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 Service at Women’s College Hospital is Canada’s first Rapid Access Clinic for individuals with psoriasis and psoriatic arthritis, offering a one-of-a-kind self-referral system for patients to get timely access to medical care. Studies have shown that seeing a rheumatologist earlier directly impacts early detection of psoriatic arthritis and may prevent long-term joint damage. The clinic provides multidisciplinary care for patients who are suspected of having the disease or have a diagnosis of psoriatic arthritis.
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 (.pdf) 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 Service team members include:
Dr. Lihi Eder – Rheumatologist
Dr. Lihi Eder is an Assistant Professor of Medicine at the University of Toronto and a Scientist at the Women’s College Research Institute. She is also a staff rheumatologist in the rheumatology department at Women’s College Hospital.
Dr. Eder has a particular interest in psoriatic disease and cardiovascular morbidity in rheumatic diseases. Her research interests include the clinical and genetic epidemiology of psoriatic disease. More recently, her research has focused on cardio-metabolic diseases in patients with psoriatic disease, with an emphasis on the interplay between inflammation and cardiovascular morbidity. Dr. Eder has also gained expertise in vascular and musculoskeletal ultrasound for research purposes.
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 her post-doctoral research fellowship at the Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, in 2015.
Dr. Eder was awarded a Canadian Institute of Health Research Fellowship (2014) to investigate the effect of biologic medications on atherosclerosis progression psoriatic disease. She serves as the research officer of the Canadian Rheumatology Ultrasound Society, and is an active member in several international research networks and societies in the field of psoriatic disease and atherosclerosis
Dr. Dana Jerome – Rheumatologist
Dr. Dana Jerome is the division head of rheumatology at Women’s College Hospital. She completed her medical school and internal medicine training at Western University. She then went on to complete her rheumatology fellowship at the University of Ottawa followed by a Lupus fellowship at the University of Toronto. Dr. Jerome completed her Master’s in Education at the Ontario Institute for Studies in Education (OISE)/ University of Toronto. Presently, she is a Rheumatologist in the Department of Medicine at Women’s College Hospital where her clinical work is focused on general rheumatology. She has received a number of university and hospital teaching awards and was a recipient of a Clinician Teacher award from The Arthritis Society.
Dr. Jensen Yeung – Dermatologist
Dr. Jensen Yeung completed an Honours B.Sc. degree at McMaster University in 1998 and obtained his Doctor of Medicine degree from the same university in 2001. In the same year, he began his dermatology residency training at the University of Toronto. During his residency training, he spent 6 months in Australia, New York, and Boston gaining clinical experience and acquiring newest knowledge in the field of melanoma and dermscopy from leading experts. In 2005, he was selected by the residency program as the co-chief resident for the year.
Having obtained his board certification from the Royal College of Physicians and Surgeons of Canada in 2006, he joined the Faculty of Dermatology at the University of Toronto, where he ran teaching clinics at both Women’s College Hospital and the Sunnybrook Health Sciences Centre. In 2007, he was promoted to the position of medical director for the RKS Dermatology Program at Women’s College Hospital, where he ran a melanoma, psoriasis, and General Dermatology clinic. In 2013, he switched from RKS to PERC (Phototherapy Education and Research Centre) and took on the new role as the medical director of PERC where he runs a weekly psoriasis clinic. In 2011, he joined Dr. Kim Papp’s research facility in Waterloo and has participated in over 75 clinical trials.
He has received a number of teaching awards including the best resident teacher award in 2005, the 2008 Women’s College Hospital Department of Medicine Postgraduate Teaching Award and the 2009 University of Toronto Dermatology Postgraduate Program Staff Teaching Award.
Chandra Farrer – Advanced Practice Physiotherapist in Arthritis Care
Chandra Farrer has been a physiotherapist since 1998. She completed her Advanced Clinician Practitioner in Arthritis Care in 2008 and currently works full time in the Rheumatology Clinic assessing both inflammatory and non-inflammatory arthritis at Women’s College Hospital. Her research interests include: evaluation of the Advanced Practice Physiotherapist role, and triage of Rheumatology patients. She holds a clinical lecturer status at the University of Toronto. She is the Professional Advisor for Athletic Therapy, Kinesiology, Massage Therapy and Physiotherapy.
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
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
- National Psoriasis Foundation
- The Arthritis Society
- Canadian Arthritis Patient Alliance
- Canadian Psoriasis Network
Relevant Research Studies
Eder L, Haddad A, Rosen CF, et al. The incidence and risk factors for psoriatic arthritis in patients with psoriasis – A prospective cohort study. Arthritis Rheumatol. 2015; doi: 10.1002/art.39494. [Epub ahead of print -.pdf]
Eder L, Wu Y, Chandran V, et al. Incidence and predictors for cardiovascular events in patients with psoriatic arthritis. Ann Rheum Dis. 2015; doi: 10.1136/annrheumdis-2015-207980. [Epub ahead of print – .pdf]
Eder L, Thavaneswaran A, Chandran V, et al. Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann Rheum Dis. 2015; 74(5):813-7.