Methotrexate Use And Risk Of Lung Disease In Psoriasis Psoriatic Arthritis And Inflammatory Bowel Disease: Systematic Literature Review And Meta
- Accepted 4 February 2015
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.
Living With Psoriatic Arthritis
There is no cure for psoriatic arthritis. However, by understanding the disease and knowing what to expect, you can learn different ways to complete daily tasks or plan activities at times of the day when you are least bothered by its effects. Once you understand and learn to predict the ways in which your body responds to the disease, you can use exercise and therapy to help decrease discomfort, stress and fatigue.
There is a significant list of comorbidities related to PsA. These include these 11 conditions:
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Psoriasis And Interstitial Lung Disease
Interstitial lung disease is a group of lung disorders that affect the tissue surrounding the air sacsthe interstitium. It includes sarcoidosis, idiopathic pulmonary fibrosis, and interstitial pneumonia. ILD causes scarring of the lung tissue and difficulty breathing. In most cases, the cause is not known. However, some medications, such as immunosuppressants that treat psoriasis, can cause it. These links led researchers to examine the relationship between psoriasis and ILD.
Studies looking at imaging exams of the lungs of people with psoriasis have found evidence of ILD. They observed this even for people who had not yet taken any immunosuppressants. This suggests a link between ILD and psoriasis itself, and not just with certain medicines that treat the disease.
Spine Shoulders And Hips
PsA that affects the spine is called axial psoriatic arthritis. It can cause bony growths and inflammation in various parts of the spine that affect the back, shoulders, and hips.
Over time, spinal inflammation may affect the joints between the vertebrae, which are the small bones in the spine. This is caused spondylitis.
PsA that affects the sacroiliac joints between the spine and the pelvis is called sacroiliitis. This is often felt at the bottom outside of your back near your hip. It can also cause pain further into the lower back, hips, or buttocks.
The back pain caused by axial PsA is different from common back pain in that it gets better with exercise and worse when sedentary. The pain may wake you up in the middle of the night and be worse the first 30 minutes after you wake up.
Over time, you may experience chronic joint pain and stiffness, which may make it hard for you to bend your spine. You may also experience decreased range of motion.
Spinal involvement usually comes later in the progression of PsA, but not always. Early treatment can often help prevent your spine from becoming affected.
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Stay In Constant Touch With Your Doctor
If you are suffering from RA, it is important for you to visit your doctor at regular intervals. This will not only help your doctor to check the progression of the disease, but will also help you detect and prevent lung complications that might be arising due to RA. Timely detection and treatment can prevent lung infections from worsening or turning fatal.
At EPIC Health, we can help you manage your rheumatoid arthritis and prevent it from causing chronic lung infections. Our expert primary care physicians carry out a number of health screenings to evaluate the extent of your disease progression and prevent RA from causing lung infections or other heath complication.
Schedule an appointment at EPIC Health today! We can help you live happy, healthy and better.
Effects On The Digestive System
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Effects On The Immune System
PsA is an autoimmune condition, which means that it influences the way that the immune system works. The immune system fights pathogens, such as bacteria and viruses. In someone with an autoimmune condition, it mistakenly attacks healthy cells.
In a person with PsA, the immune system attacks the joints, tendons, and the insertion points of tendons and ligaments. If a person also has psoriasis, it also affects the skin.
Researchers do not fully understand why this happens. They think that some bacterial infections, including strep throat, may trigger PsA. In addition, if a person has a genetic susceptibility, they may develop PsA as a result of severe stress, a physical injury, or an event that causes the immune system to react strongly.
Uveitis is a group of diseases related to eye inflammation. Without treatment, it can lead to vision loss. People with PsA should have regular eye exams for this reason.
Symptoms Of Psoriatic Arthritis And Kidney Disease
Psoriatic arthritis sometimes develops in patients with psoriasis, an autoimmune skin condition that causes red, itchy, scaly, and inflamed plaques on the skin. Psoriatic arthritis is characterized by joint pain, inflammation, and stiffness.
The widespread inflammation that affects the skin and joints in psoriatic arthritis can also extend to other areas of the body, causing:
- Swollen fingers or toes with a sausage-like appearance
- Inflammation of the eyes
- Inflammation of the sites where tendons and ligaments attach to bone
Other systemic symptoms can include chronic fatigue, digestive symptoms, such as abdominal pain, bloating, constipation, and diarrhea, and organ damage from inflammation of the heart, lungs, or kidneys.
With kidney disease, because toxic byproducts are not effectively being filtered out of the blood, increased inflammation throughout the body can manifest in several ways, including:
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Jaw Pain And Psoriatic Arthritis
Psoriatic arthritis can affect any joint, including the temporomandibular joint that connects the jawbone to the skull. The TMJ is linked to the masseter the strongest muscle in your body based on its weight. Because it works so hard, the TMJ is at risk for damage.
About 35 percent of people with psoriatic arthritis will have symptoms in their TMJ, according to the National Psoriasis Foundation.
Rheumatologists are encouraged to perform a 66-68 joint count, which essentially measures swelling in 66 joints and tenderness and pain in 68 joints. Still, doctors often miss signs of TMJ damage.
In clinical practice, rheumatologists arent necessarily used to looking at the TMJ. They are part of the 66-68 joint count, which was endorsed as a mandatory measure for clinical trials and longitudinal studies, Ana-Maria Orbai, MD, an assistant professor of rheumatology at Johns Hopkins University in Baltimore, and an NPF medical board member, told the National Psoriasis Foundation. But most people in practice will just look at patients hands. Because practitioners arent doing the full joint count, they may miss the TMJ.
Treatment options, such as biologics and disease-modifying anti-rheumatic drugs , can help prevent or slow TMJ damage. Additionally, you should try to avoid chewing hard foods to reduce pressure on your jaw.
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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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
How Is Psoriatic Arthritis Diagnosed
There is no single test to diagnose psoriatic arthritis. Healthcare providers make the diagnosis based on a patient’s medical history, physical exam, blood tests, and X-rays of the affected joints. Magnetic resonance imaging is generally not needed except in unusual circumstances.
Laboratory tests that may be helpful in diagnosis or used to monitor disease activity include:
- Rheumatoid factor and anti-CCP – types of blood tests to help diagnose rheumatoid arthritis.
- HLA-B27 – blood test to help diagnose, may also be indicated with a family history of psoriasis or psoriatic arthritis.
- Sedimentation rate and C-reactive protein – may indicate inflammation.
X-rays are not usually helpful in making a diagnosis in the early stages of the disease. In the later stages, X-rays may show changes that are more commonly seen only in psoriatic arthritis. One such finding is called the “pencil-in-cup,” which describes the finding where the end of the bone gets whittled down to a sharp point. This finding indicates more severe inflammatory changes to joints, which may require more aggressive treatment.
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Ways To Prevent Damage To Your Kidneys
To help keep your kidneys healthy, proper management of any underlying conditions decreases your risk of developing kidney disease.
Healthy lifestyle habits can also help you manage these conditions and reduce inflammation throughout the body to prevent kidney damage. Healthy lifestyle habits include:
- Getting enough sleep at night, at least seven to eight hours
- Eating a healthy diet and maintaining a healthy weight
- Quitting smoking
- Maintaining a positive attitude and learning how to cope with and manage stress
- Exercising regularly and staying active
What Is Psoriatic Arthritis
Psoriatic arthritis is an inflammatory type of arthritis that develops in some people with psoriasis, an autoimmune disease that causes itchy, scaly plaques on the skin. Psoriasis affects 74 million adults in the United States, and 30% of patients diagnosed with psoriasis will develop psoriatic arthritis.
PsA causes inflammation in many joints of the body as a result of the body producing autoantibodies that attack healthy joints by mistake. This results in joint pain, inflammation, and stiffness, in addition to symptoms of the skin for some.
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How Is Psoriatic Arthritis Treated
Mild forms of psoriatic arthritis can be treated with over-the-counter pain and anti-inflammatory medications to reduce pain and swelling. Corticosteroids may also be injected into the affected joints.
For more severe forms of the disease, disease-modifying anti-rheumatic drugs may be prescribed to decrease signs and symptoms. In some cases, biologics may be prescribed to reduce inflammation and prevent further damage.
Treatments For The Arthritis
Non-steroidal anti-inflammatory drugs
NSAIDs, or non-steroidal anti-inflammatory drugs, can reduce pain, but they might not be enough to treat symptoms of psoriatic arthritis for everyone.
Some people find that NSAIDs work well at first but become less effective after afew weeks. If this happens, itmight help to try a different NSAID.
There are about 20 different NSAIDs available, including ibuprofen, etoricoxib, etodolac and naproxen.
Like all drugs, NSAIDs can have side effects. Your doctor will reduce the risk ofthese, by prescribing the lowest effective dose for the shortest possible period of time.
NSAIDs can sometimes cause digestive problems, such as stomach upsets, indigestion or damage to the lining of the stomach. You may also be prescribed a drug called a proton pump inhibitor , such as omeprazole or lansoprazole, to help protect the stomach.
For some people, NSAIDs can increase the risk of heart attacks or strokes. Although this increased risk is small, your doctor will be cautious about prescribing NSAIDs ifthere are other factors that may increase your overall risk, for example, smoking, circulation problems, high blood pressure, high cholesterol, or diabetes.
Some people have found that taking NSAIDs made their psoriasis worse. Tell your doctor if this happens to you.
Steroid injections into a joint can reduce pain and swelling, but the effects do wear off after a few months.
Disease-modifying anti-rheumatic drugs
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Concomitant Interstitial Lung Disease With Psoriasis
Background. We encounter interstitial lung disease patients with psoriasis. The aim of this case series was to examine clinical and radiographic characteristics of patients with concomitant psoriasis and ILD. Methods. This is a retrospective review of our institutional experience of ILD concomitant with psoriasis, from the database in the Advanced Lung/Interstitial Lung Disease Program at the Mount Sinai Hospital. Out of 447 ILD patients, we identified 21 with antecedent or concomitant diagnosis of psoriasis. Clinical, radiographic, pathological, and outcome data were abstracted from our medical records. Results. Median age was 66years and 14 were male. Thirteen had not previously or concomitantly been exposed to immunosuppressive therapy directed against psoriasis. Two ultimately died. Clinical diagnosis of ILD included idiopathic pulmonary fibrosis, 11 nonspecific interstitial pneumonia , 2 cryptogenic organizing pneumonia, 2 chronic hypersensitivity pneumonitis, 2 and the others, while radiographic diagnosis included usual interstitial pneumonia pattern, 9 NSIP pattern, 6 organizing pneumonia pattern, 4 hypersensitivity pneumonitis pattern, 2 and the others. . We report 21 ILD cases with antecedent or concomitant diagnosis of psoriasis. Further prospective studies are required to determine the association between ILD and psoriasis.
2.2. Statistical Methods
The Link Between Psoriatic Arthritis And Kidney Disease
- Serum creatinine levels in the blood, a waste product of muscular activity
- Urea, a waste product produced by your liver from the digestion of protein
- Phosphate, an electrolyte
Normally, the kidneys filter out these substances from the blood to maintain levels within a healthy range.
When the kidneys don’t function properly, serum creatinine, urea, and phosphate will stay in the blood and cause higher-than-normal levels, which indicate kidney disease or malfunctioning. Elevated levels of protein in the blood are also commonly seen when the kidneys are not functioning properly.
The level of serum creatinine in your blood as well as your age, gender, and race all factor in to your glomerular filtration rate, which is another marker of healthy kidney functioning. If serum creatinine levels are elevated, your glomerular filtration rate will be lower since the kidneys are not effectively filtering out creatinine from the blood.
A 2017 epidemiological study examined markers of kidney function among patients with psoriatic arthritis, patients with psoriasis, and healthy control subjects. This study revealed that levels of serum creatinine, urea, and phosphate were all elevated in patients with psoriasis compared to healthy subjects, but levels were highest among the patients with psoriatic arthritis.
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What We Do And Dont Know About The Association Between Psoriasis Psoriatic Arthritis And Respiratory Disease
Medically reviewed in December 2020
Psoriasis and psoriatic arthritiscollectively known as psoriatic diseaseare associated with a number of serious health conditions. Cardiovascular disease, type 2 diabetes, obesity, psychiatric and mood disorders, and other inflammatory autoimmune disorders are some of the well-known examples.
Psoriatic disease is also associated with a number of diseases and disorders that affect the lungs. These include:
- Asthma. People with psoriasis, especially people who are older, are at an increased risk of having asthma, a chronic condition of the respiratory system characterized by inflammation of the airways.
- COPD. Chronic obstructive pulmonary disease refers to a collection of diseases that make it difficult to breathe. The two main types are chronic bronchitis and emphysema. People with psoriasis are at a greater risk of having COPD.
- Sarcoidosis. This is an inflammatory disease characterized by the formation of small nodules called granulomas. Granulomas can form in the lungs, lymph nodes, and other organs. The cause is unknown, but research shows people with psoriasis are at a higher risk.
- Lung cancer. Research has shown that people with psoriasis, and especially people with severe psoriasis, have a slightly higher risk of certain cancers, including lung cancer. A significant percentage of psoriasis patients are also smokers, and smoking is the number one risk factor for lung cancer.