For Some Psoriasis Is Ignored Or Dismissed As Something Else
Psoriasis can affect one area or multiple areas of the body at a time. It can also be so small that it is easily ignored or dismissed as something else.
- I had a small amount of psoriasis on one knee as a teenager but also on my scalp. My mum thought I had really bad dandruff. I only have it in small patches on my scalp now. I was diagnosed with PsA when I was 28, and Im now almost 60.
- Three years ago, I was diagnosed with PSA, having had mild psoriasis in my younger days.
Sometimes, psoriasis comes and goes in varying degrees.
- I was diagnosed with PsA without psoriasis in my 30s. But started to get scalp psoriasis in my 40s.
- I had some red itchy patches on my hands. After a while, the patches went away. I havent seen them in 30 years.
Skin Trauma Or Injury
Trauma to the skin can cause new psoriasis lesions to appear. This is called the Koebner phenomenon.
Skin injuries include:
You can help prevent skin injuries by being careful while doing activities such as cooking, gardening, nail trimming, and shaving. Wear gloves and long sleeves when doing an activity that could potentially cause injury.
What To Look Forand What To Do About It
by Health WriteriStock/ozgurdonmaz
Psoriatic arthritis doesnt always lookor feelthe same. Sometimes, symptoms are gradual and mild others might occur quickly and severely. Worsening joint pain and swelling, or new or worsening psoriatic lesions, are the most common red flags that someone is having a PsA flare, says Yamen Homsi, M.D., the section chief of rheumatology at NYU Langone Hospital in Brooklyn, NY. But there may be other signs that a flare is on the way. Knowing what to look out for is important so you can let your doctor know whats going on and stay one step ahead of a flare.
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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.
Diagnosis For Oa Flares
Contact your primary care doctor if you believe you are going through an OA flare that has not improved with time. The doctors will monitor your symptoms and order a range of tests.
A physical test is crucial in determining the extent of OA flares. The doctor will examine the affected joint to evaluate the degree of pain, swelling, and range of motion.
The doctor may also order X-rays to check the stage of osteoarthritis and exclude deterioration of the condition of the joint as the reason behind the worsening symptoms.
When visiting your doctor, ensure you let them know whether your current symptoms are similar to those of previous flares.
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What Is Acetaminophen Not To Be Taken With
Tylenol can cause liver damage. Avoid alcohol as it can increase the risk of liver damage. Second, you should consult your doctor before you take any medication for colds, allergies, pain, sleep, or other conditions.
Acetaminophen, also known as APAP in abbreviated forms, is found in many combination medications. Combining products can lead to an overdose of Acetaminophen, which can prove fatal.
You should also check the label if youre buying an OTC drug. This will help you determine if it contains Acetaminophen and APAP.
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 don’t work
- Biologic medicines to ease inflammation
- Vitamins and minerals such as calcium and vitamin D to slow bone deformation
Other treatment may include:
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Living With Psoriatic Arthritis
There is no cure for psoriatic arthritis. But you can reduce your symptoms by stickingto your treatment plan. Manage pain with medicine, acupuncture, and meditation. Getenough exercise. Good exercises include yoga, swimming, walking, and bicycling. Workwith a physical or occupational therapist. He or she can suggest devices to help you withyour daily tasks.
What Treatment Is Right For Me
The type of treatment will depend on how severe your symptoms are at the time of diagnosis with the goal being to control the disease to the point of remission and avoid complications. Medications may need to be changed over time to continue to maintain control and avoid disease progression and systemic effects. Some early indicators of more severe disease include onset at a young age, multiple joint involvement, and spinal involvement. Good control of the skin is important in the management of psoriatic arthritis. In many cases, you may be seen by two different types of healthcare providers, one in rheumatology and one in dermatology.
Early diagnosis and treatment can relieve pain and inflammation and help prevent progressive joint involvement and damage. Without treatment psoriatic arthritis can potentially be disabling, cause chronic pain, affect quality of life, and increase risk of heart disease. It is important to update your healthcare provider when you have a change in symptoms or if your medication regimen is no longer effective.
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Psoriatic Arthritis: Prognosis Life Expectancy And Quality Of Life
The big questions
If you or a loved one has been diagnosed with psoriatic arthritis , youre likely wondering how this condition might impact your life, both now and in the future.
It may help to know that there are several treatment options for easing symptoms, and researchers are always searching for new ones.
PsA can be a serious chronic inflammatory condition that can cause significant pain and, in severe cases, disability. But its possible to manage your condition through medications and lifestyle changes.
In most cases, the joint pain and inflammation caused by PsA respond well to treatment.
PsA is a chronic condition, which means theres no cure. Medications can treat its symptoms, however, and PsA isnt life-threatening.
Some research suggests that people with PsA have a slightly shorter life expectancy than the general population. This is similar to other autoimmune conditions, like rheumatoid arthritis. It might be because people with PsA are also at an increased risk of developing heart disease.
If you have severe PsA, talk to your doctor about the best treatments to ease your symptoms and prevent chronic inflammation.
Its hard to predict exactly how PsA will affect your life because people experience symptoms differently. For some, the condition progresses quickly and causes more severe symptoms, while others may go quite some time without noticing a huge change.
PsA symptoms can include:
Not The Time During Your Consultations To Really Get To Understand The Diseases Profound Impact Into Your Patients Everyday Life Discover Our Podcast Series With Stories From Patients Suffering From Rheumatic Diseases And Comments From Rheumatologists Dr Molls And Dr Joos
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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.
Is Coffee Good For Psoriatic Arthritis
Like tea, coffee contains antioxidants. Yet theres no evidence that coffee also offers an anti-inflammatory effect for people with PsA.
What are the 5 types of psoriatic arthritis? Psoriatic arthritis is categorized into five types: distal interphalangeal predominant, asymmetric oligoarticular, symmetric polyarthritis, spondylitis, and arthritis mutilans.
How long do arthritis flares last?
How long does it last? Arthritis flare-ups can be variable, but they generally last three to five days with conservative care. Home care can include anti-inflammatory medicines, changing activities, and using ice, compression, or bracing.
Is psoriatic arthritis worse than rheumatoid arthritis? Even so, the pain and discomfort associated with psoriatic arthritis can be significant. A study published in 2015 in the journal PLoS One found that the overall pain, joint pain, and fatigue reported by psoriatic arthritis patients was significantly greater than that reported by people with rheumatoid arthritis.
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Decrease Pain And Stiffness
For occasional discomfort, Fields says, nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen can be beneficial. Ask your doctor about increasing the dose during a flare-up. You can also try heat or ice at the source of discomfort, Fields says. If pain persists, he adds, your doctor may recommend prescription pain medication or a steroid injection at the affected joint.
Flare Warning: Nail Changes
Another psoriatic arthritis red flag to look out for: Changes in your nail structure, color, or aberrations. Not everyone with PsA will experience this symptom, but others report abnormalities on their finger or toenailsor both. In fact, nail changes are often an early indicator of PsA in general. Studies say that up to 80% of people with psoriatic arthritis experience nail issues, ranging from pitting and discoloration to loosening of the nail plate and subungual hyperkeratosis .
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What Are The Types Of Psoriatic Arthritis
There are different types of psoriatic arthritis, which tend to affect different parts of the body. These include:
- asymmetric arthritis usually affects one side of the body, or different joints on each side
- symmetrical polyarthritis often affects several joints on both sides of the body
- distal interphalangeal arthritis affects the joints closest to the fingernails and toenails
- spondylitis affects the spine, particularly the lower back
- arthritis mutilans a rare condition that severely affects the bones in the hands
There is also a type of psoriatic arthritis that affects children, although the symptoms are usually mild.
Does Early Treatment Raise My Chances Of Remission
Starting treatment as soon as possible to shut down the disease could make ongoing psoriatic arthritis remission more likely. Repeated episodes of joint inflammation can cause irreparable harm. Early, aggressive treatment can prevent joint damage, leading to a better long-term outlook.
For example, TNF blockers or TNF inhibitors, a kind of medicine called biologics, have been successful in treating PsA. In one study, more than half of people who used them were in remission a year later.
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Even Without Psoriasis Psa Causes Other Painful Symptoms
Skin psoriasis causes itching, burning, and sensitive skin. But other PsA symptoms can greatly affect your quality of life as well.
- I have very little psoriasis, but plenty of body aches and pains . . . oh, and fatigue!
- My joint pain is horrendous!
- I do not have psoriasis, but I do suffer constant dermatitis.
- No psoriasis, just a lot of pain.
Dendritic Cells And Macrophages
Immature and mature dendritic cells and macrophages are present in inflammatory infiltrates of skin and synovium of patients with psoriasis and PsA, where they present antigens to T cells, remove necrotic/apoptotic cells, and most importantly, they can be a source of a multitude of cytokines and chemokines such as CCL19. Several regulatory molecules are involved in this process, such as intercellular adhesion molecule 1 , lymphocyte function-associated antigen 3 and cluster differentiation -80/86 in DCs and LFA-1, CD2 and CD28 in T cells. In addition, plasmacytoid DCs , a main source of type I interferon , are also present in the skin. Myeloid dermal DCs are also increased in psoriatic lesions and induce autoproliferation of T cells as well as production of type 1 helper T cell cytokines. Keratinocytes are responsive to DC-derived and T-cell-derived cytokines, including IFNs, tumor necrosis factor , interleukin -17, and IL-20 family of cytokines, and in turn they produce proinflammatory cytokines and chemokines . Participation of cell-mediated immune responses in the pathogenesis of PsA is suggested by the demonstration in synovial fluid and peripheral blood lymphocytes of different natural killer surface markers and / T-cell receptor antigen . Endothelium may also play a role in the pathogenesis of longstanding PsA as evidenced by the increased expression of certain adhesion molecules in PsA synovium related to the disease duration .
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When Flares Seem To Last Forever
While it can sometimes feel like a flare is lasting forever, we found that there is a wide variety of experiences in how frequently people experienced flares and how long they lasted.
Among people who took the survey, almost three-quarters of people with PsA experienced flares monthly or even more frequently, with flares lasting several weeks.
What About Managing A Psoriasis Flare
Controlling psoriasis is key to managing psoriatic arthritis flare-ups. While psoriatic arthritis and psoriasis are two separate conditions, 85 percent of people with psoriatic arthritis have psoriasis before developing the joint disease, according to the NFP. The severity of one disease does not dictate the severity of the other, so your treatment should be individualized.
Some patients have severe psoriasis and mild arthritis, and the treatments are guided by the skin problem, Fields says. Some patients have severe arthritis and not such severe skin problems, in that case, the arthritis will determine the therapy.
Here are some ways to address psoriasis symptoms during a flare-up:
Additional reporting by Brian P. Dunleavy
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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.
Employ Some Life Hacks
Crow also advises taking shortcuts that can make living with PsA flares easier. These life hacks can help minimize fatigue or joint pain, she says. If your joints hurt, you can change the stuff you are using in your daily life for example, if your hands hurt, you can use a wide-grip fork while eating. You can also change how you interact with stuff, such as choosing to have grocery delivery rather than exerting the energy required to go to the store and bag all the items yourself.
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Conventional Or Traditional Disease
DMARDs are indicated for the treatment of moderate to severe or refractory cases of PsA. Patients with active disease, defined globally as one or more tender and swollen joints and poor prognostic factors, particularly those with elevated acute phase reactants, radiographical damage or clinically relevant extra-articular manifestations, who have failed to respond to NSAIDs within 3 months, should be treated with DMARDs.
Delay in the start of DMARDs may lead to worse outcome. MTX, sulfasalazine and leflunomide can be effective for peripheral but not for axial disease, enthesitis or dactylitis. Observational controlled studies with sulfasalazine have shown no reduction in long-term joint damage. Similarly, the use of antimalarials and gold salts is not recommended, and there is little convincing evidence regarding the efficacy of cyclosporine in PsA. It has been shown that the probability of continuing to take cyclosporine is significantly lower and the rate of adverse events is higher when compared with MTX or antimalarials .
Before starting DMARD therapy patients should be screened and have regular blood monitoring, usually every 3 months, including blood counts, liver function tests and serum creatinine .
Does Psoriatic Arthritis Qualify For Disability
If you have psoriatic arthritis, you may qualify for Social Security disability insurance. Your level of benefits depends on your ability to work and how long youve been paying into Social Security. Youll need a lot of documentation to make your case, but the effort is worth it.
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The Importance Of Treatment
For many people, having PsA and experiencing flares negatively impacts their quality of life. Survey respondents reported that their ability to exercise or participate in physical activity are the most frequent areas of their life to be negatively affected.
Less frequently cited, but still commonly reported aspects of life that are also compromised include the ability to work, sleep, and have a social life.