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.
How Is Psoriatic Arthritis Treated
Although there is currently no cure for psoriatic arthritis, there are treatments that can relieve symptoms and help prevent long-term damage.
While some people’s symptoms are so mild that they dont need treatment, most require ongoing treatment by a medical specialist called a rheumatologist. Depending on your symptoms, your doctor may also refer you to a skin specialist or an eye specialist .
If you have psoriatic arthritis, you may need to try several different treatments before your doctor can find out what works best for you. Treatment may also need to be changed over time.
The main treatments for psoriatic arthritis include:
- painkillers and anti-inflammatories to help control pain and swelling
- other medications, such as steroids or disease-modifying anti-rheumatic drugs , during flare ups or in severe cases
Other types of therapy may be helpful, such as physiotherapy and occupational therapy. You can also do things to help yourself, such as eat well, exercise regularly, and quit smoking if you currently smoke.
Pregnancy Fertility And Breastfeeding
Psoriatic arthritis wont affect your chances of having children. But if youre thinking of starting a family, its important to discuss your drug treatment with a doctor well in advance. If you become pregnant unexpectedly, talk to your rheumatology department as soon as possible.
The following treatments must be avoided when trying to start a family, during pregnancy and when breastfeeding:
- leflunomide
- retinoid tablets and creams.
Theres growing evidence that some other drugs for psoriatic arthritis are safe to take during pregnancy. Your rheumatology department will be able to tell you which ones.
It will help if you try for a baby when your arthritis is under control.
Its also important that your arthritis is kept under control as much as possible during pregnancy. A flare-up of your arthritis during pregnancy can be harmful for you and your baby.
Psoriasis and psoriatic arthritis can run in families. If you have either condition, you could pass on genes that may increase your childrens risk though its difficult to predict.
As treatments continue to improve, people with psoriatic arthritis in years to come can expect a better outlook. If you have any questions or concerns, talk to your doctor.
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Complications Of Psoriatic Arthritis
Joint damage is the main complication of psoriatic arthritis, but the condition has several comorbidities. Be mindful of the following:
Eye conditions, such as uveitis, or inflammation of the eye
Anxiety and depression
Gastrointestinal problems such as irritable bowel syndrome , Crohns disease, and ulcerative colitis
Four Main Types Of Psoriatic Arthritis
There are 78 major joints in the body and psoriatic arthritis can affect any one of these. Usually, however, certain joints are more likely to be affected . Different patterns are found. Sometimes just one or two joints are a problem but often several joints, both large and small and on both sides of the body, are involved. About a third of people with psoriatic arthritis also have spondylitis which can result in a painful, stiff back or neck. Psoriasis can affect the nails with pitting, discolouration and thickening and this may be associated with inflammation in the joints at the end of the finger or toe. Another way in which psoriatic arthritis can be recognized is the finding of a sausage-like swelling of a finger or toe, called dactylitis. This is caused by inflammation occurring simultaneously in joints and tendons, painful heels and other bony prominence can also occur and this is caused by inflammation where gristle attaches to bone.
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Hold And Cold Therapy
Cold and hot packs can make a difference in how you feel. Cold packs have a numbing effect, so they can dull pain. A heating pad can relieve pain and swelling in joints by relaxing the muscles.
You dont have to use an ice pack or a heating pad for relief. For cold therapy, you can use a bag of frozen veggies wrapped in a towel, or for heat, try a warm bath. If you are applying heat or cold for a long period, wrap the ice or heat source in a towel before applying it to your body.
How Does It Help With Psoriatic Arthritis
PsA is an autoimmune condition in which the bodys immune system mistakenly attacks healthy tissue, causing inflammation. In PsA, this inflammation triggers joint pain, swelling, and stiffness, and it may also cause a skin rash. Over time, this systemic inflammation can lead to permanent joint and tissue damage.
A doctor may prescribe prednisone to help suppress the overactivity of the immune system and reduce the production of chemicals that trigger inflammation. In these ways, the drug helps alleviate joint pain, swelling, and stiffness.
An older suggested that early PsA treatment combining corticosteroids and disease-modifying antirheumatic drugs could improve outcomes for people with PsA. Specifically, it may have the following benefits:
- controlling joint inflammation in its early stages
- preventing joint damage
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What Will Happen To Me
With the right treatment, most people with psoriatic arthritis can lead full and active lives. However the course of psoriatic arthritis is variable and no two cases are the same. Many people find their symptoms worsen at times and then settle down for a period of time. About one in 20 people with psoriatic arthritis will develop a more severe, destructive form which can cause deformity to the joints in the hands and/or feet. Most people with psoriatic arthritis will need some ongoing treatment to control their symptoms and prevent damage to the joints. This is usually managed by a rheumatologist.
Lifestyle Remedies For Psoriatic Arthritis
Making lifestyle changes can prevent and control flares as well as alleviate the muscle weakness and joint stiffness associated with psoriatic arthritis. Lifestyle remedies include the following:
- Use assistive devices during flare-ups. Immobilize certain body parts with the use of splints, braces, orthotics, crutches, or walkers so they can rest.
- Exercise can keep joints flexible, strengthen your muscles, and boost your overall health. Walking, biking, swimming, and yoga are just a few exercises that wont stress your joints.
- Protect your joints by modifying how you perform daily tasks. For example, use a jar opener to remove a lid.
- Apply hot and cold packs. The heat and cold can help lessen the pain sensation.
- Keep your weight at a healthy level. Your joints will have less strain on them as a result.
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Treatments For Your Skin
If your psoriasis is affecting your quality of life, or your treatment is not working, you may be referred to a dermatologist.
There are a number of treatment options for psoriasis.
Ointments, creams, and gels that can be applied to the skin include:
- ointments made from a medicine called dithranol
- steroid-based creams and lotions
- vitamin D-like ointments such ascalcipotriol and tacalcitol
- vitamin A-like gels such astazarotene
- salicylic acid
- tar-based ointments.
For more information about the benefits and disadvantages of any of these talk to your GP, dermatologist, or pharmacist.
If the creams and ointments dont help, your doctor may suggest light therapy, also known as phototherapy. This involves being exposed to short spells of strong ultraviolet light in hospital.
Once this treatment has started, youll need to have it regularly and stick to the appointments youve been given, for it to be successful. This treatment is not suitable for people at high risk of skin cancer or for children. For some people, this treatment can make their psoriasis worse.
Retinoid tablets, such as acitretin, are made from substances related to vitamin A. These can be useful if your psoriasis isnt responding to other treatments. However, they can cause dry skin and you may not be able to take them if you have diabetes.
Some DMARDs used for psoriatic arthritis will also help with psoriasis.
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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Work And Psoriatic Arthritis
Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.
Help and support is available, and you have rights and options.
The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else.
Psoriatic arthritis can be classed as a disability if it:
- makes daily tasks difficult
- lasts for more than 12 months.
Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.
You might be able to change some aspects of your job or working arrangements, or train for a different role.
In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.
Other available support might include:
- your workplace occupational health department, if there is one
- an occupational therapist. You could be referred to one by your GP or you could see one privately
- disability employment advisors, or other staff, at your local JobCentre Plus
- a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.
Not Taking Your Medications On Time
Even if you are feeling fine, you should still be taking your medications as prescribed. If you miss a mediation dose or two, PsA can flare-up. In addition, skipping your medications can make it harder for the medicine to do its job.
If you have side effects that are bothering you, talk to your healthcare provider about switching to another medicine. To avoid missing doses, keep a daily pill log or download a smartphone reminder app.
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How To Hold A Job And Handle Psa
Itâs important to understand your disease, your rights and the resources available to you.
Schedule a meeting with your supervisor at a time when neither of you is under pressure. Describe how your PsA may affect your performance, including scheduling doctor appointments and the use of assistive devices. The goal of this talk is to find the workplace adjustments that will benefit the company, your co-workers and yourself. Itâs better to ask for support or adaptations from your employer than to try to push through it on your own and risk a flare-up.
âAssistive devicesâ covers everything you need to be comfortable and more productive on the job. You might need something as simple as additional breaks or assistance with lifting heavy objects or adjusting the height of your chair and desk and the distance to your computer monitor. You might need equipment, such as switching from a mouse to a track pad or using a writing bird to help you grip a pen. Research options and prices ahead of time. If possible, try new equipment at home.
Your employer may not be required to purchase expensive equipment for you. However, tax deductions and/or tax credits may be available to certain employers who provide accommodations and/or jobs for people with disabilities.
What Are The Symptoms
Psoriatic arthritis can affect any joint in the body and symptoms can vary from person to person. It can develop slowly with mild symptoms, or come on quickly and be severe. The most common symptoms are:
- pain, swelling and stiffness in one or more joints
- pain and stiffness in the buttocks, lower back or neck
- pain in tendons, such as at the back of the heel or sole of the foot
- changes in nails, such as thickening, colour change or separation from the skin
- pain and redness in the eyes.
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Here Are The Main Clues A Psoriatic Arthritis Flare Is Coming And How To Make It Go Away More Quickly
You could fry an egg on it is how one patient with psoriatic arthritis described her skin flare in a 2015 study. Affecting up to one-third of people with the inflammatory skin condition psoriasis, psoriatic arthritis is a double-whammy that has the hallmarks of both psoriasis and inflammatory arthritis . These painful symptoms may increase at certain times, called flares or flare-ups.
Science hasnt come as far in understanding psoriatic arthritis flares as it has with other types of inflammatory arthritis, such as rheumatoid arthritis.
Flares are one of the toughest things to pin down because theres no real set definition a flare, which could mean different things to different people, says Elaine Husni, MD, MPH, a rheumatologist at Cleveland Clinic. Because of this, it can be hard for patients especially those recently diagnosed with psoriatic arthritis to know when its happening.
The line between an official flare-up and the normal waxing and waning of symptoms is definitely a difficult and confusing determination for many patients to make, says occupational therapist Cheryl Crow, MOT, OTR/L, an adjunct faculty member of the Occupational Therapy Assistant program at Lake Washington Institute of Technology and an American Occupational Therapy Association spokesperson. At the most basic level, a flare-up is a period of acutely worsening symptoms however, for psoriatic arthritis, the symptoms may differ from patient to patient.
Can Psoriatic Arthritis Affect Children Too
As many as 12,000 children in the UK are affected by arthritis. It is known as juvenile chronic arthritis , of which there are three main types, stills disease, polyarticular juvenile chronic arthritis and polyarticular onset juvenile chronic arthritis. Psoriatic arthritis is a minor subset of JCA and is uncommon.
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Manage Symptoms During A Psoriatic Flare
- Moisturize: During a flare-up, locking in moisture is the first step to relieving the itch. Create a good skincare routine, especially in dry weather. Moisturizing will help prevent flares and help ease symptoms.
- Utilize assistive devices: Talk to your doctor about helpful assistive devices to provide additional support for an affected joint. They can recommend tools such as wraps, splints, or special inserts to assist with pain.
- Hot and cold therapy: Cold packs can have a numbing effect, which will help dull your pain. Heat can help relieve pain and swelling by soothing sore muscles.
Rheumatologists are experts in the diagnosis and treatment of psoriatic arthritis. With the advent of newer therapies, the majority of patients can live healthy, productive lives.
At Carolina Arthritis, we believe it is imperative for our patients to fully understand their diagnosis and be comfortable with the treatment. While there is no single treatment for psoriatic arthritis that suits everyone, the doctors at Carolina Arthritis are well trained in lessening ongoing symptoms and enhancing a patients quality of life.
If youre ready to tackle your psoriatic arthritis, contact us right away to schedule an appointment.
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Stress Is The Top Psoriatic Arthritis Trigger
The number-one thing patients tell me is that when stress levels go up, they have a flare and more pain, says Alexis Ogdie-Beatty, MD, a rheumatologist at the Perelman Center for Advanced Medicine and an associate professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia.
Why? Stress sets off the immune systems inflammatory response, according to the Arthritis Foundation. Inflammation, in turn, can fuel joint damage in people with psoriatic arthritis and other arthritic conditions.
The longer youre exposed to stress, the worse your psoriatic arthritis symptoms may get.
Another reason stress can create a cycle of pain, then more stress, is that when youre stressed, you tend to sleep less, says Dr. Ogdie-Beatty.
And when you get less sleep, your pain is likely to seem worse.
Stress can also prompt you to engage in unhealthy behaviors like smoking, drinking alcohol, and overeating, which may worsen symptoms.
How to avoid this trigger Stress busters such as yoga and meditation can help ease pain, according to the Arthritis Foundation.
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What Are The Symptoms Of Psoriatic Arthritis
The symptoms of psoriatic arthritis may be gradual and subtle in some patients in others, they may be sudden and dramatic. It may be mild, affecting only one joint or can be severe, affecting multiple joints. Not all patients experience all symptoms.
The most common symptoms of psoriatic arthritis are:
Joint symptoms
- Pain or aching, tenderness, and/or swelling in one or more joints – most commonly hands, feet, wrists, ankles, knees.
- Joint stiffness most notable in the morning or with prolonged inactivity such as sitting for a long time.
- Reduced range of motion in affected joints.
- Pain or stiffness in the lower back.
- Tenderness, pain, or swelling where tendons and ligaments attach to the bone , such as the Achilles tendon of the heel.
- Swelling of an entire finger or toe with a sausage-like appearance .
Skin symptoms
- Silver or gray scaly spots on the scalp, elbows, knees, and/or the lower spine.
- Small, round spots called papules that are raised and sometimes scaly on the arms, legs and torso.
- Pitting of the nails.
- Detachment or lifting of fingernails or toenails.
Other symptoms