Fatty Liver And Psoriatic Disease
Theres a much higher prevalence of fatty liver disease in people with psoriatic arthritis, says Ritchlin.
A review of studies published in March 2015 in the Journal of Clinical and Aesthetic Dermatology found that up to 47 percent of psoriatic patients develop nonalcoholic fatty liver disease a condition that causes fatty deposits to develop on the liver and can lead to permanent scarring or damage. According to a study published in February 2016 in the journal Gastroenterology Review, NAFLD is frequent in patients with psoriasis and is also associated with the duration and severity of the disease.
Drugs used to treat psoriatic arthritis, including NSAIDs and methotrexate, can adversely affect your liver. If youre taking these drugs, your doctor will want to monitor your liver function.
What Is Psoriatic Arthritis
Psoriatic arthritis is a type of arthritis linked with psoriasis, a chronic skin andnail disease. Psoriasis causes red, scaly rashes and thick, pitted fingernails.Psoriatic arthritis is similar to rheumatoid arthritis in symptoms and jointswelling . But it tends to affect fewer joints than RA. And it does notmake the typical RA antibodies. The arthritis of psoriatic arthritis comes in 5forms:
- Arthritis that affects the small joints in the fingers, toes, or both
- Asymmetrical arthritis of the joints in the hands and feet
- Symmetrical polyarthritis, which is similar to RA
- Arthritis mutilans, a rare type of arthritis that destroys and deforms joints
- Psoriatic spondylitis, arthritis of the lower back and the spine
Psoriasis and Psoriasis Arthritis FAQ
Do We Know What Causes Psoriatic Arthritis
- The cause of psoriatic arthritis is the subject of much research.
- You cannot catch psoriatic arthritis or psoriasis from someone else. Therefore they are not contagious.
- The cause of psoriatic arthritis is not proven but experts believe it to be a combination of genetic, immunological and environmental factors. 2 out of 5 people with psoriasis or psoriatic arthritis have a first-degree relative with the condition. This means you have a higher chance of developing psoriasis or psoriatic arthritis if you have relative who has the condition. Some experts believe infections such as streptococcal infections may provoke psoriatic arthritis, though this is not proven.
- The role of bacteria in the gut and developing psoriatic arthritis is the subject of current research.
- Trauma and stress may be contributing factors, although this is not proven.
- The genetic make-up of an individual is likely to determine the risk of developing psoriasis and psoriatic arthritis and probably influences the severity.
- Being overweight is now understood to be linked to developing psoriatic arthritis and is the subject of ongoing research.
- There are certain genetic markers linked to the immune system which are now being used to predict the severity of psoriatic arthritis. Much more is known about the mechanisms that lead to inflammation in other conditions and it is likely advances in science will lead to much more effective treatments with fewer side effects.
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There Are Various Forms Of Psoriasis And Psoriatic Arthritis
There are five types of psoriatic arthritis, and the disease can trigger symptoms in different areas of your body depending on the type you have, according to NYU Langone Health. They are:
- Asymmetric oligoarthritis can cause pain and stiffness in up to five joints on either side of your body.
- Symmetric arthritis is characterized by painful, swollen joints on just one side of your body.
- Spondylitic arthritis When you experience arthritis symptoms in your spine, or you might have neck pain and difficulty moving your head.
- Distal interphalangeal predominant psoriatic arthritis involves inflammation in your fingernails and toenails.
- Arthritis mutilans is a rare but severe form of psoriatic arthritis that causes damage in the bones of your toes and fingers, according to NYU Langone.
The Mayo Clinic explains there are six types of psoriasis, and your symptoms may vary depending on the type you have.
Psoriasis and psoriatic arthritis do share one common symptom: fatigue, which is likely due to high levels of inflammation, according to NYU Langone Health.
Treat Your Psoriatic Arthritis
If your muscle pain is tied to your PsA diagnosis, treating the condition could reduce your enthesitis and help you stay active. This, in turn, could potentially prevent muscle aches and pains.
You have many options when it comes to treating psoriatic arthritis. In addition to NSAIDs, you may be prescribed medications including:
- Immunosuppressants
- Corticosteroids
These medications can all have side effects, so talk to your health care provider to develop your treatment plan. Although none of these PsA treatments will take your muscle pain away immediately during flare-ups, they can be very helpful in providing relief.
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Psoriatic Arthritis Vs Rheumatoid Arthritis
If you have psoriasis and consistently experience joint pains and aches, you should see your healthcare provider. Thats because joint pain can be a symptom of psoriatic arthritis and rheumatoid arthritis both very real possibilities for people with psoriasis.
Indeed, a study published in the Journal of the American Academy of Dermatology in June 2021 found that adults with psoriasis experience an increased likelihood of having rheumatoid arthritis compared to adults without psoriasis.
Determining whether you have psoriatic or rheumatoid arthritis can be challenging, but making the distinction is important, says Natalie E. Azar, MD, a clinical assistant professor of medicine and rheumatology at New York University Langone Medical Center in New York City.
Although rheumatoid arthritis and psoriatic arthritis share many traits joint pain, stiffness, swelling they also have unique symptoms. For instance, psoriatic arthritis symptoms can include a skin rash as well as nail damage.
Its important to distinguish which type of arthritis you have to manage it well and know what to expect, Dr. Azar says.
Although treatment options can be strikingly similar, Azar says, significant advances have been made in the development and discovery of new biologic therapies very specifically for psoriatic arthritis.
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How Psoriatic Arthritis Affects The Knees
About 30 percent of people with psoriasis develop psoriatic arthritis . Like rheumatoid arthritis, this form of chronic inflammatory arthritis occurs when the bodys immune system mistakenly attacks its own healthy tissues.
Although some people have only one joint affected by PsA, it can affect any joint in the body. For many individuals, the symptoms of psoriatic arthritis develop in the knees, causing joint pain, swelling, and stiffness.
A rheumatologist can help identify PsA symptoms in your knee joints and prescribe or recommend treatments to alleviate pain and prevent the condition from progressing.
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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.
Does Treating Psa Reduce Cardiovascular Risk
It makes sense that drugs that suppress skin and joint inflammation would suppress inflammation in blood vessels, too. But Dr. Ogdie-Beatty says theres lack of good evidence to support that idea.
Systemic inflammation can accelerate plaque development, so we think suppressing inflammation might decrease cardiovascular risk. Observational studies suggest thats the case, and anti-TNFs are possibly better than methotrexate for that. But we just dont have a lot of good data. We do know that reducing weight and treating diabetes effectively are important and lead to better outcomes, she says.
Some arthritis medications, especially nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen, are known to raise the risk of heart attack, stroke and heart failure in the general population even when taken for a short time. Dr. Ogdie-Beatty says its not clear NSAIDs have the same effect in people with inflammatory arthritis, but says shes very cautious prescribing them for patients with existing heart disease.
She says both doctors and patients need to understand the cardiovascular risks in PsA, and patients should feel empowered to ask questions about treatments, including medications. Dr. Mody agrees, saying primary care physicians and cardiologists should treat PsA patients as higher-risk and work to modify any traditional cardiovascular risk factors they have.
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How Is Psoriatic Arthritis Diagnosed
Psoriatic arthritis is easier to confirm if you already have psoriasis. If you donthave the skin symptoms, diagnosis is more difficult. The process starts with a healthhistory and a physical exam. Your healthcare provider will ask about your symptoms. Youmay have blood tests to check the following:
- Erythrocyte sedimentation rate . This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the bloods proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- Uric acid. High blood uric acid levels can be seen in psoriatic arthritis but are not used for diagnosis or monitoring.
- Imaging. X-rays, CT scans, ultrasound, MRI, and skin biopsies may all be used to help diagnosis.
When To Get Medical Advice
See a GP if you have persistent pain, swelling or stiffness in your joints even if you have not been diagnosed with psoriasis.
If you’ve been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let the doctor know if you’re experiencing any problems with your joints.
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Getting A Diagnosis Of Psoriatic Arthritis
The presence of psoriasis may provide an indication of psoriatic arthritis when someone develops joint symptoms. Psoriatic arthritis can develop in people with a lot or a little of psoriasis, and may be more common in people with nail psoriasis. As well as joint symptoms, psoriatic arthritis can lead to feeling tired. Many people become frustrated by a lack of diagnosis psoriatic arthritis tends to have periods of improvement and worsening, which may also be attributed to mechanical joint problems and not inflammatory arthritis.
If you have the symptoms of inflammatory arthritis, such as psoriatic arthritis, your doctor will often refer you to a rheumatologist. In some cases, further tests and imagery may be sought, although this will depend on the individual circumstances and level of confidence in the initial diagnosis.
What Can I Do To Help My Feet
The most important action is to seek advice and help when you notice any changes in your foot, whatever they may be. You can talk to your GP or local pharmacist for advice. Some problems can be resolved simply. For issues that are more persistent you may be referred to a specialist, such as a dermatologist, rheumatologist, physiotherapist, surgeon or chiropodist/podiatrist.
For general foot care, personal hygiene is important, particularly in avoiding fungal and viral infections. Change shoes and socks regularly, avoid shoes which are ill-fitting or cause bad posture. If you are overweight, losing weight could relieve the pressure on your joints and improve your walking gait.
If you are diagnosed with psoriasis, develop a treatment regime that works for you often, applying treatment after a bath or shower, along with the use of an emollient, can make the process easier.
If you have nail involvement, keep nails trimmed and clean. If they are thick, try trimming them after soaking them in a bath or shower, as this makes them softer and easier to cut. Alternatively, seek an appointment with a chiropodist, which is often available via the NHS.
If you have psoriatic arthritis, it is important to rest inflamed joints. Sourcing footwear that supports the foot and helps to reduce the pressure on the inflamed areas can help, as can inner soles and orthotic supports. Once again, a chiropodist is best placed to advise you.
This article is adapted from The psoriatic foot leaflet.
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How Successful Are The Treatments
Anti-inflammatory drugs can help to reduce pain, swelling and stiffness. Unfortunately, however, they can make skin symptoms worse in some people. Steroid injections to joints may give relief. Disease-modifying drugs such as methotrexate can damp down both skin and joint symptoms, as can targeted biologic agents.
In some cases, surgery to remove a thickened synovial membrane , realign a joint or to fuse a joint may stop pain which results from movement.
Sometimes it is possible to remove the painful end of a bone .
Remember: All treatments may have unwanted side effects or require special precautions . Always make sure you have all the information before embarking on any course of therapy this includes reading the patient information leaflets provided with your medicines.
How Psoriatic Arthritis Treatment Prevents Disease Progression
The primary way to slow the progression of PsA is through medications that modify the immune system. It may take trial and error to find the treatment that works best for a given patient, notes Dr. Haberman. While we have a lot of medication options for PsA, we dont know which ones a patient will respond to, so sometimes we need to try more than one medication to find the one thats right for that patient, she says.
In addition, medications that have been effective for you can stop working over time. If this happens, your doctor may recommend a medication that works differently say, targets a different part of the immune system to control disease activity.
There are many drugs used to treat PsA. The ones that you will use will depend on the type and severity of symptoms as well as the most problematic areas .
Medications use to treat PsA include:
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Common Psoriatic Arthritis Symptoms Include:
Swollen fingers and toes
Tender, painful, or swollen joints
Reduced range of motion of joints
Morning stiffness
Lower back, upper back, or neck pain
General fatigue
or separationfrom nail bed
If you are experiencing any symptoms of psoriatic arthritis listed above, it’s important to talk to your doctor.
Psoriatic Arthritis And Psoriasis: Which Comes First
People with psoriatic arthritis almost always have psoriasis first, says Francis C. Luk, MD, a rheumatologist at Wake Forest Baptist Health in Winston-Salem, North Carolina. There is a small percentage of people who will actually get the arthritis first, but thats a minority of cases, says Dr. Luk.
Its estimated that about 30 percent of people with psoriasis go on to develop psoriatic arthritis, according to the National Psoriasis Foundation. The first signs of arthritis are often swelling and pain in the hands, but the disease can cause early symptoms in other parts of the body too. Feet, knees, or ankles pretty much any joint can be involved in the arthritis, Luk says.
Symptoms of psoriasis and psoriatic arthritis can flare or subside at different times, according to the American College of Rheumatology. Either condition can be mild, moderate, or severe for instance, you can have severe psoriasis and mild psoriatic arthritis, or vice versa. The disorders might target the same or different parts of the body you could have psoriasis lesions on your elbows, say, but no pain in your elbow joints. When the two conditions flare at the same time, one may be worse than the other, according to an overview published in the American Journal of Managed Care.
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How Bad Can Psoriatic Arthritis Get
Severe symptoms of PsA can affect your daily life. Untreated or severe PsA can cause permanent joint damage. Extended periods of inflammation can cause affected bones to erode, and the joint space may begin to narrow. All of these things will make it harder for you to move.
PsA is also associated with many different comorbid conditions that are indicators of disease progression.Comorbid conditions associated with PsA include cardiovascular disease, obesity, diabetes, and gastrointestinal inflammation. PsA can also shorten life expectancy and lead to a decreased quality of life.
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.
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Diagnosing Psoriasis And Psa
Unfortunately, theres no one simple diagnostic test to check for psoriasis or psoriatic arthritis. This means your doctor will need to make a clinical diagnosis, which requires taking into account your symptoms, risk factors, as well as the results of bloodwork and X-rays or other imaging scans to assess any joint involvement.
During the physical exam, your doctor might look for signs of psoriasis on the elbows and knees as well as less visible places like the scalp, belly button, intergluteal cleft, palms of hands, and soles of feet. Theyll also check for any fingernail or toenail abnormalities, like pitting or ridging, as well as swollen fingers or toes .
The presence of dactylitis and finger and toenail changes are evidence of psoriasis that can be used to aid in the diagnosis of psoriatic arthritis if there is no evidence of skin disease, says Dr. Haberman.
Here are some common steps used to diagnose psoriasis and PsA:
- A medical exam to discuss family history, risk factors, and symptoms
- Blood tests to check for markers of inflammation and antibodies , which can help rule out other types of arthritis, including rheumatoid arthritis
- Imaging tests to detect any joint damage, dislocation of small or large joints, disfiguration , new bone formation, and inflammation in the enthesis
- Skin biopsy of a skin plaque, if you have previously undiagnosed psoriasis