Approximately 30% of the people with psoriasis will develop an inflammatory arthritis known as psoriatic arthritis. Psoriatic arthritis causes pain, swelling and stiffness in and around the joints and can also involve the spine. If left untreated psoriatic arthritis can cause irreversible joint damage and disability. Furthermore, psoriatic arthritis is often associated with other medical conditions that require medical attention, such as high blood pressure, diabetes and heart disease.
The diagnosis of psoriatic arthritis can be complex and requires an assessment by an experienced rheumatologist. The Psoriatic Arthritis clinic provides multidisciplinary care for patients who are suspected of having the disease or have a diagnosis of psoriatic arthritis. The clinic rheumatologists use advanced ultrasound technology at the point of care to facilitate rapid diagnosis and monitoring of disease activity. The clinic staff work closely with the dermatology division at Women’s College Hospital to coordinate care of both skin and joint issues.
You may have psoriatic arthritis if you have:
- a diagnosis of psoriasis, and also suffer from
- joint pain, swelling or stiffness
For more information about this disease, please see the About Psoriatic Arthritis (PsA) section below.
Please note that a referral from your primary care physician is required.
You may ask your primary care physician to complete our patient referral form and have them fax the form to us at 416-323-6115.
What can I expect at my first visit?
When you arrive on the 4th floor, please proceed to check in at the information desk where you will be asked to fill out some important forms, including your current medications and questionnaires about your general health and function. Please arrive 15 minutes before your scheduled appointment to complete these forms.
What should I bring with me?
- A list of medications you are currently taking
- CD or DVD of your diagnostic imaging tests, such as x-ray, MRI, etc. (if available)
- Medical records from other specialists – If seen by other specialists for musculoskeletal problems, please bring the summary report (if available)
- A list of doctors and hospitals
- Questions to ask
How long is the appointment?
The first appointment will take longer than follow-up appointments. Your first appointment may be 2 hours or longer. After your visit, you will likely go to the Lab for blood tests and to Medical Imaging for x-rays. Follow-up appointments usually take 30 minutes.
We do everything that we can to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays.
The Psoriatic Arthritis Clinic team members include:
Dr. Lihi Eder – Rheumatologist
Dr. Lihi Eder is Director of the Psoriatic Arthritis Program at Women’s College Hospital. She is an Associate Professor of Medicine at the University of Toronto and a Scientist at the Women’s College Research Institute.
Dr. Eder has a broad background in rheumatology with specific training and expertise in clinical epidemiology and imaging of psoriatic arthritis and cardiovascular diseases in rheumatic patients. Dr. Eder was awarded Canada Research Chair in Inflammatory Rheumatic Diseases (2021-2026) for studying barriers of equitable care in rheumatology including the role of sex and gender as determinants of disease outcomes.
Dr. Eder graduated from the Ben-Gurion University Medical School in Beer Sheva, Israel, in 2002. She obtained her PhD in genetic epidemiology from the Institute of Medical Science, Faculty of Medicine, at the University of Toronto in 2011, followed by a post-doctoral research fellowship at the Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, in 2015.
Dr. Eder’s research efforts have resulted in over 150 peer-reviewed publications in medical journals, book chapters and editorials. She is frequently invited to present the result of her studies in national and international conferences in the fields of rheumatology, dermatology and cardiology. She is elected member of GRAPPA steering committee and President of the Canadian Rheumatology Ultrasound Society. As a recognized expert in rheumatology she received a New Investigator Award from the Arthritis Society (2016) and Early Research Award from the Ontario Ministry of Research Innovation and Science (2018).
Dr. Sahil Koppikar – Rheumatologist
Dr. Sahil Koppikar is a rheumatologist at Women’s College Hospital and an Assistant Professor of Medicine at the University of Toronto. He completed medical school and internal medicine residency at Queen’s University, followed by rheumatology training at the University of Toronto. Dr. Koppikar completed further training with a clinical-research fellowship at University of Toronto in point-of-care musculoskeletal ultrasound in inflammatory arthritis (psoriatic arthritis and rheumatoid arthritis). He is currently completing a Master of Health Professions Education (MHPE) at Maastricht University in the Netherlands.
Dr. Koppikar is actively involved in the clinical, research and educational components of the WCH Psoriatic Arthritis Program. He currently co-directs the Canadian Rheumatology Ultrasound Society (CRUS) basic course. He also has a regional practice in Northern ON (Timmins), delivering both in-person and virtual care in a unique multi-disciplinary model of care. Dr. Koppikar has received several university and hospital teaching awards as a resident and faculty member.
What is psoriasis?
Psoriasis is a chronic skin condition that affects approximately 2% of the general population. Psoriasis features red patches covered by silvery scales that typically affects the knees, elbows and scalp, but it can also affect the trunk, palms, soles and genital area. These lesions may be itchy and painful, and they sometimes crack and bleed. Psoriasis may also affect the fingernails and toenails with discoloration and pitting of the nails; the nails may also begin to crumble or detach from the nail bed.
What is psoriatic arthritis?
Psoriatic arthritis is a form of arthritis that affects approximately one-third of the patients with psoriasis. Most people first develop psoriasis and only later develop psoriatic arthritis, however, some people can develop the joint problems prior to the skin disease. Although most of the people with psoriatic arthritis also have psoriasis, the disease can be diagnosed among people without a personal history of psoriasis but have first or second degree relatives with psoriasis.
What are the symptoms of psoriatic arthritis?
Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of the body, including the fingertips and spine, and can range from relatively mild to severe. Psoriatic arthritis is also associated with fatigue, pain over tendons and swelling of the entire digit (‘sausage digit’). In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.
How is psoriatic arthritis diagnosed?
A person with psoriasis who develops symptoms that may be suggestive of psoriatic arthritis should talk to a doctor. Ideally, any person who is suspected of having psoriatic arthritis should consider seeing a rheumatologist.
There is no definitive test for psoriatic arthritis. The diagnosis is made on the basis of information collected by the medical history, physical examination, blood tests and imaging (such as x-rays, ultrasound, MRI).
What are the complications of psoriatic arthritis?
If left untreated, psoriatic arthritis can lead to irreversible joint damage that significantly affect the person’s activity level. Active disease is associated with poor sleep quality and fatigue that could also significantly affect daily function. People with psoriatic arthritis are more likely to develop colitis (inflammation of the bowel), uveitis (a specific type of eye inflammation), high blood pressure, diabetes and heart disease.
How is psoriatic arthritis treated?
The goals of treatment are controlling symptoms, preventing damage to the joints, improving function and reducing long-term complications. Without treatment, psoriatic arthritis may be disabling. Treatment decisions take into consideration the age, general health, the severity and the distribution of arthritis and psoriasis. Some of the medications are effective for the skin and the joints while others are only good for one of them. The management of psoriatic arthritis often requires multidisciplinary care of specialists from various fields, including rheumatology, dermatology, physiotherapy, occupational therapy and nutrition.
Psoriatic Arthritis (PsA) Clinic
Women’s College Hospital
76 Grenville Street
Toronto, ON M5S 1B2
Hours of Service
Thursday 9 a.m. to 5 p.m.
Complete our referral form and fax the form to us at 416-323-6115.
There are many resources available for both patients and health care professionals. The following are websites that will provide the answers to many questions you may have about psoriatic arthritis and care:
Dr. Lihi Eder, rheumatologist at WCH, explains what psoriatic arthritis is, the risks for developing the condition and proper treatment guidelines