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 .
Youre A Serious Germaphobe
You wash your hands religiously, carry sanitizing wipes everywhere, and avoid germ hubs, such as bowling alleys and movie theaters. And with good reason: Anything that can affect your immune system may worsen your symptoms. Many psoriatic arthritis medications suppress the immune system, leaving you more susceptible to germs, and flare-ups can occur when you get an infection. While vitamins and general attention to hygiene can help ward off sickness, having to skip bowling night with your family to avoid getting sick can still sting even if it does help you avoid a monthlong cold.
Try Gentle Stretching And Strengthening Exercises
If you’re less active because of psoriatic arthritis pain, your muscles can start to weaken. And tight, weak muscles can put extra pressure on your joints, which can make pain worse, says Katie Lawton, MEd, an exercise physiologist at the Cleveland Clinic in Ohio. Stretching and strengthening exercises can increase your range of motion and build muscle to help take pressure off of your joints.
The key is to determine which muscles to work and how much to work them, says Lawton. If you have chronic pain, start by stretching to a tolerable limit and then gradually increasing the stretch over time. Strength training, which includes exercising with free weights, resistance bands, or your own body weight, is also beneficial, but its important to understand your limitations. You may want to consider working with a physical therapist or personal trainer, who can help you develop a workout plan thats right for you.
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What Are The Symptoms Of Psoriasis
There are different types of psoriasis. The most common is chronic plaque psoriasis. This causes patches of red, raised skin, with white and silvery flakes.
It can occur anywhere on the skin, but most commonly at the elbows, knees, back, buttocks and scalp.
Psoriasis can cause small round dents in finger and toe nails, this is known as pitting. Nails can also change colour, become thicker and the nail may lift away from your finger.
Managing Psoriatic Arthritis Flares
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.
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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.
Maintain A Healthy Weight
Being overweight can drive up your inflammation. Where body fat is distributed can contribute, as well. For instance, a large waist circumference is typically associated with excess inflammation.
Researchers recognize that there is a connection between inflammation and obesity, although more needs to be learned. At the very least, talk to your doctor to determine the ideal body mass index for your frame, and work toward that goal.
You don’t need to lose a lot of weight to improve inflammation. Reducing your weight by between 5% and 10% significantly lowers your level of inflammation, according to the Obesity Action Coalition.
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Lasts At Least A Few Days
Dr. Husni also says that a psoriatic arthritis flare usually doesnt go away after an hour or two. If you get better right away we dont really consider that a flare, which usually lasts over a couple of days or a week, she says. But, if the symptoms are really severe, you should still call your doctor even if its only been a short time. Theres no magic number of days or hours its more of how it affects your activities of daily living, Dr. Husni says.
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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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.
Rule Out Other Causes
Psoriatic arthritis can be accompanied by fibromyalgia, depression and anxiety. All also have the ability to cause fatigue.
Lastly, remember to take your medications to ease inflammation and pain as prescribed by your doctor.
Setting reminders on your phone may help. If you take your medications properly, your fatigue should be minimized.
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However, in some cases, your medication may be the blame for your fatigue. In that case, you should ask your doctor about changing or adjusting your medication. You should never adjust or stop taking your medication on your own.
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Arthritis Prevention: What Can You Do
How to avoid achy joints
You cant always prevent arthritis. Some causes, such as increasing age, family history, and gender , are out of your control.
There are more than 100 different types of arthritis. The three main types are osteoarthritis , rheumatoid arthritis , and psoriatic arthritis . Each type develops differently, but all are painful and can lead to loss of function and deformity.
There are a few healthy habits you can practice to reduce your risk of developing painful joints as you get older. Many of these practices like exercising and eating a healthy diet prevent other diseases, too.
Other Medications For Pain
When the pain of PsA is severe or when it does not go away with traditional PsA treatments, you may want to talk to your health care provider about medication that helps reduce your sensitivity to pain.
Prescription pain medications such as Gabapentin and Pregabalin are used to treat neurological pain. Certain anti-depressants called noradrenergic and specific serotonergics can reduce your sensitivity to pain as well. Capsaicin, a compound found in chili peppers, has a numbing effect on pain receptors. Applying a local anesthetic like prilocaine can help minimize the initial burning sensation of capsaicin.
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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:
- Splinting.
- Surgery.
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.
Exercise
Heat and cold therapy
Splinting
Surgery
Work With A Physical Therapist If You Can
If you have this condition, we dont have to tell you how tricky it can be to exercise for psoriatic arthritis. Dr. Bilsborrow says working with someone who understands what youre dealing with can be really beneficial. A certified personal trainer may have the skills to safely coach someone without psoriatic arthritis, but they typically arent trained in the pathology of different conditions and may not know whats best for you, according to Maura Iversen3, DPT, MPH, who is dean of the College of Health Professions and professor of physical therapy, movement science, and public health at Sacred Heart University in Fairfield, Connecticut. Physical therapy can be expensive and may not be an option for everyone. If you have insurance, you can check with your provider to see if your plan covers it.
If working with a physical therapist is an option for you, consider asking your doctor for recommendations of clinicians familiar with psoriatic arthritis, since even some physical therapists may not have the advanced training or experience to fully understand how it can affect your ability to work out. Otherwise, your physician may be able to recommend specific workouts, online resources, or even support groups in your area that can help.
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Why Your Mental Health Matters When Living With Psoriatic Arthritis
Living with a chronic condition that requires life-long management to ease pain and reduce disease progression can take its toll on a persons mental and emotional reserves. Anxiety and depression are both prevalent in people with psoriatic arthritis, with data showing 1 in 3 patients with at least mild anxiety and 1 in 5 with at least mild depression.
Not only do anxiety and depression interfere with your quality of life, but they also are linked to greater disease activity.13 So it is important to recognize any mental or emotional challenges you may be feeling and seek help.
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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But Wait Psa Gets More Complicated: Symptoms And Causes
Psoriatic arthritis can progress over time. In some people, it only causes mild disease punctuated by severe symptoms during periods of more disease activity . In others, disease activity is more persistent. No matter which camp youre in, early treatment is critical to relieve pain from affected joints, prevent joint damage, and to maintain your ability to walk and be active.5
Treatment will also help to reduce or prevent other health-related problems from developing, such as fatigue and depression .
The good news is that if diagnosed and treated early , many of these problems can be avoided or reduced. Learning to recognize the symptoms of PsA will help you and your doctor intervene to lessen the impact of the disease on your life and prevent potentially irreversible changes to your joints and bones.
How Lifestyle Changes Help
In addition to drugs that slow down the march of psoriatic arthritis, you can change your lifestyle to ease the pain, stiffness, and fatigue that come with the disease:
Simplify tasks. Why strain your joints when there are products to make twisting, turning, pushing, and pulling easier? Look for arthritis-friendly products to suit your needs, large and small — from gardening tools to walk-in bathtubs. You can also change the way you do everyday things. For example: Use your body, not your hands, to push open doors lift cookware with two hands instead of one.
Slim down. Losing weight is hard, whether youâre trying to shed 10 or 100 pounds. But achieving a healthy weight can make a difference in your PsA. It lightens the load on your joints, which means less pain, more energy, and better mobility. Plus, being overweight can make some PsA medications less effective.
Master your stress. Like fanning a flame, stress causes your body to release chemicals that aggravate PsA. Consider a therapist or support group for PsA, as well as these proven ways to manage stress:
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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
Can You Work With Psoriatic Arthritis Pain
Each persons experience with psoriatic arthritis is different. If pain is interfering with work, you should discuss it with a healthcare professional. Workplace accommodations, including schedule and workstation changes, can be sought. People with PsA should avoid demanding physical occupations or daily requirements.
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What Is Psoriatic Arthritis
Psoriatic arthritis is a chronic form of inflammatory arthritis. It can develop in people with psoriasis. Psoriasis is a skin condition that causes patches of red, scaly skin. Theres no cure, so treating symptoms is a priority. Your doctor may prescribe medications to reduce inflammation and pain. There are also natural remedies and lifestyle changes that may help relieve symptoms and improve your overall quality of life.