How Will Psoriatic Arthritis Affect Me
Starting the right treatment as soon as possible will give you the best chance of keeping your arthritis under control and minimise damage to your body.
Psoriatic arthritis can vary a great deal between different people. This makes it difficult to offer advice on what you should expect.
It will usually have some effect on your ability to get around and your quality of life, but treatment will reduce the effect it has.
Psoriatic arthritis can cause long-term damage to joints, bones and other tissues in the body, especially if it isnt treated.
What Complications Are Associated With Sacroiliitis
Left untreated, sacroiliitis causes a loss of mobility for some people. Untreated pain also can disrupt your sleep and lead to psychological conditions like depression.
Sacroiliitis associated with ankylosing spondylitis can progress over time. Over time, this type of arthritis causes the vertebrae in your spine to fuse together and stiffen.
How Is Spinal Arthritis Diagnosed
Your doctor may use some or all of the following diagnostic methods to confirm spinal arthritis:
Medical history and physical exam
Blood tests for genetic markers and/or RA antibodies
X-rays of the spine to locate the arthritic joint
MRI, CT scan, myelography, bone scan and/or ultrasound to zero in on the damage, detect nerve and spinal cord involvement or rule out other causes
Joint aspiration: testing of the synovial fluid inside a joint
To pinpoint the painful joint, your doctor may numb it with an injection and check whether the pain goes away.
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Psoriatic Arthritis Vs Ankylosing Spondylitis
It may be difficult for a doctor to determine whether a person has psoriatic arthritis in the spine or ankylosing spondylitis. Both conditions cause pain and stiffness in the spinal joints.
Ankylosing spondylitis is a form of arthritis that mainly affects the spine, but it can develop in other joints. It causes inflammation and severe discomfort. In serious cases, new bone matter forms, fusing the bones in the spine and significantly limiting mobility.
To ensure correct diagnosis of psoriatic arthritis or ankylosing spondylitis, a person should see a rheumatologist. They will assess the personâs symptoms and take into account the family history and the results of imaging and blood tests when making a diagnosis.
Psoriatic arthritis in the spine can also develop in other areas, such as the hands and feet. Symptoms can range from mild to severe.
A person with this type of arthritis in the spine may experience any combination of the following symptoms:
- back pain that disrupts sleep
- pain that gets better with exercise and worse with rest
- pain with no known cause
- pain in the hips or buttocks
- skin issues, including scaly plaques that may be itchy
- reduced range of motion in the affected joints
- general fatigue
- joint stiffness, which may last for more than 30 minutes, after rest or in the morning
Symptoms of psoriatic arthritis can grow worse, then lessen or disappear for a time. Many people refer to a period of worsened symptoms as a flare.
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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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.
Sex Fertility And Pregnancy
Sex can sometimes be painful for people with psoriatic arthritis, particularly a woman whose hips are affected. Experimenting with different positions and communicating well with your partner will usually provide a solution.
Psoriatic arthritis wont affect your chances of having children. But if youre thinking of starting a family, its important to discuss your drug treatment with a doctor well in advance. If you become pregnant unexpectedly, talk to your rheumatology department as soon as possible.
The following must be avoided when trying to start a family, during pregnancy and when breastfeeding:
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What Are The Symptoms Of Spinal Arthritis
Symptoms of spinal arthritis may differ from person to person. In general, they may include:
Back and neck pain, especially in the lower back
Stiffness and loss of flexibility in the spine, such as being unable to straighten your back or turn your neck
Swelling and tenderness over the affected vertebrae
Feeling of grinding when moving the spine
Pain, swelling and stiffness in other areas of the body
Whole-body weakness and fatigue
Pain and numbness in your arms or legs if the nerves are affected
Although back pain is a common symptom, not all people have it, even those with advanced spinal arthritis. On the other hand, some may experience pain even before arthritis can be seen on an X-ray.
In certain types of spondyloarthritis, eye inflammation may occur, causing pain, watery eyes and blurred vision.
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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:
What Is An Autoimmune Disease
Autoimmune disease happens when the bodys natural defense system cant tell the difference between your own cells and foreign cells, causing the body to mistakenly attack normal cells. There are more than 80 types of autoimmune diseases that affect a wide range of body parts.
According to the classification criteria of the Assessment of SpondyloArthritis international Society , inflammatory back pain typically lasts for three months or more with an insidious or unknown onset, begins in patients at an age younger than 40, improves with exercise but gets worse with rest, and causes increased pain at night.
Mechanical back pain, however, can have an onset at any age, although it is more common in middle-aged and older individuals, can be acute from a specific event that causes an injury, and often feels worse with movement but improves with rest. These symptoms can result from injury or damage to the lower back muscles, tendons, ligaments, discs, joints, or vertebrae.
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What Does Psa In The Knees Feel Like
Many MyPsoriasisTeam members have shared how it feels to have PsA affect their knees. One MyPsoriasisTeam member wrote that their left knee was hot to the touch and that pain had spread to the area behind their knees. Another member with psoriasis and PsA commented, I dont know which is worse the knee pain or the psoriasis.
Some members have shared what its like to deal with a limited range of motion as a result of their PsA. One member, describing the stiffness they felt while walking, wrote: I felt like I was walking like a robot because my knees were so stiff and wouldnt bend right. This member added that although they made it through, they still experienced stiffness and some back-of-knee pain on one side the next day. Another member reported experiencing similar symptoms, writing: There are days my knees and legs lock up.
Many MyPsoriasisTeam members have expressed frustration while waiting to have surgery to help alleviate their symptoms. As one member wrote, The pain in my knees is getting worse every day. Im not sure how much longer I can keep putting off knee replacement surgery. I was told a year ago that was pretty much my last option.
Limitations Of Identification Criteria And Measurement Of Ibp And Mbp
The current standard ASAS criteria used to identify IBP are limited by sensitivity and specificity the reported sensitivity would result in 23% of IBP cases not being identified in patients with chronic back pain . Identification of IBP by MRI is limited by low specificity . Many patients with non-SpA, including healthy individuals, show evidence of sacroiliitis when the sacroiliac joint is examined for lesions . Limitations of MRI include the subjectivity and variability of the radiologist/rheumatologist examining the scan results for signs indicating inflammation, often in terms of confidence levels rather than a simple yes or no . Signs and symptoms of MBP differ across guidelines, and little consensus or evidence exists about which are clinically relevant .
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Medical Writing And Editorial Assistance
The authors thank Kheng Bekdache, PhD, and Eric Deutsch, PhD, CMPP, of Health Interactions, Inc, Hamilton, NJ, USA, for providing medical writing support/editorial support, which was funded by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, in accordance with Good Publication Practice guidelines .
When To Speak With A Doctor
A person should speak with a doctor when they are experiencing any form of chest pain, regardless of whether they have a PsA diagnosis already. They should also speak with a doctor if they have PsA symptoms, such as painful joints or scaly patches of skin.
It is important to call 911 or the number of the nearest emergency department straight away if the following symptoms occur:
- severe chest pain
- a feeling of tightness, squeezing, or pressure in the chest
- difficulty breathing
- pain in the arms, jaw, neck, upper back, or stomach
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Appropriate Screening For Back Pain In Psa
Back pain is one of the most common reasons for physician visits globally and the most costly in terms of healthcare provider visits , leading to significant direct medical costs and indirect societal costs arising from absenteeism, presenteeism, disability, and workers compensation claims . Because back pain has many different causes that can present with similar symptoms, it can be difficult to identify its fundamental pathological features during musculoskeletal evaluation . Back pain is very common in the general population approximately 80% of people experience it in some form at least once in their lifetimes . Most chronic back pain episodes are reported to be mechanical in nature. Nonmechanical causes may include those being of rheumatologic, vascular, gastrointestinal, renal, infectious, or oncologic origin .
Back pain can impair productivity, which influences long-term profitability . In a 4-year review of presenteeism data among employees of a large US healthcare system, chronic back pain ranked among the highest for minutes of daily productivity loss and annual cost per person . Low back pain with or without lower extremity pain is one of the most common reasons for physician visits, and treatment costs remain a significant burden on healthcare resources . In a recent US study, the total cost of care over 12 months after diagnosis was $1.8 billion among patients with low back pain with or without lower extremity pain and not undergoing surgery .
Symptoms Of Psoriatic Arthritis
Effects of psoriatic arthritis may include:
- Heat in the joints of the body
- Organ inflammation
- Breakage, holes, discoloration, and other problems in finger and toenails
- Heart complications
- Grayish spots of parts of the body
- Early morning stiffness in the bodys joints
- Acne breakouts
- Difficulty breathing
These symptoms can be very painful and damaging to the body. Sufferers are encouraged to seek pain treatment as soon as possible for psoriatic arthritis and other pain types. Pain rehab at a pain treatment center may be an effective way to begin this pain treatment.
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Is There A Cure
Although there is currently no known cure, there are treatments and medications available to reduce symptoms and manage the pain and inflammation caused by PsA.
The most common medications for PsA are often also used to treat ankylosing spondylitis, including nonsteroidal anti-inflammatory drugs , disease-modifying antirheumatic drugs , sulfasalazine , immunosuppressants, and biologic medications, such as TNF inhibitors.
Exercise is essential for preserving strength and maintaining range of motion in patients with PsA. Isometric exercises, which contract muscles without joint motion, may be less damaging to inflamed joints. Physical and occupational therapy may greatly help patients maximize the function of arthritic joints.
Patients should consult with their physician to determine which of these treatments is most appropriate for their condition.
While PsA can certainly affect an individuals quality of life, the symptoms of the disease can be managed effectively. Paying attention to symptoms of the disease and addressing them as soon as they arise are important in achieving positive outcomes.
How Arthritis In The Back Is Diagnosed
Diagnosing arthritis in the back begins with taking your medical history and doing a physical exam of your back and legs to assess your mobility/flexibility and make sure your nerves are working properly. The doctor will ask questions about:
- Where the pain is occurring
- How long the pain has lasted
- What the pain feels like/how severe it is
- What situations/activities make the pain feel better or worse
- How the pain is affecting/limiting your daily function
Imaging tests are usually needed to help confirm a diagnosis of arthritis. X-rays are typically the first imaging test ordered. They can joint damage/bone spurs, but cannot show damage to soft tissues such as muscles, ligaments, or bulging discs. Other tests may be ordered to look for changes or damage that is not visible on X-rays. These may include MRI, CT, ultrasound, bone scans, or other tests as needed. The gold standard to diagnose arthritis in the back is actually an injection called a medial branch block, but its not often necessary, says Dr. Kirschner.
If your doctor suspects you could have a type of inflammatory arthritis, they may order blood tests to look for signs of inflammation, such as C-reactive protein or erythrocyte sedimentation rate.
Other blood tests may look for genetic markers associated with axial spondyloarthritis, such as HLA-B27, or antibodies associated with rheumatoid arthritis .
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Swollen Fingers Or Toes
PsA may begin in smaller joints, such as those of the fingers or toes, and progress from there.
Spondylitis may be accompanied by dactylitis, or swelling of the toe or finger joints. This is sometimes called sausage fingers.
Dactylitis is estimated to affect up to 50 percent of patients with PsA, and is uncommon in other types of arthritis, except gout or pseudogout.
When caused by PsA, dactylitis may affect individual digits differently. For example, your left hand may be swollen while your right is not.
Unlike other types of arthritis, PsA tends to make your entire finger or toe appear swollen, rather than just the joint.
People with PsA may experience eye problems, such as inflammation and redness. Symptoms of eye inflammation include:
- red eyes
- dry eyes or feeling of grit or sand in the eyes
- difficulty focusing or blurred vision
- pain or sensitivity, especially to bright light
- floaters, or small specks, lines, or other shapes in your field of vision
If you develop new or large floaters along with flashing lights in your field of vision, it may be a sign of a medical emergency. Seek immediate treatment from a qualified medical professional.
You may also experience uveitis, or inflammation of the middle layer of the eye called the uvea. Between 7 and 25 percent of people with PsA develop uveitis.
Symptoms of uveitis include:
Causes Of Psoriatic Arthritis
Almost 1 in 3 people with psoriasis also have psoriatic arthritis.
It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms.
Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue.
But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not.
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Treating And Managing Psa In The Knees
Its important to let your health care provider know if you experience signs and symptoms of psoriatic arthritis in one or both knees. Studies have shown that even a six-month delay in diagnosis or starting medication after first noticing psoriatic arthritis symptoms can have an impact on the effectiveness of treatment.
Being diagnosed with PsA may involve X-rays or blood tests along with a thorough exam of your joints. After your doctor has determined that psoriatic arthritis is the cause of your knee pain, they will work with you to find the right treatment or combination of treatments for your condition.
Treatment of psoriatic arthritis usually aims to reduce inflammation and provide relief for painful joints. Your health care team may prescribe or recommend the following treatments for your PsA-related knee symptoms.