Nail Changes: A Sign Of Psoriasis
Up to 80 percent of people living with psoriatic arthritis experience some type of nail issue, according to a study published in 2017 in the journal Reumatologia. Evidence suggests that nail psoriasis is a strong predictor of joint disease and may show up years before arthritis symptoms.
The study notes that pitting is the most common sign of nail psoriasis. Pitting looks like superficial depressions in the nail.
Another type of nail change that can occur is known as onycholysis, or a separating of the nail from the nail bed.
Many people find the appearance of nail symptoms psychologically distressing, says Dr. Gupta. Extensive cases may confer significant morbidity and functional impairments. Therefore, managing nail psoriasis is an integral part of psoriatic arthritis therapy.
Treatment options for nail psoriasis include topical ointments as well as systemic therapies.
Treatments And Lifestyle Changes Can Ease Psa Symptoms
If you experience skin symptoms along with joint pain, its a good idea to ask your doctor about psoriatic arthritis. This is especially important if you already have psoriasis, because up to 30 percent of patients with this autoimmune condition will develop psoriatic arthritis, too.
Patients with psoriasis should be aware of the connection between psoriasis and arthritis, says Lihi Eder, MD, PhD, a rheumatologist at the University of Toronto and the Womens College Research Institute. Those with psoriasis experiencing joint symptoms should consult their primary care physician or dermatologist, who can determine the need for an assessment by a rheumatologist.
Psoriatic arthritis can cause irreversible joint damage, but the good news is that certain treatments can prevent or delay permanent changes, manage symptoms, and improve quality of life.
Beyond Joints: How Psoriatic Arthritis Affects The Body
This autoimmune, inflammatory disease can reach beyond skin and joints to attack organs and more.
Joint pain is a big part of living with psoriatic arthritis . But the inflammation that affects your joints can cause problems for other organs and tissues, too, and comorbidities, or conditions that often occur with PsA, including obesity and diabetes, bring additional effects not directly related to joints. Youll probably think of skin issues first, but your eyes, heart, lungs, gastrointestinal tract , liver and kidneys may also be affected.
Skin. Psoriasis appears first in 60% to 80% of patients, usually followed within 10 years but sometimes longer by arthritis. Some people are diagnosed with both diseases at the same time, and 10% to 15% have psoriatic arthritis symptoms before psoriasis. Psoriasis creates thick, reddish, inflamed patches of skin, often with silvery-white scales. These patches, which sometimes itch and burn, may appear anywhere on the body, but are most common on the elbows, knees, scalp, back, face, palms and feet. Its considered severe when more than 10% of the body is covered.
Lungs. The inflammation that causes PsA may also harm your lungs, causing a condition known as interstitial lung disease that leads to shortness of breath, coughing and fatigue. This condition occurs less frequently with PsA than with certain other rheumatic diseases, such as rheumatoid arthritis.
Last reviewed 4/21/2021
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What Is Psoriatic Arthritis Anyway
Given that its name references psoriasis, its easy to think that psoriatic arthritis is a complication or even form of the condition that causes red, scaly plaques on the skin. But lets get this straight from the get-go: These are two relatedbut separateautoimmune conditions, both of which are driven by an out-of-whack inflammatory response. In psoriasis, your immune system targets the skin, causing inflammation and rapid growth that leads to those uncomfortable, itchy rashes. In PsA, the joints, ligaments, and tendons are the target, leading to joint pain, swelling, and stiffness that, if left untreated, can lead to irreversible joint damage that can seriously interfere with your ability to move or function normally. Both conditions are systemic diseases and can cause symptoms body-wide.
About 30% of people with psoriasis will develop PsA , most commonly in their 30s and 40s. Right now, 8 million people in the US are living with psoriasis, and 10-30% of them have psoriatic arthritis.
Usually, skin problems show up first, but in some people the first signs are joint-related, which can make diagnosis trickier . Also confounding: The severity and location of skin lesions have very little impact on the severity and location of PsA joint symptoms and vice versa. Case in point: You could have skin lesions only on your legs and knees but have swelling only in your fingers on one hand. Its annoying like that.
What The Doctor Does
Doctors first ask questions about the persons symptoms and medical history. Then they do a physical examination. What doctors find during the history and physical examination often suggests a cause for joint pain and guides the tests that may need to be done .
Doctors ask about pain severity, onset , how symptoms vary over time, and what increases or decreases pain . They ask about joint stiffness and swelling, previously diagnosed joint disorders, and risk of exposure to sexually transmitted diseases and Lyme disease.
Doctors then do a complete physical examination. They check all joints for swelling, redness, warmth, tenderness, and noises that are made when the joints are moved . The joints are moved through their full range of motion, first by the person without assistance and then by the doctor . This examination helps determine which structure is causing the pain and if inflammation is present. They also check the eyes, mouth, nose, and genital area for sores or other signs of inflammation. The skin is examined for rashes. Lymph nodes are felt and the lungs and heart examined. Doctors usually test function of the nervous system so that they can detect disorders of the muscles or nerves.
The following tests are the most important overall:
Tests of joint fluid
Erythrocyte sedimentation rate and C-reactive protein
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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:
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 onspecial insoles and good supportive footwear.
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How Do Doctors Diagnose Psa
Unfortunately, theres no single test that can diagnose PsA. Your doctor will perform a physical exam, which will include a medical history to determine if psoriasis or PsA runs in your family. He or she will also check your skin for signs of psoriasis, which may appear as red or dry scaly patches, examine your joints for symptoms like swelling or tenderness, and check your fingernails for telltale pitting and flaking. He or she will press or probe the soles of your feet and around your heels checking for tenderness .
Your doctor may also run lab tests to rule out other causes of joint pain like rheumatoid arthritis or gout. These include:
Early Stages Of Psoriatic Arthritis
Recognizing the signs of psoriatic arthritis can be tricky since symptoms differ from patient to patient. For example, one person can experience psoriasis skin involvement and peripheral arthritis, another may experience axial disease , and someone else could have a combination of all three.
Whats more, especially during early disease, you may confuse your symptoms with other conditions. People can mistake enthesitis, inflammation of the entheses for tennis elbow or dactylitis for an infection, explains Dr. Mikulik.
If you have psoriasis and are having pain in your tendon and musculature and you think maybe Ive been too active lately, that may be the first sign of PsA, says Dr. Haberman. Doctors commonly hear people chalk up their symptoms to overuse, such as getting more exercise than usual or doing work around the house.
If you experience any of the following signs of early psoriatic arthritis its important to see your doctor as soon as possible:
- Changes in your fingernails or toenails, including holes, pitting, discoloration, or softness
- Eye inflammation
- Sausage-like swelling of an entire finger or toe
- Scalp psoriasis
- Tendon or ligament pain at the Achilles tendon, bottom of the foot , or elbow
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How Is It Treated
Some kids who have JIA might take medicine like ibuprofen to help control pain and inflammation. If the arthritis is more severe, they may need to take other medicines to help lower the pain and inflammation. Some of these medicines are pills, but others are shots.
Itâs important that kids with JIA keep their joints moving. Often a kid will see a physical therapist or occupational therapist. In addition to working with children to move their joints and strengthen their muscles, these therapists can help create special exercise programs for home or school that can help a kid stay active.
In addition to joint problems, JIA may cause uveitis , an inflammation of the eye that can lead to problems with vision if itâs not treated. All kids diagnosed with JIA should get their eyes checked by an ophthalmologist, a doctor who specializes in diagnosing and treating eye problems. If the eyes are affected, they may be treated with eye drops.
Besides taking medicines, a kid can do a few things to help with the symptoms of JIA:
- Keep joints warm and stay active.
- Take warm baths, which can make a kidâs joints hurt less.
- Use an electric blanket on a timer that turns on 1 hour before a kid wakes up, which can help warm the joints and help a kid move better.
- Some kids dip their hands in a special warm wax called paraffin that helps their joints ache less.
What Are The Treatment Options For Psoriatic Arthritis
The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:
Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs . Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.
DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.
Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.
Heat and cold therapy
Joint protection and energy conservation
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Pain That Migrates Between And Among The Bodys Joints
Arthritis is a broad termclassified into over 100 categoriesthat defines joint pain and inflammation. Migratory arthritis is characterized by rapid onset of swelling in one or two joints. As symptoms resolve, similar symptoms begin to emerge in another joint, usually in an asymmetric location. The symptoms then generally fade within the next few days before they flare again. Migratory arthritis is mostly associated with the following forms of arthritis:
- Rheumatoid arthritis, an autoimmune disorder in which the body attacks healthy tissue
- Osteoarthritis, a breakdown of the cartilage that covers the joint bones
- Gout, caused by urate crystal buildup between joints
- Lupus, an inflammatory disease in which your immune system attacks the bodys joints and tissues
Other medical conditions such as inflammatory bowel disease , hepatitis B, hepatitis C and various bacterial infections can also cause migratory arthritis. No matter the type of arthritis a person experiences, its impossible to predict where or when the pain will move.
Weight Gain Or Changes In Appetite And Thirst
Psoriatic arthritis increases your risk for metabolic syndrome, which is the term for a group of risk factors, including belly fat and high blood pressure, that increase your risk of developing health conditions such as heart disease and type 2 diabetes. The more severe your psoriatic arthritis, the greater your risk for metabolic syndrome.
Get your blood pressure checked regularly and work with your doctor to lose weight, especially if youre carrying extra pounds around your midsection.
See your doctor right away if you experience telltale signs of type 2 diabetes, such as feeling constantly hungry, thirsty, or fatigued.
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When To See A Doctor For Moving Pain In Body
A person suffering from moving pain in the body should consult a doctor if home treatments prove ineffective. Medical attention should also be sought if migratory body ache is persistent and intense, if it is caused by certain medications or tick bite, or if the moving pain is accompanied by symptoms like rash, constant fever, severe swelling or redness. Other symptoms that can accompany a moving body ache and need emergency medical attention are breathlessness, severe water retention, stiff neck, muscle weakness, inability to move the affected area, extreme fatigue, nausea, vomiting, sensitivity to light, difficulty in swallowing, fainting, and seizures. If moving body pain persists for more than 2 weeks and the underlying cause cannot be determined, a person must consult a doctor regardless of whether any other symptoms occur or not. The doctor can help diagnose the exact cause of the migratory pain and ascertain if treatment is necessary.
|Written, Edited or Reviewed By:Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc.This article does not provide medical advice. See disclaimerLast Modified On: August 29, 2018
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Getting Insufficient Or Poor Quality Sleep
The vast majority of people who suffer from arthritis, approximately 80 percent, have difficulty sleeping. When your joints ache or you are experiencing joint inflammation or stiffness, it can make it harder to sleep. Researchers have found that the opposite is also true. If you suffer from sleep problems, they can actually make joint pain and joint symptoms worse. Sleep difficulties trigger inflammation, which may make joint pain and inflammatory conditions such as some kinds of autoimmune disease, chronic fatigue syndrome, fibromyalgia, ankylosing spondylitis, idiopathic arthritis, psoriatic arthritis, grout, osteoarthritis, and rheumatoid arthritis worse.
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Medications For Psoriatic Arthritis
Theres a pretty wide range of drugs that can treat your PsA, everything from drugstore aspirin to advanced biologics.
Nonsteroidal Anti-inflammatory Drugs
NSAIDs are usually the first step if your pain and inflammation are very mild. It may take several weeks for these drugs to kick in though, and they are not recommended for long-term use since they carry side effects like stomach irritation, heart problems, and kidney damage. The most common NSAIDs include:
Bayer, Bufferin among others
COX-2 inhibitors, a subclass of NSAIDs with less of a risk of internal bleeding or stomach ulcers, a common side effect of other NSAIDs that are used in large doses for a long time. Brand names include Bextra and Celebrex .
These disease-modifying anti-rheumatic drugs used to be the mainstay for treating PsA. They work by down-regulatingor suppressingthe bodys overactive immune system. They can all be taken orally . Due to the immune-suppressing nature of these drugs, they can come with side effects, like mouth sores, hair loss, stomach upset, infection, fatigue, or liver damage. As a result, patients must be closely monitored with regular lab tests.
Theyre typically delivered either by self-injection or via an IV infusion , and you may need monitoring with blood tests. Generally, biologics are intended to be taken long-term. Theyre categorized by the cells they target:
Management Of Psoriatic Arthritis
PsA can be treated with a variety of strategies and, depending on the severity, chronicity, and other comorbidities, low remission or low disease activity should be the target.11 The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis , the European League Against Rheumatism , and the American College of Rheumatology and the National Psoriasis Foundation in collaboration have all published and revised psoriatic arthritis treatment recommendations.1
Figure 3: Suggested treatment algorithm for patients with psoriasis and/or psoriatic arthritis.15
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