What Are The Symptoms
Scalp psoriasis causes redness and scaliness, which may also involve the hairline, the forehead, behind the ears and the back of the neck. It can range from very mild with slight fine scaling to very severe, crusted thick scaling covering the entire scalp. Hair loss during the flare-up can occur in some cases, but the hair will normally grow back. Psoriasis can be itchy, make the scalp feel tight and occasionally cause soreness, especially if there are cracks in the skin.
Types Symptoms And Treatment
Like psoriasis and PsA elsewhere on the body, psoriatic disease in the hands and feet can cause itchy, scaling, reddened skin plaques and painful, swollen joints. Specific types and symptoms of hand and foot psoriasis and PsA, however, can also cause less-familiar skin and joint issues.
Palmoplantar psoriasis, plaque psoriasis on the feet or hands, affects about 40 percent of people with plaque psoriasis, who often donât have much skin disease elsewhere. As noted, its substantial effects on function and quality of life mean dermatologists typically use advanced medications to control symptoms. Treating certain types of palmoplantar psoriasis is still challenging, despite the rapidly expanding list of medications for psoriasis and PsA. Often, palmoplantar psoriasis doesnât respond as well to treatment as does psoriasis on other parts of the body.
Most biologics, which work by targeting specific proteins that turn up inflammation in psoriatic disease, such as tumor necrosis factor or interleukin-17 , have some effect on certain people with palmoplantar psoriasis.
No one treatment works for everyone, and people with palmoplantar psoriasis may have to try several medications or combinations of treatments to relieve symptoms. Gary Bixby, for example, didnât get better with either a TNF or an IL-17 inhibitor. The third biologic he tried blocks another interleukin protein, IL-23, and, three months after his first injection, heâs getting better results.
Spondylitis With Or Without Sacroiliitis
This occurs in approximately 5% of patients with psoriatic arthritis and has a male predominance.
Clinical evidence of spondylitis and/or sacroiliitis can occur in conjunction with other subgroups of psoriatic arthritis.
Spondylitis may occur without radiologic evidence of sacroiliitis, which frequently tends to be asymmetrical, or sacroiliitis may appear radiologically without the classic symptoms of morning stiffness in the lower back. Thus, the correlation between the symptoms and radiologic signs of sacroiliitis can be poor.
Vertebral involvement differs from that observed in ankylosing spondylitis. Vertebrae are affected asymmetrically, and the atlantoaxial joint may be involved with erosion of the odontoid and subluxation . Therapy may limit subluxation-associated disability.
Unusual radiologic features may be present, such as nonmarginal asymmetrical syndesmophytes , paravertebral ossification, and, less commonly, vertebral fusion with disk calcification.
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Key Points About Psoriatic Arthritis
- Psoriatic arthritis is a form of arthritis with a skin rash.
- Psoriasis is a chronic skin and nail disease. It causes red, scaly rashes and thick, pitted fingernails. The rash may come before or after the arthritis symptoms.
- Psoriatic arthritis causes inflamed, swollen, and painful joints. It happens most often in the fingers and toes. It can lead to deformed joints.
- Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.
Understanding Remission And Minimal Disease Activity
Psoriatic arthritis disease progression is not inevitable. When your PsA is treated with medications that reduce immune system overactivity, you can reduce your disease activity to a point that its no longer causing significant symptoms or increasing the risk of long-term health issues.
In general, going into remission means that you are no longer showing signs of active disease. Decades ago, remission wasnt conceivable for most people with psoriatic arthritis, but thanks to a proliferation in medication treatment options, getting to remission is a possibility for PsA patients today.
However, going into remission does not mean that you will stay there indefinitely. It is common for PsA symptoms to wax and wane. Even if youve been in remission for a long time and your pain starts coming back and you start flaring more, you may need to change your medication for better control, says Dr. Haberman.
You may also hear the phrase minimal disease activity in conjunction with psoriatic arthritis and remission.
Doctors dont have a clear definition of what it means to be in remission in PsA, but they have defined something called minimal disease activity as a treatment target. This is what your doctor may use to determine whether your PsA disease activity is low enough that you have few symptoms and a low risk of long-term damage.
People are considered to be in minimal disease activity when their scores on five out of these seven criteria are low enough.
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Psoriatic Arthritis Vs Rheumatoid Arthritis
PsA and RA are two of several types of arthritis. While they may share a common name and many similar symptoms, different underlying factors cause them.
PsA occurs in people with psoriasis. This is a skin condition that causes lesions and scaly spots on the skins surface.
RA is an autoimmune disorder. It occurs when the body mistakenly attacks the tissues lining the joints. This causes swelling and eventually pain and joint destruction.
PsA occurs almost equally in men and women, but women are more likely to develop RA. PsA often first shows up between the ages of 30 and 50 for most individuals. RA usually first develops a bit later in middle age.
In their early stages, both PsA and RA share many similar symptoms. These include pain, swelling, and joint stiffness. As the conditions progress, it may become clearer which condition you have.
Fortunately, a doctor wont have to wait for the arthritis to progress in order to make a diagnosis. Blood and imaging tests can help your doctor decide which condition is affecting your joints.
Can Psoriatic Arthritis Affect Other Parts Of The Body
Having psoriatic arthritis can put you at risk of developing other conditions and complications around the body.
The chances of getting one of these are rare. But its worth knowing about them and talking to your doctor if you have any concerns.
Eyes
Seek urgent medical attention if one or both of your eyes are red and painful, particularly if you have a change in your vision. You could go to your GP, an eye hospital, or your local A& E department.
These symptoms could be caused by a condition called uveitis, which is also known as iritis. It involves inflammation at the front of the eye.
This can permanently damage your eyesight if left untreated.
Other symptoms are:
- blurred or cloudy vision
- sensitivity to light
- not being able to see things at the side of your field of vision known as a loss of peripheral vision
- small shapes moving across your field of vision.
These symptoms can come on suddenly, or gradually over a few days. It can affect one or both eyes. It can be treated effectively with steroids.
Heart
Psoriatic arthritis can put you at a slightly higher risk of having a heart condition. You can reduce your risk by:
- not smoking
- staying at a healthy weight
- exercising regularly
- eating a healthy diet, thats low in fat, sugar and salt
- not drinking too much alcohol.
These positive lifestyle choices can help to improve your arthritis and skin symptoms.
Talk to your doctor if you have any concerns about your heart health.
Crohns disease
Non-alcoholic fatty liver disease
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Signs And Symptoms Of Psoriatic Arthritis
For most people, psoriatic arthritis develops years after psoriasis. Contact your dermatologist if you have psoriasis and any of these signs or symptoms:
- A very noticeable swollen finger or toe
- Swollen and tender joints
- Stiffness when you wake up or sit for hours that fades as you move
- Nails that are pitted
- Nail separating from nail bed
- Lower back pain
How Can I Help My Child Live With Psoriatic Arthritis
Help your child manage his or her symptoms by sticking to the treatment plan. This includes getting enough sleep. Encourage exercise and physical therapy and find ways to make it fun. Work with your child’s school to make sure your child has help as needed. Work with other caregivers to help your child take part as much possible in school, social, and physical activities. Your child may also qualify for special help under Section 504 of the Rehabilitation Act of 1973. You can also help your child find a support group to be around with other children with pediatric arthritis.
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Joint Pain Or Stiffness
Psoriatic arthritis causes inflammation in the joints, which can cause pain, tenderness, and stiffness. You might feel this in just one joint or in several.
Psoriatic arthritis usually affects the knees, fingers, toes, ankles, and lower back. Symptoms of pain and stiffness may disappear at times, and then return and worsen at other times. When symptoms subside for a time, its known as a remission. When they worsen, its called a flare-up.
Key Points About Psoriatic Arthritis In Children
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Psoriatic arthritis is a rare form of arthritis or joint inflammation that affects both skin and joints. It can occur in people who have the skin disease psoriasis.
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It is most common in adults ages 30 to 50. But it can start in childhood.
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This condition causes inflamed, swollen, and painful joints. It also causes eye pain and fatigue.
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Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.
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Early treatment can help the disease go into remission. Delayed treatment may lead to long-term disability.
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How Is Psoriatic Arthritis Treated In A Child
Treatment will depend on your childs symptoms, age, and general health. It will also depend on how severe the condition is.
The treatment team will include your child’s primary healthcare provider. It will also include a pediatric rheumatologist, and an ophthalmologist.
Treatment is done for both the skin condition and the joint inflammation. Some medicines used to treat psoriatic arthritis include:
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Nonsteroidal anti-inflammatory drugs to relieve symptoms. These include aspirin, ibuprofen, and naproxen.
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Medicines that weaken the bodys immune system . These can be used to ease inflammation if NSAIDs are not working.
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Vitamins and minerals to slow bone deformities. These include calcium and vitamin D.
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Biologic medicines such as infliximab
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Corticosteroids to ease redness and swelling
Other treatment may include:
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Ultraviolet light treatment
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Heat and cold
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Physical therapy to improve and keep muscle and joint function
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Occupational therapy to improve ability to do activities of daily living
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Managing the psoriasis skin rash
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Surgery to fix or replace a damaged joint
Loss Of Significant Joint Mobility
For example, you were able to flex your wrist 60 degrees, and two years later, you lost 50 percent of that range of motion. Its possible to feel okay and still experience loss of range of motion, says Dr. Domingues. But the idea is to prevent joint damage and to make you have less pain. If you have less pain and are still progressing, that means your treatment could be working better.
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Acrodermatitis Continua Of Hallopeau
Acrodermatitis continua of Hallopeau is another rare type of palmar-plantar pustular psoriasis. It is characterised by skin lesions on the ends of the fingers, including the nails which can sometimes become completely destroyed, and sometimes on the toes. The eruption sometimes starts after localised physical trauma. Often the lesions are painful and disabling, with the nails deformed, and bone changes may occur. This condition is quite hard to treat satisfactorily.
How Is Psoriatic Arthritis Treated
Treatment will depend on your symptoms, age, and general health. It will also depend on the severity of your condition.
Boththe skin condition and the joint inflammation are treated. Early diagnosis andtreatment helps prevent joint damage. Some medicines used to treat psoriatic arthritisinclude:
- Nonsteroidal anti-inflammatory medicines to ease symptoms
- Corticosteroids for inflammation
- Immunosuppressive medicines such as methotrexate to reduce inflammation if NSAIDs don’t work
- Biologic medicines to ease inflammation
- Vitamins and minerals such as calcium and vitamin D to slow bone deformation
Other treatment may include:
- Obesity
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Symptoms Of Psoriatic Arthritis
The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in 1 or 2 joints.
There may be times when your symptoms improve and periods when they get worse .
Relapses can be very difficult to predict, but can often be managed with medicine when they do occur.
Treatment For Psoriatic Arthritis
Treatment for psoriatic arthritis aims to:
- relieve symptoms
- slow the condition’s progression
- improve quality of life
This usually involves trying a number of different medicines, some of which can also treat the psoriasis. If possible, you should take 1 medicine to treat both your psoriasis and psoriatic arthritis.
The main medicines used to treat psoriatic arthritis are:
- non-steroidal anti-inflammatory drugs
- biological therapies
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What Causes Psoriatic Arthritis
The cause of psoriatic arthritis is unknown. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma play a role in determining who will develop the disease. Psoriasis itself is neither infectious nor contagious.
Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with psoriatic arthritis.
Classification Of Psoriatic Arthritis
The simple and highly specific Classification Criteria for Psoriatic Arthritis , developed by a large international study group, has a sensitivity and specificity of 98.7% and 91.4%, respectively. The criteria consist of established inflammatory articular disease with at least 3 points from the following features:
- Current psoriasis
- A history of psoriasis
- A family history of psoriasis
- Dactylitis
- Juxta-articular new-bone formation
- RF negativity
- Nail dystrophy
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Tlc For Hands And Feet
Avoiding injuries, even small ones , makes good sense for people with psoriasis or PsA affecting the hands and feet.
âThe Koebner phenomenon is the flaring of psoriasis in response to injury. Even minor trauma can cause a flare,â says Duffin. âFor example, if you use your nails to pry open a lid, youâre probably going to make your nail psoriasis worse.â
Similarly, shoving feet into shoes without enough room to wiggle toes or wearing high heels means youâre putting constant pressure on nails and joints, which can increase pain and nail problems.
âI generally recommend flats that have good cushioning and arch support that takes the weight off toe joints â which doesnât mean wearing ballet slippers that have no padding in the bottom,â says Gottlieb.
âYou donât want a triangle profile that squeezes the toes, because that elicits pain.â She also cautions that flip-flops, a summer favorite, expose toes and feet to trauma.
A consultation with a podiatrist, who can advise on the right footwear and design an orthotic for individual foot issues, is often helpful for people with PsA that affects the feet, Gottlieb says.
Surprising Ways Psoriatic Arthritis Can Affect Your Health
The autoimmune disease can cause more than joint pain and may target several different organs.
Psoriatic arthritis is most often associated with joint pain. Like psoriasis, its an autoimmune disorder that commonly impacts the skin in the case of psoriatic arthritis, the immune system also targets the joints. But the disease can affect many parts of the body, and its symptoms vary widely.
causes a lot of inflammation, says Christopher Ritchlin, MD, MPH, a rheumatologist from the University of Rochester Medical Center in New York. I dont think many patients fully understand that if you have inflammation, youre at risk for inflammation in other areas of the body.
Here are eight surprising ways psoriatic arthritis can affect your body:
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Increased Risk Of Pancreatitis And Diabetes
A study published in July 2016 in the journal PLoS One found that psoriatic disease is associated with a significantly increased risk of chronic pancreatitis, an inflammatory disease of the pancreas.
The researchers found that the incidence of chronic pancreatitis was roughly twofold in people with psoriasis compared with those without psoriasis. They also determined that psoriasis patients using nonsteroidal anti-inflammatory drugs and Trexall , commonly used to treat psoriatic arthritis, had a lower risk of developing chronic pancreatitis.
The pancreas produces insulin, which helps maintain the bodys blood glucose levels. If the pancreas isnt functioning properly, it can lead to type 1 or type 2 diabetes. A study published in February 2017 in the Journal of Rheumatology found that the prevalence of diabetes mellitus is higher in patients with psoriatic arthritis. The risk of developing diabetes was shown to increase with elevated levels of psoriatic arthritis activity.
Consider Natural Supplements And Spices
Omega-3 fatty acids have anti-inflammatory properties. These healthy fats, found in many supplements, reduce inflammation and stiffness in joints.
While research suggests there are health benefits, the Food and Drug Administration doesnt monitor the purity or quality of supplements. Its important to talk with your doctor before you begin taking supplements.
Turmeric, a potent spice, also serves up a dose of anti-inflammatory properties and may help reduce inflammation and PsA flare-ups. Turmeric can be added to any dish. Some people even stir it into tea or lattes, like golden milk.
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Treatment Of Psoriatic Arthritis
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Arthritis treated with disease-modifying antirheumatic drugs and biologic agents
Ustekinumab is an interleukin -12 and IL-23 antagonist. The dosage is 45 mg subcutaneously at weeks 0 and 4 followed by 45 mg every 12 weeks thereafter. The dosage is 90 mg subcutaneously if the patient weighs > 100 kg. Adverse effects are similar to those of the other biologic agents Biologic agents Rheumatoid arthritis is a chronic systemic autoimmune disease that primarily involves the joints. RA causes damage mediated by cytokines, chemokines, and metalloproteases. Characteristically… read more .
Secukinumab is an IL-17 inhibitor. Secukinumab can be given at a dosage of 150 mg subcutaneously at weeks 0, 1, 2, 3, and 4 and every 4 weeks thereafter. Without the loading dosage, secukinumab is given at 150 mg subcutaneously every 4 weeks. If patients continue to have active psoriatic arthritis, a dose of 300 mg should be considered. Secukinumab may be given with or without methotrexate. Adverse effects include urticaria, upper respiratory infections, fungal infections due to Candida, diarrhea, herpes zoster, and inflammatory bowel disease.