Genetic Markers Of Psoriatic Arthritis
In the last 3 years, significant progress has been made toward identifying genetic markers associated with psoriatic arthritis. However, most of these markers are also associated with psoriasis, and thus a major remaining challenge is to identify genetic risk factors that are specific to psoriatic arthritis.
The HLA locus contains many genes responsible for immunologic function in humans. Psoriasis and psoriatic arthritis demonstrate human leukocyte antigen associations, most frequently with HLA-Cw6.29,6769 However, the HLA region may potentially harbor multiple genes that are associated with psoriasis and psoriatic arthritis. For psoriasis, Feng et al.70 recently identified three independent signals near the HLA locus that contribute to psoriasis risk: HLA-Cw6, c6orf10, and the region between HLA-B and MICA.
Although psoriatic arthritis is most strongly associated with HLA-Cw6, other HLA markers have also been associated with it. The frequency of HLA-B27 is reportedly higher among patients with psoriatic arthritis.28,71,72 Gladmann and Farewell71 performed a univariate analysis of psoriatic arthritis patients and showed that HLA-B27, HLA-B39, and HLA-DQw3 antigens were associated with psoriatic arthritis disease progression, whereas HLA-DR7 was protective. Additionally, the presence of HLA-B39 suggested early progression in psoriatic arthritis.
Other genetic loci
What Is Cdc Doing About Psoriasis
In 2010, CDC worked with experts in psoriasis, psoriatic arthritis, and public health to develop a public health perspective that considers how these conditions affect the entire population. The resulting report is Developing and Addressing the Public Health Agenda for Psoriasis and Psoriatic Arthritis pdf icon. You can read a short article about the agendaexternal icon in The American Journal of Preventive Medicine.
CDCs National Health and Nutrition Examination Survey , an intermittent source of national psoriasis data, has included questions about psoriasis as late as the 2013-2014 cycle. A recent analysis of NHANES data estimates that 7.4 million adults had psoriasis in 2013external icon.
- Psoriasis causes patches of thick red skin and silvery scales. Patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places . The most common type of psoriasis is called plaque psoriasis.
- Psoriatic arthritis is an inflammatory type of arthritis that eventually occurs in 10% to 20% of people with psoriasis. It is different from more common types of arthritis and is thought to be related to the underlying problem of psoriasis.
- Psoriasis and psoriatic arthritis are sometimes considered together as psoriatic disease.
Who is at risk for psoriasis?
Anyone can get psoriasis. It occurs mostly in adults, but children can also get it. Men and women seem to have equal risk.
Can I get psoriasis from someone who has it?
Why Some People With Psoriasis Develop Psa
Although psoriasis and PsA may appear unrelated, both conditions reflect underlying immune system problems.
In psoriasis, your overactive immune system causes your bodys skin cells to develop too rapidly. This can be triggered by many environmental factors, such as stress or smoking.
One thing these triggers have in common is that they stimulate your bodys inflammation response. This same inflammation response can happen in your joints. Inflamed joints are what cause PsA.
In PsA, white blood cells target your bodys tissues instead of protecting your body against foreign substances. Though PsA is connected to psoriasis, it has very distinctive symptoms of its own. For this reason, some researchers have referred to PsA as a disease within a disease.
The Centers for Disease Control and Prevention calculates that 10 to 20 percent of people with psoriasis will go on to develop PsA. This is slightly lower than the figures provided by the National Psoriasis Foundation, which put the risk at about 1 in 3, or 30 percent.
Psoriasis is typically diagnosed by the onset of plaques. These are scaly patches of raised, silver-white or reddish skin. PsA affects your joints, typically those in your fingers, toes, and lower back.
PsA can come in many forms. It can trigger other side effects such as fatigue and decreased range of motion. Because psoriasis is more visibly apparent, its often easier to diagnosis than PsA.
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Early Symptoms Of Psoriatic Arthritis
Here are some common first signs of PsA. If you experience any of these, talk to your primary care provider. Early detection and treatment of the disease can help prevent future joint damage.
Treatment For Psoriatic Arthritis
Some people with psoriatic arthritis have mild symptoms. They may be able to control pain and swelling with over-the-counter anti-inflammatory drugs.
People with advanced disease usually need prescription medications. These drugs can relieve symptoms and prevent permanent joint damage. They include:
- Nonsteroidal anti-inflammatory medications to reduce pain and swelling.
- Cortisone injections and oral steroids to quickly reduce inflammation in the short term.
- Disease-modifying antirheumatic drugs , which protect joints by blocking inflammation.
- Biologics, a special class of DMARDs that target the specific parts of your immune system that drive inflammation.
Besides medications, there are things you can do to help relieve pain and protect your joints:
- Maintain a healthy weight.
- Use splints to stabilize inflamed joints.
- Use hot packs and ice packs to ease pain and swelling.
- Engage in gentle exercises like walking, swimming and tai chi.
- Quit smoking.
- Consider surgery. Most people with psoriatic arthritis dont need surgery. But if you have severely damaged joints, joint replacement surgery can restore function.
Theres no cure for psoriasis or psoriatic arthritis, but you can manage both with treatment. And new medications come out every year, says Dr. Parody. By working with your doctor, you can develop a plan to protect your joints and keep doing the things you love.
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How Are Psoriasis And Psoriatic Arthritis Connected
You may have heard that psoriatic arthritis and psoriasis are connected, but might not understand how. Although the conditions share a similar name, they can have some very different symptoms and treatments. People with psoriasis are at a greater risk of developing psoriatic arthritis, and sometimes people with psoriatic arthritis develop psoriasis later on, meaning its helpful to have an understanding of both conditions if you are diagnosed with one, according to the Mayo Clinic.
Untangling the nuances between these two conditions can be a bit complicated. Thats why we spoke with experts about the important things you should know about psoriatic arthritis and psoriasis, including how the two are linked.
If You Have Autoimmune Thyroid Disease
If you have Hashimotos thyroiditis or Graves disease, your risk of developing another autoimmune disease is increased. As a result, its important to become knowledgeable about the common signs and symptoms of other autoimmune conditions. These include fatigue, muscle and joint pain and/or swelling, digestive problems, dry eyes, brain fog and difficulty concentrating, and skin rashes. If you have symptoms that continue after , you should discuss them with your doctor.
Theres also a caution if you have Graves disease and are being treated with a beta blocker. While most Graves disease patients are not given beta blockers for extended periods, long-term beta blocker use is associated with a significantly increased risk of developing psoriasis.
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Psoriasis Psoriatic Arthritis And Crohns Disease: Whats The Connection
Crohns disease and ulcerative colitis can be associated with psoriasis and psoriatic arthritis , which are comorbidities of CD and colitis. A comorbidity is when two or more disorders occur in the same person and cause adverse interactions.
CD and UC are the two main types of inflammatory bowel disease . CD is characterized by chronic inflammation in the lining and deeper layers of the digestive tract. UC causes sores and inflammation in the lining of the colon and rectum.
Psoriasis causes a proliferation of skin cells that become dry, itchy, and scaly with discolored patches of thickened skin . Skin can become infected during flares. Approximately 30 percent of people with psoriasis develop PsA, a type of inflammatory arthritis. Symptoms include joint pain, swollen and stiff joints, tendon pain, fatigue, and eye redness and pain .
For people with Crohns or colitis, the increased risk for psoriasis is approximately three times that of the general population.
MyCrohnsAndColitisTeam members have discussed their challenges with IBD, psoriasis, and PsA. Today, I meet with a dermatologist to discuss Stelara to treat both Crohn’s and psoriasis, one member wrote. The GI doctor gave me a prescription for prednisone to help, but I have severe osteoporosis, so before starting, I am trying to connect all medical providers to be on one page.
What Is Psoriatic Arthritis Video
Psoriatic arthritis can cause pain, swelling and stiffness inand around your joints.
It usually affects 3 in 10 people who already have the skin condition psoriasis .
Psoriasis causes patches of red, flaky skin which is covered with silvery-like patches.
Some people may develop psoriatic arthritis before the psoriasis is even present. In rare cases people have psoriatic arthritis and never have any noticeable patches of psoriasis.
Psoriatic arthritis and psoriasis are both autoimmune conditions, caused by a fault in the immune system.
Our immune system protects us from illness and infection. But in autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body, often causing inflammation.
Psoriatic arthritis is a type of spondylarthritis. This is a group of conditions with some similar symptoms.
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What Are Your Next Steps
If you have psoriasis or PsA, you should familiarize yourself with the symptoms of the two key autoimmune thyroid diseases and the conditions they cause:
Hashimotos thyroiditis and the resulting hypothyroidism
Graves disease and the resulting hyperthyroidism
Common symptoms of Hashimotos and hypothyroidism include fatigue, weight gain, depression, hair loss, constipation, puffiness, hoarseness, neck discomfort, and brain fog. Common include insomnia, weight loss, anxiety, diarrhea, neck enlargement , muscle weakness, and eye and vision problems.
If you have psoriasis/PsA and notice any of these symptoms, your first step should be a complete thyroid screening and evaluation. This should include:
A hands-on clinical examination to detect irregularities in the size and shape of your thyroid
Thyroid blood tests, including a thyroid stimulating hormone ,
free thyroxine and free triiodothyronine
Blood tests for thyroid antibodies, including , and
Your physician may also order a to check for the thyroid enlargement or shrinkage commonly seen in autoimmune thyroid disease.
The Role Of Inflammation
Inflammation is an important reaction to infection, injuries, and toxins. When the immune response of the body is triggered in cases of psoriatic disease, it can lead to inflammation that can cause skin and/or joint symptoms to flare , along with systemic inflammation that can affect other parts of the body.
Normally, it takes 21 to 28 days for cells on the surface of the skin to grow and shed it may take as few as four days in skin affected by psoriasis, due to the increased immune response. For psoriasis, a flare may include new psoriasis plaques or the return of plaques to a prior location, itch, irritation, or burning.
With PsA, a flare may include new or increased pain, tenderness, swelling, or stiffness in joints. Flares may last for various amounts of time and may vary in level of severity.
However, having skin affected by psoriasis or joints affected by PsA can be a sign of inflammation occurring in other parts of the body. Even people living with mild psoriasis may have inflammation in the body.
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Treatment Options For Both Psoriasis And Psa
Drugs to suppress immune system activity are among the most effective treatments for psoriasis and PsA.
Systemic, immune-suppressing drugs often provide relief for both conditions. However, your risk of secondary infections and other side effects is greater when using these drugs.
If you have severe psoriasis and are diagnosed with PsA, your doctor may prescribe the anti-inflammatory and immune-suppressant drug methotrexate . This medication aims to slow down the cells in your body that are reproducing too quickly and causing psoriasis flares.
Common side effects of methotrexate include:
- upset stomach
A newer class of drugs called biologics, in particular TNF blockers, targets specific parts of the immune system more precisely. Because of this, your doctor may be more likely to recommend them over methotrexate.
Biologics reduce inflammation and psoriasis outbreaks in most people who take them. There are a number of brands of biologics approved for treatment of psoriasis in the United States.
Biologics need to be injected. Some need to be administered more often than others. Common side effects include:
- allergic reaction
How Do Psoriasis And Psa Overlap
For every 10 patients who walk in the door with psoriasis, about three or four of them will eventually get PsA, says Elaine Husni, MD, MPH, vice chair of the department of rheumatic & immunologic diseases at the Cleveland Clinic in Ohio. Most cases almost always start with the skin condition and then within seven to 10 years later, joint pain symptoms start to develop.
However, skin and joint symptoms can develop at the same time and, more rarely, joint symptoms can appear before skin involvement, says Dr. Haberman. While estimates vary, one study showed that up to 3 percent of patients developed joint disease before skin disease, she notes.
In some cases, there may have been skin involvement that went unnoticed or undiagnosed. For example, psoriasis can be sneaky and show up in hidden or private areas like the scalp, intergluteal cleft , belly button, and inside the ear, explains Dr. Husni. Since people dont really examine their scalp or buttocks very often, small psoriasis patches can get missed and delay diagnosis, she says.
Adds Dr. Haberman: You might have a small fleck in your scalp that you just think of as dandruff that is actually psoriasis.
Whats more, people with psoriasis in some of these hidden areas may actually be more prone to PsA. Studies have shown that you may be at higher risk of developing PsA if you have scalp, nail, or inverse psoriasis, says Dr. Haberman.
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Conditions Related To Psoriatic Arthritis
Certain underlying health conditions are more common in people with psoriatic arthritis than in the general population. Some people may have these conditions before their PsA diagnosis, while other people may develop them as a result of the disease or its treatment.
PsA is a chronic autoimmune condition that affects the joints and where the tendons and ligaments connect to bone. This causes joint pain, tenderness, and swelling, along with swollen fingers and morning stiffness that is similar to rheumatoid arthritis.
How To Prevent Psoriasis And Psa Flare
The symptoms of psoriatic disease cant be completely stopped, but they can usually be controlled with treatment.
Identifying what triggers your psoriasis and PsA flares is key to treating the condition. Because PsA is a result of psoriasis, both conditions may be triggered by the same environmental factors.
For some people, stress can be a major trigger for a psoriasis flare. Learning breathing exercises, practicing yoga, and using other coping mechanisms for stress may help stop stressful situations from making your psoriasis symptoms worse.
The biggest lifestyle change that might ease the symptoms of psoriatic disease is diet. Looking at your diet to identify things that trigger your psoriasis symptoms could mean removing some foods as a form of treatment.
Obesity is known to contribute to psoriasis symptoms. Maintaining a healthy diet is essential to being in a healthy weight range. If you can avoid carrying extra pounds, studies indicate that your symptoms will be less severe.
Drinking alcohol and smoking can also trigger flares, so limiting or eliminating these factors entirely can be beneficial.
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Up To 30 Percent Of People With Psoriasis Will Go On To Develop Psa And 85 Percent Of People With Psa Also Have Skin Psoriasis
Writing and reporting by Susan Jara and Steven Newmark
Psoriasis and psoriatic arthritis are distinct conditions, but they are connected. In fact, data show that up to 30 percent of people with psoriasis will go on to develop PsA and 85 percent of people with PsA also have skin psoriasis.
Although people can be diagnosed with PsA without having any skin involvement, most often they will have a family member with skin psoriasis, says Rebecca Haberman, MD, a rheumatologist at NYU Langone Health in New York City.
Psoriasis is an inflammatory condition of the skin, while psoriatic arthritis also includes inflammation of the joints and entheses , .
Read on to find out the different symptoms of psoriasis vs. PsA, how they are diagnosed and treated, and what you need know about the link between these health conditions.