Who Will Be Responsible For My Healthcare
Youre likely to see a team of healthcare professionals.
Your doctor, usually a rheumatologist, will be responsible for your overall care. And a specialist nurse may help monitor your condition and treatments. A skin specialist called a dermatologist may be responsible for the treatment of your psoriasis.
You may also see:
- a physiotherapist, who can advise on exercises to help maintain your mobility
- an occupational therapist, who can help you protect your joints, for example, by using splints for the wrist or knee braces. You may be advised to change the way you do some tasks to reduce the strain on your joints.
- a podiatrist, who can assess your footcare needs and offer advice on special insoles and good supportive footwear.
Will Drug Treatments For Psoriatic Arthritis Make My Psoriasis Worse
Some drug treatments may make psoriasis worse, but then again, some can also make it better too. Before you start any treatments offered, discuss this both with your dermatologist and rheumatologist. DONT FORGET to politely request that both consultants let each other know of your treatment regimes, this helps both of them evaluate your treatment and any side effects that you may be likely to experience. Some people find that when their psoriasis is bad their arthritis is also bad and as one improves, so does the other. This most often occurs when the skin and joint disease start simultaneously. Some of the arthritis treatments also help the skin and this is can help the doctors decide which is the best drug to use.
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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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.
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.
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.
Non-alcoholic fatty liver disease
Take Special Care With Your Scalp
Itâs fine to color your grays. But be careful. Even if you donât have plaques on your scalp, itâs smart not to shampoo your hair 1 or 2 days before and after dyeing it. This lets your hairâs natural oils protect your scalp and helps prevent irritation that could cause a flare.
âBe sure to use any topical medications your doctor prescribes before and after dyeing so your scalp stays in the best shape it can,â says Lipner.
Ask your stylist to shampoo and style your hair gently. If youâre in the middle of a flare or are especially sensitive, think about going with highlights or lowlights instead. They can be put on with foil, which keeps hair dye from getting on your scalp.
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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
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.
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What Are The Possible Complications Of Psoriatic Arthritis In A Child
Children with psoriatic arthritis are at risk of having an eye condition called uveitis. This is an inflammation of the eyes middle layer.
With early diagnosis and treatment, children can go into remission. This means that symptoms go away. But when treatment is delayed, remission is less likely. Then the condition may lead to long-term disability.
How Can I Find The Appropriate Care I Need
Initially your GP is the first point of contact, who then should refer you on to a dermatologist/rheumatologist, if this is not already the case. If you are not happy with the advice you receive, remember you are always entitled to seek a second opinion. Remember, If you are seeing a dermatologists for your psoriasis and a rheumatologists for your arthritis make sure each is aware of this, so they can liaise and provide you with appropriate care for both conditons.
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How Psoriatic Arthritis And Rheumatoid Arthritis Differ
Psoriatic arthritis and rheumatoid arthritis are both autoimmune diseases that affect the joints. Both are inflammatory and progressivecausing joint stiffness, pain, and swelling, as well as persistent fatigue. In addition, both occur in flares and can be treated with medications that suppress the immune system.
However, PsA and RA are different diseasesand the differences are important when it comes to their prognosis and the best approach for managing each condition.
With PsA, the joint symptoms are tightly linked to inflammation of the skin from psoriasis . With RA, the immune system primarily targets joint tissue.
The different underlying disease processes mean that the conditions are diagnosed with different methods and they also require different therapeutic approaches.
You May Have Concerns About Starting A Family When You Have Psoriatic Arthritis
Because there are a significant number of younger people with psoriatic arthritis, its not unusual to see patients who are at least starting to think about family planning, notes Snyder.
Thats a big conversation my husband and I are having right now, says Meleney. We discuss how my pregnancy may impact my arthritis and managing it while also being a parent.
While it may not be a fun conversation to have, she believes that talking through how psoriatic arthritis will impact different aspects of life including having a family can help make those things easier to manage.
Its also important to include your doctor in discussions around family planning, says Snyder. There are some medications that can present a problem with pregnancy, and so those would need to be changed. It just takes a little bit of thought and preparation, but its certainly possible, she says.
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You May Wonder About Your Psoriatic Arthritis Treatment Choices
If a person in their twenties gets a diagnosis of psoriatic arthritis, treatment will depend on a number of factors, including the degree of arthritis at time of diagnosis, as well as the preference of the patient.
Over-the-counter or prescription strength nonsteroidal anti-inflammatory drugs , such as ibuprofen and aspirin, can help reduce pain and swelling. These medications can be a good option for a patient with mild disease without any preexisting conditions to limit use, such as elevated blood pressure, kidney disease or acid reflux, Snyder notes.
For people with more severe arthritis thats limiting function or is destructive, its more likely that they would be prescribed a disease modifying anti-rheumatic drug , which can help slow joint damage and the progression of the disease. An argument could also be made to start a DMARD in patients with mild disease as an attempt to prevent progression of their arthritis, says Snyder.
Doctors often consider several factors when making the recommendation for DMARD therapy, which include:
- Severity of symptoms
- Level of pain or discomfort
- Functional impairment
- The presence or absence of joint swelling or deformity
- Evidence or degree of damage on radiographs
The medications come with risks and side effects, and we have to factor that in the decision as well, explains Snyder.
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 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.
The Clinical Manifestation Of Psa
In the 60s and 70s five clinical forms of PsA were distinguished by Moll and Wright:
The classic course of the disease with involvement of the distal interphalangeal joints .
Destructive form of arthritis .
X-ray of hands: The destructive form of psoriatic arthritis . Numerous destructive changes in joints of both hands. Ankylosis of the right wrist. Typical for PsA changes called pencil-in-cup involving metacarpophalangeal joints.
Symmetric polyarthritis indistinguishable from rheumatoid arthritis with a negative rheumatoid factor .
Asymmetric form involving a few interphalangeal joints and metacarpophalangeal joints. It is the most common form of arthritis in psoriasis .
A form resembling ankylosing spondylitis .
A group of diseases with similar clinical manifestation called seronegative spondyloarthropathies has also been defined . The group includes:
Ankylosing spondylitis .
Spondylitis with associated bowel disease .
To support the diagnosis of seronegative spondyloarthropathies, the European Spondyloarthropathy Study Group created some clinical criteria. Basing on these criteria the assessment includes the following features:
Inflammatory back pain.
Patient with PsA X-ray of forefoot. Shows a form of the disease involving distal interphalangeal joints. Margin erosions and periostosis in DIP joint of the first finger of the left foot are visible.
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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.
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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Why Choose Cooper To Diagnose And Treat Psoriatic Arthritis
Cooper University Health Cares Division of Rheumatology has a team of expert, board-certified and fellowship-trained rheumatologists with extensive experience in diagnosing and treating psoriatic arthritis. Our capabilities include:
- Thorough diagnostic testing: Diagnosing psoriatic arthritis begins with a comprehensive medical history, physical exam and laboratory tests. These tests may include:
- Erythrocyte sedimentation rate : A blood test that can reveal inflammatory activity in the body
- Uric acid: High uric acid levels in the blood are linked with psoriatic arthritis
- Diagnostic imaging, including X-rays, musculoskeletal ultrasound or MRI, to look for bone damage and inflammation
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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Swollen Joints Fingers And Toes
Often you’ll notice swelling in your knees, ankles, feet, and hands. Usually, a few joints are inflamed at a time. They get painful and puffy, and sometimes hot and red. When your fingers or toes are affected, they might take on a sausage shape. Psoriatic arthritis might affect pairs of joints on both sides of your body, like both of your knees, ankles, hips, and elbows.
What Are The Symptoms Of Psoriatic Arthritis In A Child
The skin condition psoriasis may start before or after the arthritis. Psoriasis causes a scaly, red, itchy rash on the knees, elbows, scalp, face, and the folds of the buttocks. It can also cause pitting of fingernails or toenails.
Each childs symptoms may vary. Symptoms of psoriatic arthritis may include:
Inflamed, swollen, and painful joints, usually in the fingers and toes
Morning stiffness in the joints
Reddened skin over the affected joints
Sausage-like swelling of fingers and toes, plus swollen wrists
Deformed joints from chronic inflammation
Symptoms in the spine or sacroiliac joint
Lack of energy
The symptoms of psoriatic arthritis can seem like other health conditions. Make sure to see your childs healthcare provider for a diagnosis
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How To Deal With Psoriatic Arthritis Pain As You Get Older
It took me 25 years to get the proper treatment for my psoriatic arthritis pain. This is a form of arthritis that affects people diagnosed with the skin disorder psoriasis. People with psoriasis experience flare-ups of red, patchy skin or skin lesions. 15% of people with psoriasis develop psoriatic arthritis. There are some cases where you get the arthritis before you get the psoriasis. There is no cure yet.
My psoriatic arthritis has started affecting different parts of me. I have my good days and my bad days. As I get older, I am having more bad days. I am having lots of inflammation in the joints which is causing stiffness, swelling, and joint pain. In the past couple of years I have developed inflammation in the knees making it harder to walk.
When you try to explain what you have, people really dont get it. They only hear the word arthritis and automatically think you have rheumatoid arthritis or some sort of other arthritis. It took me years to explain what it was.
I have had to have tests like a MRI, CT scans, and X-rays to see were the arthritis is in my body. My fingers and toes have been swelling for years, which sometimes can cause soreness and be very painful. I have started doing some light exercise to keep the joints flexible. Walking has help me a lot.
Research has shown now that psoriasis can also lead to vision problems. Inflammatory lesions such as conjunctivitis are the most likely side effect. In very rare cases, psoriasis causes a loss of vision.