Is Widespread Pain More Common In Psa Patients Than Expected
The findings indicate that, widespread and extra-articular pain was present in PsA patients, showing that this non-articular pain could contribute to an important aspect of this challenging and multifaceted disease, the authors wrote.
In other words, psoriatic arthritis patients may have pain that is unrelated to joint pain and swelling, which could require different treatment approaches in addition to disease-modifying antirheumatic drugs taken to control inflammation.
That said, there are some limitations to this recent study. Since disease activity scores factor in subjective measures, including perceived pain, the authors noted that patients might overestimate or underestimate a patients disease. Additionally, the researchers did not account for possible confounding factors that might increase pain, such as depression.
Finally, given this studys small size, more research on the subject is warranted. In the meantime, the researchers wrote that, a more detailed pain evaluation may be useful for the management of PsA.
Its important to be as detailed as possible when describing your pain symptoms to your doctor. This can help them determine whether your pain may be due to inflammation related to psoriatic arthritis disease activity, a widespread pain condition like fibromyalgia, or other issues.
Points To Remember About Psoriatic Arthritis
- Psoriatic arthritis causes swelling and pain in joints and the places where tendons and ligaments attach to bones.
- Most people who get psoriatic arthritis already have the skin disease psoriasis.
- Although there is no cure for psoriatic arthritis, treatments can slow its progress, lower pain, and protect the joints.
- You can do things at home to help you live with the condition, such as maintain a healthy weight, do low-impact exercise, and avoid smoking.
How Does It Affect Cartilage
In arthritis, the cartilage at the end of the bones becomes damaged and breaks down. In PsA, this damage results from persistent inflammation. As the cartilage erodes, the bones rub together, causing further pain and joint damage. Inflammation can also lead to bone erosion and extra bone growth.
Chronic inflammation can also affect the ligaments and tendons around the joint.
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When To Seek Medical Advice
You should speak to your GP if you experience constant pain, swelling or stiffness in your joints even if you haven’t been diagnosed with psoriasis.
If you have been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let your doctor know if you’re experiencing any problems with your joints.
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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Can Imaging Exams Detect Arthritis
Imaging exams can help your healthcare provider get a clear picture of your bones, joints and soft tissues. An X-ray, MRI or ultrasound can reveal:
- Bone fractures or dislocations that may be causing you joint pain.
- Cartilage breakdown around your joints.
- Muscle, ligament or tendon injuries near your joints.
- Soft tissue inflammation.
Psoriatic Arthritis Patients With Moderate And High Disease Activity Had Worse Widespread Pain Which Could Have An Impact On How To Best Treat Pain And Disease Activity
One of the main symptoms of psoriatic arthritis is joint pain and stiffness, particularly in the hands and feet. But a new study suggests that widespread pain might be more common among PsA patients than previously realized.
The study, published in the Journal of Rheumatology, included 50 PsA patients, as well as 50 people with fibromyalgia who were used as control subjects. The researchers, who are based in Italy, asked participants to map the location and intensity of their pain by filling out a body chart. The researchers also recorded the PsA patients current disease activity level, based on the Disease Activity Index for PsA .
According to the findings, the fibromyalgia patients reported more pain overall. This is not unexpected, considering that fibromyalgia is a chronic widespread pain condition. But the researchers were surprised to find that 45 psoriatic arthritis patients reported areas of pain. Additionally, reports of widespread pain meaning pain in several different areas of the body was fairly common among PsA patients.
Researchers observed a correlation between the number of painful areas and disease activity scores. People with moderate or high disease activity scores had more painful areas.
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Depression: A Sadness You Cant Shake
People who have psoriatic arthritis often struggle with emotional distress theyre not prepared to deal with, according to a review published in January 2020 in the journal Acta Dermato-Venereologica.
Persistent sadness or hopelessness, withdrawing from your circle of friends, and loss of interest in activities you once enjoyed are potential symptoms of depression. Signs of depression are common in people who have psoriatic arthritis due to social withdrawal due to skin lesions and the inability to do the tasks they were previously able to do, Gupta says.
The severity of your psoriatic arthritis isnt necessarily related to your risk of developing depression or another mental health issue, he says, but if your psoriatic arthritis is well controlled, it may help with depression.
If youre experiencing symptoms of depression, be sure to talk to your doctor.
Neither Will Taking Deep Breaths Or Meditating
While your well-meaning yogi friend may think the cure for your symptoms is to practice a few asanas, try as you might, yoga is not a cure for psoriatic arthritis. However, it may alleviate stress, and stress can worsen symptoms and bring on a flare. Yoga can also help ease pain and increase mobility, according to the National Psoriasis Foundation . So if you find the practice relaxing and beneficial, go for it!
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What Are Options For Pain Management
Minor pain and stiffness of mild PsA can be alleviated with non-steroidal anti-inflammatory drugs . In addition, injections of corticosteroids may be used.5
For moderate to severe disease, treatments that target joint disease in PsA frequently can reduce symptoms and prevent disease progression. Recommended treatments include disease-modifying anti-rheumatic drugs .
The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor , a chemical that produces a wide range of inflammation in PsA.
Examples of TNF blockers include etanercept , adalimumab , infliximab , golimumab , and certolizumab pegol . Other DMARDs that have proven effective in clinical trials include ustekinumab Stelara), and secukinumab .1
The FDA has also recently approved Inflectra , a biosimilar to infliximab, for the treatment of psoriatic arthritis.7Physical and occupational therapy can be critical treatment approaches to both protect the involved joints and maintain function.5
Fatigue: A Common Problem That Can Worsen Pain
People who have psoriatic arthritis report higher levels of fatigue than those without the condition, according to a study published in January 2020 in the journal Dermatology. Psoriatic arthritis is a systemic inflammatory condition, Gupta says. Left untreated, it can result in fatigue and a general feeling of sickness. It can also result in anemia due to prolonged inflammation.
Unchecked fatigue can worsen your pain and vice versa, so talk to your doctor about adding pain management and sleep strategies to your psoriatic arthritis management plan.
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Changing Your Diet Wont Cure Psoriatic Arthritis
There is no known cure for psoriatic arthritis, and making dietary changes like going paleo or gluten free isn’t a remedy. The good news, however, is that a healthy diet with plenty of anti-inflammatory fruits and vegetables that’s low in fats and sugars can help keep psoriatic arthritis symptoms under control. Also try to steer clear of dairy and caffeine, which may aggravate psoriatic arthritis symptoms, says Dr. Markenson.
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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Psoriatic Arthritis Is Not Just A Different Kind Of Rheumatoid Arthritis
Autoimmune disorders are among the trickiest types of conditions to diagnose, and psoriatic arthritis is no exception. There arent any blood tests that can identify this form of arthritis, which causes inflammation of the joints, skin, and nails.
To complicate matters, some doctors dont always consider a diagnosis of psoriatic arthritis because they may be looking for joint symptoms associated with rheumatoid arthritis.
One of the most common misconceptions about psoriatic arthritis is that its a combination of rheumatoid arthritis and psoriasis, which isnt the case, says Alexis Ogdie, MD, MSCE, a rheumatologist in Philadelphia and director of the Penn Psoriatic Arthritis Clinic. Psoriatic arthritis and rheumatoid arthritis do share some symptoms, but psoriatic arthritis is a different disease with symptoms you wouldnt see in people with RA.
Here, she shares the signs the doctors should be looking for when considering a diagnosis of psoriatic arthritis.
Psoriatic Arthritis And Back Pain
Learn more about axial arthritis or spondylitis, which causes back pain and may affect your treatment for PsA.
When you think of psoriatic arthritis , you may imagine skin symptoms or the commonly affected joints, like the fingers, knees, ankles or elbows . However, for many people with the disease, back pain can become a symptom as well. When the spine is affected, its known as axial arthritis or spondylitis. Spondylitis affects the spine and sacroiliac joints, which are located at the bottom of the back.
Who Does Spondylitis Affect?
Many people with PsA have axial arthritis and most of them will have a mix of peripheral and axial arthritis. A much smaller number of people with PsA can have inflammation primarily in the axial area without peripheral symptoms.Axial involvement is usually a late-onset feature of PsA, but not always. Studies show that most PsA patients with spondylitis can have back symptoms for up to 10 years before diagnosis is made.Other symptoms of PsA that people with axial disease may have include inflammation where ligaments and tendons insert into bones inflammation of an entire finger or toe skin disease pitting and lifting of nails from the nailbed eye inflammation and inflammatory bowel disease .Since the treatment for PsA with axial involvement may be different than for PsA with only peripheral symptoms, it is important to know the signs and talk to your doctor about your back pain.
Mechanical Pain vs. Inflammatory Back Pain in PsA
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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.
How Does This Condition Affect The Tendons & Ligaments
Enthesitis occurs in up to 50% of people with PsA.4 Symptoms of PsA in the tendons and ligaments include pain and inflammation. When enthesitis affects the heel of the foot, it is known as Achilles tendonitis.
At the bottom of the foot, enthesitis can cause plantar fasciitis. Enthesitis can also occur in the fingers, toes, pelvis, knees or upper body.5,6
PsA can be asymmetrical, occurring on only one side of the body. For example, all the joints in one finger on the left hand may be affected while the same finger on the right hand is unaffected. PsA can also be symmetrical, with the same joints affected on both sides of the body.2
PsA and enthesitis are chronic and can have periods of remission and flares.6
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Cardiovascular Warning Signs: Chest Pain Weakness
People who have psoriatic arthritis are more likely to die from cardiovascular problems, such as stroke or heart attack, according to both the NPF and a review published in January 2020 in the journal Joint Bone Spine.
Know the warning signs of a heart attack, which include discomfort or pain in the chest, extreme fatigue, shortness of breath, and pain in the upper body, according to the National Heart, Lung, and Blood Institute. Stroke warning signs include drooping on one side of the face, arm weakness , and difficulty speaking, notes the American Stroke Association.
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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Impact Of Psa In The Shoulder
MyPsoriasisTeam members describe psoriatic arthritis pain in the shoulder and the way it affects their lives.
One noted, I hurt like hell. My hip and shoulder make life a struggle, but I’m still here. Another shared that they have PsA pain in their shoulders and between their shoulder blades: Im in agony with it. I need some relief. Its hard to lie down.
As this member pointed out, PsA pain in the shoulder can also affect your ability to sleep, as putting pressure on the joint can be painful. Another member shared their experience with this: Im having a terrible time using my arm and shoulders and trying to sleep on my sides. The pain is killing my shoulder. Another wrote, My shoulder is in agony. Its hard to lie down.
What Are The Symptoms Of Psoriasis
There are different types of psoriasis. The most common is chronic plaque psoriasis. This causes patches of red, raised skin, with white and silvery flakes.
It can occur anywhere on the skin, but most commonly at the elbows, knees, back, buttocks and scalp.
Psoriasis can cause small round dents in finger and toe nails, this is known as pitting. Nails can also change colour, become thicker and the nail may lift away from your finger.
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Who Is At Risk For Psoriatic Arthritis
Psoriasis affects 2-3 percent of the population or approximately 7 million people in the U.S. and up to 30% of these people can develop psoriatic arthritis. Psoriatic arthritis occurs most commonly in adults between the ages of 35 and 55 however, it can develop at any age. Psoriatic arthritis affects men and women equally.
It is possible to develop psoriatic arthritis with only a family history of psoriasis and while less common, psoriatic arthritis can occur before psoriasis appears. Children of parents with psoriasis are three times more likely to have psoriasis and are at greater risk for developing psoriatic arthritis. The most typical age of juvenile onset is 9-11 years of age.
Can I Get Financial Support
Many people worry about what happens if they cannot work or need financial help because of the effects of psoriatic arthritis. Fortunately for many, with good therapy and management the condition can be controlled and allow for a full and active working life. But if you do find that even for a short period of time you are likely to need help, visit the national government websites online. If it is easier, contact your local government or council office, where you should be directed to the appropriate resource and information.
Always consult your doctor or healthcare provider.
This article is adapted from the What is Psoriatic Arthritis? leaflet.
Other leaflets are also available to or order FREE from our shop and include the following:
- About Us
- Occupational Therapy and Psoriatic Arthritis
- Physiotherapy and Exercise: Psoriatic Arthritis
- Psoriasis and Sensitive Areas
- Psoriatic Arthritis – Did you know?
- Psoriatic Arthritis – When to treat?
- Psoriatic Fatigue
- Treatments for Psoriasis: An overview
- Treatments for Psoriatic Arthritis: An overview
- What is Psoriasis?
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