Why Does Psoriatic Arthritis Make You Tired
Studies show close to 80% of people with psoriatic arthritis have some degree of fatigue. When you have this disease, your body makes proteins called cytokines that cause inflammation. They make your joints swell and become painful or stiff. These proteins may also cause fatigue, although doctors arent sure why.
Does psoriatic arthritis show up on xray? Experts note that an X-ray may not show the early signs of PsA, as there may be no visible changes to bones. As PsA advances, an X-ray can show that bones are becoming damaged and changing shape.
What happens if psoriatic arthritis goes untreated?
If left untreated, psoriatic arthritis can cause permanent joint damage, which may be disabling. In addition to preventing irreversible joint damage, treating your PsA may also help reduce inflammation in your body that could lead to other diseases. These other diseases are often referred to as comorbidities.
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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.
Early Diagnosis And Appropriate Treatment
Now the good news: treatment has come a long way in recent years.
There are a number of good treatment paradigms for psoriatic arthritis, and the likelihood of severe deformity like there was in the past is close to zero with the new therapies we have, Hylland says.
There are also effective treatments for managing rheumatoid arthritis. And while its possible to have both psoriatic arthritis and rheumatoid arthritis at the same time, that wont necessarily complicate your treatment plan.
The initial treatments are the same for both, says Bauer, noting that tumor necrosis factor inhibitors work well for both types of arthritis, especially for people who cant take methotrexate, which is another first-line treatment.
Another med that can be used to treat either RA or psoriatic arthritis is a Janus kinase inhibitor, or JAK inhibitor, like tofacitinib. This type of drug interrupt your immune systems urge to overproduce lots of inflammation-causing proteins called cytokines. They may work better for you than other kinds of drugs and they have the bonus of being available in pill form, rather than an injection or infusion.
With either condition, its crucial that you dont ignore the symptoms until they become very severe. Early diagnosis is critically important for slowing the progression of these diseases.
The earlier we catch it, the less we have to do to quiet itthe less medication we have to use it quite it, says Hylland.
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What Are Some Psoriatic Arthritis Causes Versus Rheumatoid Arthritis Causes
You may search through your family tree looking for a hereditary link to these conditionsbut is rheumatoid arthritis genetic? What about psoriatic arthritis? We wish the answers were clearer: There isnt a single gene that we could test to determine if a person has psoriatic or rheumatoid arthritis, or that they will go on to develop those conditions, Maureen Dubreuil, M.D., assistant professor of medicine at Boston University School of Medicine and rheumatologist at Boston Medical Center, tells SELF.
Although there isnt a single rheumatoid arthritis gene, some people who were born with genes called human leukocyte antigens are more likely to develop rheumatoid arthritis.4 The presence of these genes has also been linked to more severe symptoms, according to the CDC, although its not fully understood why. And while genes likely set the stage for rheumatoid arthritis, they dont necessarily act alone. Theres probably some genetic increased risk, and then some trigger causes the disease to become active, Dr. Edens says. Possible environmental triggers include things like cigarette smoking and air pollution, and certain occupational hazards, research shows.5
Treatment Options For Ra And Psa
Because of the differences in disease pathogenesis, clinical manifestations and response to therapy between RA and PsA, treatment strategies may differ. provides a summary of current Food and Drug Administration -approved treatments for RA and PsA. Agents targeting more upstream factors are effective in both PsA and RA, while agents targeting more downstream cytokines are more disease-specific, demonstrating significant efficacy in either RA or PsA , but not in both diseases.
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How Do Ra And Psa Affect You
When you have RA, your immune system attacks the lining of the tissues around your joints. They swell up and become painful. Over time, they can become damaged and deformed.
With PsA, your immune system attacks and damages not just your joints, but your skin, as well. It causes your body to make too many skin cells, which leads to psoriasis, a skin condition that often affects people with PsA.
How Women Experience Psoriatic Arthritis
shows up at near equal rates in women and men, however, women experience different disease activity compared to men, experts say. Men tend to present with more axial symptoms , while women have more symmetrical polyarthritis , says Samira Chowdhury, M.D., a rheumatologist at NYU Langone in Patchogue, NY. And even though the disease shows up more often on X-rays for men, women tend to have a tougher time with PsA symptoms than men do. Results of a 2022 survey published in the Journal of Rheumatologyshowed that women with PsA reported worse quality of life, greater disability, and more work impairment compared to men. In another study that explored gender differences in PsA, women had higher disease activity, more tender or swollen joints, worse patient-reported symptoms, were less likely to work full time, and were more likely to have a diagnosis of depression compared to their male counterparts. According to one of the lead researchers of the study, Philip Mease, M.D., a rheumatologist and clinical professor at the University of Washington in Seattle, Even at baseline before treatment, we found women were worse off with more pain and more fatigue with PsA. Women also tend to have less response than men to treatment, he adds.
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Pharmaceutical Treatments For Ra And Psa:
- Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen
- Corticosteroids like prednisone
- Disease-modifying anti-rheumatic agents like methotrexate and hydroxychloroquine
- Biologics, a more advanced type of DMARD that can stop or slow inflammation these include Tumor Necrosis Factor- inhibitors and interleukin inhibitors
How Much Alcohol Is Safe
The benefits in these studies were only seen with moderate drinking. Itâs never a good idea to drink too much. For women, experts say that one drink a day is usually safe. A drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor. For men, itâs usually safe to have two drinks a day.
If you donât drink or drink very little, experts say you shouldnât start or drink more because you think it may be good for you. But if you have RA and you like to relax with an alcoholic drink, you probably donât need to stop.
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Rheumatoid Arthritis Symptoms Versus Psoriatic Arthritis Symptoms
Rheumatoid arthritis tends to be a more symmetrical inflammatory disease, meaning the same joints on both sides of your body are likely to be affected. According to the CDC, you might experience the following symptoms of rheumatoid arthritis:
- Smaller joints may hurt first: Pay close attention to your wrists, fingers, and toes. As rheumatoid arthritis progresses, your larger joints can become affected.
- Pain and stiffness in the same joints: Tenderness and swelling can become worse when you move. For example, you may have pain in both of your knees or both of your wristsnot just one knee. Sometimes, your pain can be so severe that you have trouble tying your shoes, brushing your hair, or getting out of bed. You may feel especially stiff and in pain when you wake up.
- Firm lumps: These are called rheumatoid nodules, and they typically form around joints like your elbows, notes the Mayo Clinic, but can pop up anywhere in the body.
- Feeling especially tired or weak: This fatigue can get to the point where you need to nap midday or feel like you cant function as you normally can.
- Fever: This can happen occasionally due to the bodys immune response.
- Unintentional weight loss: Experts theorize this happens because proteins called cytokines, which are involved with rheumatoid arthritis inflammation,8 may also affect your metabolism and cause your muscles to break down.9 You may also just have a hard time preparing your meals, so you may eat less than you normally would.
Signs And Symptoms Of Psoriatic Arthritis
In psoriatic arthritis, the joints affected may become tender, swollen and stiff. These symptoms tend to be worse first thing in the morning and with rest, and ease with exercise. Inflammation of tendons without obvious inflammation of the joints can also occur in psoriatic arthritis, which makes it easy to misdiagnose as tendonitis or tennis elbow, for example. Psoriatic arthritis commonly affects the small joints of the hands and feet, and so a swollen sausage-like finger or toe is another common sign.
- Stiffness, pain, throbbing, swelling and tenderness in one or more joints
- Swollen sausage-like finger or toe
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Lupus Vs Rheumatoid Arthritis
If you test positive for ANA, your doctor may order the AVISE CTD, a blood test that can confirm lupus and other autoimmune diseases such as rheumatoid arthritis, Sjogrens syndrome, or scleroderma.The AVISE test measures the lupus biomarkers called cell-bound complement activation products . 1-3 Anti-dsDNA antibody
What Causes Psoriatic Arthritis
The genes you inherit from your parents and grandparents can make you more likely to develop psoriatic arthritis. If you have genes that put you at risk of this condition, the following may then trigger it:
- being overweight
There is also an element of chance, and it might not be possible to say for certain what caused your condition.
Psoriasis and psoriatic arthritis are not contagious, so people cant catch it from one another.
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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 donât work
- Biologic medicines to ease inflammation
- Vitamins and minerals such as calcium and vitamin D to slow bone deformation
Other treatment may include:
Treatment Recommendations And Guidelines For Management Of Psa
Table 1 Pro-inflammatory cytokines associated with disease pathogenesis of PsA, RA, and OA
For patients with an inadequate response to TNFis and other bDMARDs, tsDMARDs are increasingly recommended for patients with PsA and RA . The efficacy of JAK inhibition in PsA has been established for patients with inadequate response or intolerance to csDMARDs and has been reported to significantly improve physical function, psoriasis, enthesitis, and dactylitis related to PsA . Similarly, inhibiting PDE4 has been reported to significantly improve signs and symptoms of PsA and patient-reported outcome measures with sustained response up to 5 years regardless of prior bDMARD experience however, inhibition of radiographic progression is not established with PDE4 inhibition . tsDMARDs effectively improve clinical manifestations, disease activity, and patient-related outcome measures of RA compared with csDMARDs, although greater improvements are achieved when administered in combination with csDMARDs . While efficacy of tsDMARDs has been recognized for both diseases, it is still important to differentiate PsA from RA for the consideration of tsDMARD treatment since some agents have not been thoroughly studied in PsA and may not be as effective as in RA. Although PsA, RA, and OA have various overlapping clinical manifestations, variations in underlying pathogenesis and response to therapy translate into significantly varying clinical outcomes.
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How Are Psa And Rheumatoid Arthritis Similar Yet Different
Psoriatic arthritis and rheumatoid arthritis are autoimmune diseases, in which the immune system mistakenly attacks healthy cells, causing swelling, pain, and stiffness in the joints.
Psoriatic and rheumatoid arthritis are similar but separate diseases, sometimes with manifestations that look quite similar, says , the director of the rheumatology clinic at Stanford Health Care in Palo Alto, California. In general, the two diseases do not coexist together.
Dr. Genovese points out, however, that during the months or even years when the arthritis is first developing, the type of arthritis a patient has may be unclear.
One of the features that distinguishes psoriatic arthritis from rheumatoid arthritis is dactylitis, according to Jason Faller, MD, a rheumatologist at Lenox Hill Hospital in New York City. With this condition, fingers or toes swell and take on a sausage-like appearance.
Enthesitis, or inflammation of the areas where ligaments or tendons enter into the bones, is also a characteristic of psoriatic arthritis that does not occur in rheumatoid arthritis or osteoarthritis.
As many as 30 percent of individuals who have psoriasis develop psoriatic arthritis, according to the National Psoriasis Foundation. Signs of the condition, such as red, scaly skin, can help doctors differentiate PsA from RA.
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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Can Psoriatic Arthritis Attack Other Organs Of The Body
Apart from the skin, nails and joints, increased cardiovascular morbidity is considered part of psoriatic disease, as is the association with inflammatory bowel disease. An itchy, red eye due to conjunctivitis is more common in people with psoriatic arthritis and some people occasionally develop a painful, red eye caused by inflammation around the pupil of the eye, which is called iritis or uveitis. Anaemia may also be found but this is the result of long-term inflammation and is not a specific feature of psoriatic arthritis.
Treatments For Your Skin
If your psoriasis is affecting your quality of life, or your treatment is not working, you may be referred to a dermatologist.
There are a number of treatment options for psoriasis.
Ointments, creams, and gels that can be applied to the skin include:
- ointments made from a medicine called dithranol
- steroid-based creams and lotions
- vitamin D-like ointments such ascalcipotriol and tacalcitol
- vitamin A-like gels such astazarotene
- tar-based ointments.
For more information about the benefits and disadvantages of any of these talk to your GP, dermatologist, or pharmacist.
If the creams and ointments dont help, your doctor may suggest light therapy, also known as phototherapy. This involves being exposed to short spells of strong ultraviolet light in hospital.
Once this treatment has started, youll need to have it regularly and stick to the appointments youve been given, for it to be successful. This treatment is not suitable for people at high risk of skin cancer or for children. For some people, this treatment can make their psoriasis worse.
Retinoid tablets, such as acitretin, are made from substances related to vitamin A. These can be useful if your psoriasis isnt responding to other treatments. However, they can cause dry skin and you may not be able to take them if you have diabetes.
Some DMARDs used for psoriatic arthritis will also help with psoriasis.
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Is There A Typical Psoriatic Arthritis
Eighty-percent of the time, psoriasis symptoms appear first. However, in some patients, the psoriasis is barely even perceptible. Or only the nail tissues may be affected.
Like RA, PA symptoms can vary greatly between patients. Psoriatic Arthritis may be symmetrical or asymmetrical. The spine and sacroiliac joints may or may not be involved. Fingers and toes may swell into a sausage-shaped deformity called dactylitis. A very destructive hand deformity called arthritis mutilans is caused by destruction of joint tissue.
Getting To The Bottom Of A Psoriatic Arthritis Diagnosis
Getting a proper PsA diagnosis depends on so many things, including seeing a savvy provider who spends the time to take a comprehensive medical history. The history is really definitive, explains Dr. Domingues.
That means a doctor will probably ask you if you have or ever had psoriasis. This is the time to mention any itchy, flaky spots, even if youve always thought you just had dry skin. The provider should also ask about any first-degree family members a sibling or parent who might have had psoriasis, because you can be diagnosed with PsA with a family history of the condition, Dr. Haberman explains.
The doctor will also examine your nails and toenails because they can be affected by psoriasis, even though its not obvious. Some signs include nails that are pitted or have ridges, are discolored or look theyre crumbling and separating from the nail bed.
Then the doctor will ask you about your joint pain as well as do a thorough physical examination. Blood tests can reveal inflammatory markers and X-rays and other imaging tests can show joint damage and inflammation in the joint.
If you are having any aches and pains and you think or know you have psoriasis, dont write off your symptoms. Instead, ask your provider to refer you to a rheumatologist, which is the best type of provider to determine if you have PsA or another condition.
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