan for your back or musculoskeletal pain?

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Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.

You must have your own regular GP before booking. This service works alongside your GP for focused care. Booking requirements.

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