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.
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.
Cut Out The Junk Food
Avoid foods that are loaded with sugar, fat, and salt, since they can leave you feeling sluggish. Instead, eat foods that fight inflammation, like fresh fruits and veggies, lean protein, and whole grains. A healthy diet isn’t just good for your psoriatic arthritis — it can also help you lose weight.
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When To Seek Medical Advice
You should speak to your GP if you experience constant pain, swelling or stiffness in your joints even if you haven’t been diagnosed with psoriasis.
If you have been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let your doctor know if you’re experiencing any problems with your joints.
Managing Psoriatic Arthritis Muscle Pain
Muscle pain is not one of the most common symptoms of psoriatic arthritis . However, some people diagnosed with the condition experience muscle aches and pain related to their diagnosis, in addition to the more common joint pain.
Understanding how muscle pain can be tied to psoriatic arthritis is important. That knowledge can help you recognize what is going on with your body and make sure you get the necessary treatments to keep doing your daily activities and to maintain your well-being and quality of life. Heres what you need to know about managing muscle pain with psoriatic arthritis.
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What Medications Are Available For Treating Inflammatory Arthritis
Medicines for inflammatory arthritis are used to relieve pain, reduce swelling and slow or stop joint damage. Each person responds differently to arthritis medicines. This means you need to work with your rheumatologist to identify the treatment that works best for you.Your GP will probably monitor your treatment and refer you back to a rheumatologist if necessary.Common medicines for rheumatoid arthritis include:
- disease-modifying anti-rheumatic drugs
- corticosteroids .
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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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:
Ways To Protect Your Joints
You donât have to give up the things you love to do. Just look for ways to do them that take the stress off your joints.
The way you walk, sit, stand, or hold things can help. Change your position at work, at home, and throughout the day. Sit and stand up straight, and don’t arch your back. Good posture helps you feel better.
Make these three things a habit:
1. Pace yourself. Switch between heavy, hard, or repetitive tasks and light or easy tasks. Make sure you take breaks.
2. Be kind to your joints. Put as little stress on them as possible. Use larger, stronger joints when you can, instead of smaller ones. For example, wear a shoulder bag rather than a handheld purse.
3. Get an assist. Many helpful devices — like canes, grab bars, extra-thick pens, luggage carts, or sit/stand stools — can make your day easier. Ask an occupational therapist which ones would help you.
It’s natural to have flare-ups, but then you’ll have times where you feel better. If you notice any new symptoms, tell your doctor. Thatâll help keep things in check so you don’t have more joint damage. You can keep your symptoms under control with treatment.
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Managing Psoriatic Arthritis Flares
Knowing triggers and early warning signs is key.
When Julie Cerrone developed psoriatic arthritis , she didnt know what it was. Shed had knee problems and chronic pain for years but wasnt diagnosed with PsA until she was in her late 20s. Even after the diagnosis, she didnt immediately connect the profound fatigue she sometimes felt with flaring PsA.
Its a bone-chilling fatigue that has me in bed all day, says Cerrone, a health and wellness consultant in Pittsburgh. Walking up my front steps feels like Im hiking Mount Everest.”
Flares for Cerrone can also mean painful, swollen joints and widespread discomfort. It may start in my hands but can travel up my forearm, and all the way to my neck, she says. “Its like my bones hurt.
More Than Skin and Joints
Although Cerrones symptoms arent unusual, rheumatologist Philip Mease, MD, says flares can vary widely.
For some people, it may be joints for others, its a worsening of skin disease or spinal pain, explains Dr. Mease, director of the Rheumatology Clinical Research Division at Swedish Medical Center and clinical professor of medicine at the University of Washington, both in Seattle.
These things dont necessarily happen together sometimes its a single joint or a flare of skin alone. For example, skin lesions may become hot, red, painful or itchy or spread to new areas.
Being Proactive Can Prevent Flare Triggers
What Your Doctor Can Do
Complementary And Alternative Medicine
In addition to medications and lifestyle changes, there are also natural treatment options for PsA, including:
- Acupuncture: A 2020 study found acupuncture to be a suitable treatment option for people with PsA.
- Ta chi: Ta chi can help with stress and pain relief through calm, slow movements.
- Cannabis: In preliminary research, cannabis has been shown to be a great option for pain and other symptoms. Another study showed positive results of cannabis on chronic pain.
- Essential oils: Essential oils are derived from plants and bottled into small doses for a variety of uses. When it comes to treating psoriatic arthritis, research is limited, but essential oils may offer pain or swelling relief. Those used most in treating pain, swelling, and other symptoms of PsA include lavender, eucalyptus, and turmeric.
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What Causes Psoriatic Arthritis
The cause of psoriatic arthritis is unknown. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma play a role in determining who will develop the disease. Psoriasis itself is neither infectious nor contagious.
Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with psoriatic arthritis.
Do Certain Foods Trigger Psoriatic Arthritis Flares
There is no substantial evidence that diet impacts PsA disease or symptoms. If you wish to change what you eat and see if it helps, see .
1. CDC. Psoriasis overview. 2018. Available at: www.cdc.gov/psoriasis/index.htm. Accessed July 25, 2020.
2. National Psoriasis Foundation. Psoriatic arthritis , an inflammatory form of arthritis, affects about 30 percent of people with psoriasis.2020. Available at: www.psoriasis.org/about-psoriatic-arthritis. Accessed July 25, 2020.
3. NIH. Psoriatic arthritis.2020. Available at: https://ghr.nlm.nih.gov/condition/psoriatic-arthritis. Accessed July 25, 2020.
4. Jadon DR, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phenotype of psoriatic spondyloarthritis. Ann Rheum Dis. 2017 76:701.
5. ACR. Psoriatic Arthritis. www.rheumatology.org
6. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Psoriatic Arthritis. Available at: www.niams.nih.gov/health-topics/psoriatic-arthritis#tab-symptoms. Accessed July 30, 2020.
7. Alexis AF, Blackcloud P.Psoriasis in Skin of Color: Epidemiology, Genetics, Clinical Presentation, and Treatment Nuances. J Clin Aesthet Dermatol. 2014 7:16-24
8. FitzGerald O, Haroon M, Giles JT, et al. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Res Ther. 2015 17**.
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Causes Of Psoriatic Arthritis
Almost 1 in 3 people with psoriasis also have psoriatic arthritis.
It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms.
Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue.
But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not.
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
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How Can I Care For Myself If I Have Inflammatory Arthritis
Although there’s no cure for inflammatory arthritis, there are many things you can do to reduce pain and stiffness and to help prevent joint damage and disability.
- Have regular check-ups with your GP. Your doctor can advise you on treatment options and other things you can do to help reduce pain, swelling and inflammation. Your doctor will monitor you after you start on preventative maintenance treatment, and you’ll need to have regular blood tests.
- Try some non-drug treatments, such as physiotherapy, hydrotherapy and occupational therapy. Ask your GP or rheumatologist about these options, and how you can access them.
- Stop smoking as this can increase your risk of inflammatory arthritis.
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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Get Back On Track With Your Meds
Don’t cut back on your psoriatic arthritis drugs even if you start to feel better. Your symptoms may have improved, but it doesn’t mean you’re cured. If you did give in to temptation and stopped your medicine, the first thing to do is call your doctor. The two of you can set a plan to restart your medication and adjust the doses if necessary.
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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What Is Psoriatic Arthritis
Psoriatic arthritis is a form of inflammatory arthritis characterized by joint pain, swelling, and morning stiffness. It is associated with having psoriasis or a family history of psoriasis. Both psoriasis and psoriatic arthritis are chronic autoimmune diseases meaning, conditions in which certain cells of the body attack other cells and tissues of the body.
Psoriatic arthritis can vary from mild to severe, it can present in the following ways:
- Oligoarticular, affects four or fewer joints in the body.
- Polyarticular, affecting four or more joints.
- Spondylitis, less common and affecting the spine, hips, and shoulders.
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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Make Sleep A Priority
It’s super important to get enough rest when a flare strikes. If your symptoms make it hard to get shut-eye, a few simple changes can help break the cycle:
- Go to bed and wake up at the same time every day.
- Sleep in a cool, dark room.
- Cut out caffeine after lunch.
- Ban electronics from your bedroom.
Work Out At Times When You Feel Your Best
You might try to schedule your workouts first thing in the morning before life has a chance to interfere with your plans. But working out when you feel your best is usually more doable when you have psoriatic arthritis, according to Dr. Iversen.
For many people, exercising is easier later in the afternoon because theyre too sore and stiff in the morning, Dr. Iversen says. You may be more motivated to exercise when your body feels its best, plus you can focus on your form when youre not distracted by any pain. Some individuals find that light movement in the morning, such as stretching, can help ease tightness. Dr. Iversen suggests doing some gentle movements before you even get out of bed, then doing a little more while youre standing under warm water if you shower in the morning.
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What Triggers Psoriatic Pain
Many things can trigger a flare-up and increased pain. Making healthy changes to your lifestyle and avoiding overwhelming physical activity is a major part of avoiding psoriatic arthritis pain. Smoking and stress are common triggers and should be avoided or managed as much as possible.