What Is Psoriatic Arthritis
Psoriatic arthritis is a type of arthritis linked with psoriasis, a chronic skin andnail disease. Psoriasis causes red, scaly rashes and thick, pitted fingernails.Psoriatic arthritis is similar to rheumatoid arthritis in symptoms and jointswelling . But it tends to affect fewer joints than RA. And it does notmake the typical RA antibodies. The arthritis of psoriatic arthritis comes in 5forms:
- Arthritis that affects the small joints in the fingers, toes, or both
- Asymmetrical arthritis of the joints in the hands and feet
- Symmetrical polyarthritis, which is similar to RA
- Arthritis mutilans, a rare type of arthritis that destroys and deforms joints
- Psoriatic spondylitis, arthritis of the lower back and the spine
Psoriasis and Psoriasis Arthritis FAQ
How Is Psoriatic Arthritis Linked To Plaque Psoriasis
About 85% of people who develop psoriatic arthritis in their joints had psoriasis skin symptoms first. Most of those patients have mild psoriasis and have had skin symptoms for years before they develop joint symptoms1. Nail involvement is often one of the first signs that people with plaque psoriasis will also develop psoriatic arthritis5.
However, many patients with both conditions find that their joint symptoms and skin symptoms do not usually flare up at the same time2. Further, research has shown that there does not seem to be a direct link between the severity of the two conditions among people who have both of them3. For example, having severe skin symptoms does not necessarily mean that you will also have severe joint symptoms, and vice versa.
An Immune System Cell May Be The Common Culprit
A butterfly-shaped gland located in the neck just above the collarbone, the thyroid makes hormones and regulates heart and digestive function, mood, bone maintenance, calorie-burning, muscle control, and brain development.
- 47 percent higher risk of Hashimotos thyroiditis
- 22 percent higher risk of having hyperthyroidism
- 26 percent higher risk of Graves disease
I have seen patients throughout the years with psoriasis and thyroid disease, mainly Hashimotos thyroid disorder and hypothyroidism, saysSpyros Mezitis, MD, an endocrinologist affiliated with Lenox Hill HospitalNorthwell Health and NewYorkPresbyterian Hospital and Cornell Medicine in New York City. There may be a link related to T-helper 1 cells, which are part of our immune system and play a role in the process of these diseases.
The research in JAAD suggested that thyroid problems and psoriasis may be explained by type 1 T-helper cells, which play an important role in inflammatory response.
They do share some of the same kind of T cells and T-cell response, says Matthew Lewis, MD, a dermatologist with Stanford Health Care in Redwood City, California.
Dr. Lewis, however, points out that the connection between the two diseases may be due solely to chance because about 5 percent of the population has hypothyroidism, according to the National Institute of Diabetes and Digestive and Kidney Disease, while 2 to 3 percent have psoriasis, according to the National Psoriasis Foundation .
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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.
How To Prevent Psoriasis And Psa Flare
The symptoms of psoriatic disease cant be completely stopped, but they can usually be controlled with treatment.
Identifying what triggers your psoriasis and PsA flares is key to treating the condition. Because PsA is a result of psoriasis, both conditions may be triggered by the same environmental factors.
For some people, stress can be a major trigger for a psoriasis flare. Learning breathing exercises, practicing yoga, and using other coping mechanisms for stress may help stop stressful situations from making your psoriasis symptoms worse.
The biggest lifestyle change that might ease the symptoms of psoriatic disease is diet. Looking at your diet to identify things that trigger your psoriasis symptoms could mean removing some foods as a form of treatment.
Obesity is known to contribute to psoriasis symptoms. Maintaining a healthy diet is essential to being in a healthy weight range. If you can avoid carrying extra pounds, studies indicate that your symptoms will be less severe.
Drinking alcohol and smoking can also trigger flares, so limiting or eliminating these factors entirely can be beneficial.
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Does Diet Make A Difference
- No particular diet is uniformly effective some people with psoriatic arthritis have found cutting down on saturated fats helps and may reduce the doses needed of other treatments, though research has not confirmed this.
- Dietary supplements such as evening primrose oil and certain fish oils may have a variable effect. They are safe and have other health benefits, but effects specifically beneficial to psoriatic arthritis have not been proven in research.
- Following guidelines about healthy lifestyle, keeping weight down and moderating alcohol intake are all generally accepted as beneficial regardless of having psoriasis or psoriatic arthritis. Keeping weight in the healthy range has been shown to improve the likelihood of responding to medication. See Psoriatic Lifestyle
Remember: many so-called cures for arthritis are not proven by clinical trials to be of use and may be driven by profit to those advocating them.
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 dont 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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Psoriasis And Your Risk For Other Conditions
As an autoimmune inflammatory condition, psoriasis shares a link with other systemic conditions like diabetes, metabolic syndrome, heart disease, stroke, and high blood pressure based on a shared underlying cause.
It is believed that these conditions result from chronic inflammation throughout the body caused by the activation of T-cells, a type of white blood cell involved in immune system responses, and specific cytokines .
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.
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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.
Treatments Target Markers In The Blood
Generally, dermatologists treat mild psoriasis in patientswithout PsA with a topical cream or phototherapy that only penetrates the topskin layers.
However, for someone who has PsA and/or moderate to severe psoriasis, pills or injected medications often biologics are needed to control systemic inflammation. There are now many treatment options that effectively control psoriasis inflammation in both the skin and joints.
Topical medications have no way to control systemicinflammation, Dr. Fernandez says. Thats why pills and injectables are soimportant. They can access the bloodstream and can reduce inflammation all overthe body.
While glucocorticoids are a help, injecting them can carry asmall risk of serious joint infection, and side effects make long-term useundesirable. Your doctor will likely screen for active infections or a historyof frequent infections when deciding whether to use this therapy.
Some pills may stimulate liver inflammation. They can alsoreduce blood counts or impair kidney function, he says.
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Psoriasis And Psoriatic Arthritis Are Linked With Heart Disease
- Researchers looked over data from thousands of people who underwent testing for suspected coronary artery disease to understand the risk of cardiovascular events in people with psoriasis and psoriatic arthritis.
- The study showed that people with psoriasis and psoriatic arthritis had more plaque buildup in their arteries and had a higher risk of heart disease.
A new study helps people with psoriasis and psoriatic arthritis better understand their risk for developing heart problems. The study, called Prevalence and Severity of Coronary Artery Disease Linked to Prognosis in Psoriasis and Psoriatic Arthritis Patients: A Multi-centre Cohort Study, was published on May 12 in the Journal of Internal Medicine.
The researchers undertook the study because they wanted to determine whether people with psoriasis were likely to have more severe coronary artery disease. Coronary artery disease is the most common form of heart disease. It develops when the arteries fill with plaque material made up of fatty substances, cholesterol, calcium, and other substances. When too much plaque builds up, blood has a hard time flowing through the arteries, leading to heart problems.
Coronary artery disease can be diagnosed with several different tests, including a coronary computed tomography angiography . This test scores the amount of plaque in the arteries. The higher the coronary artery calcium score , the higher a persons risk of heart disease or a heart attack.
Experts Arent Sure Why Psoriasis And Psoriatic Arthritis Are Linked
Psoriasis and psoriatic arthritis are clearly connected, but experts dont know why some people develop both conditions. However, genetics appears to be involved. Researchers have pinpointed a family of genes called the human leukocyte antigen complex as a possible contributor to psoriasis and psoriatic arthritis, according to the U.S. National Library of Medicine. People with psoriasis or psoriatic arthritis have HLA genes that are different from people who dont have either condition, according to a May 2021 paper published in The Journal of Rheumatology. And people with psoriasis who have a specific HLA gene mutation are more likely to develop psoriatic arthritis, according to the same paper.
Medical experts also believe that psoriatic arthritis may be inherited. About 40% of people with psoriatic arthritis have a family member with either psoriasis or psoriatic arthritis, according to the U.S. National Library of Medicine.
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How Is Psoriatic Arthritis Diagnosed
Psoriatic arthritis is easier to confirm if you already have psoriasis. If you donthave the skin symptoms, diagnosis is more difficult. The process starts with a healthhistory and a physical exam. Your healthcare provider will ask about your symptoms. Youmay have blood tests to check the following:
- Erythrocyte sedimentation rate . This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the bloods proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- Uric acid. High blood uric acid levels can be seen in psoriatic arthritis but are not used for diagnosis or monitoring.
- Imaging. X-rays, CT scans, ultrasound, MRI, and skin biopsies may all be used to help diagnosis.
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 its making every-day tasks difficult.
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.
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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
Summary And Clinical Applicability
We found patients with PsA and psoriasis had an increased prevalence of risk factors for and fracture , the researchers noted.
Fractures, in particular ostseoporotic fractures, are a major health concern that results in poor outcomes, the researchers concluded, adding that osteoporosis is largely underdiagnosed. Screening and management of should still be considered for patients with psoriasis and PsA using guidelines available for the general population.
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Psoriatic Arthritis And Psoriasis Are Both Autoimmune Conditions
Both conditions happen when your autoimmune system mistakenly attacks healthy cells in your body, causing inflammation. With psoriasis, new skin cells grow too quickly and build up, resulting in thick, scaly rashes that can make it painful to move, according to the Cleveland Clinic. People with psoriatic arthritis also have inflammation, but their symptoms generally result in stiff, painful joints, and swollen skin surrounding the joints, according to the Mayo Clinic.
The exact causes of autoimmune diseases are not clear. Some experts theorize that injuries might trigger psoriatic arthritis and that infections could trigger psoriasis, according to John Hopkins University. Doctors commonly suspect that genetics may determine whether someone is susceptible to autoimmune disorders, but the specifics explaining how or why are up in the air.
Both conditions are lifelong diseases that can alternate between periods of remission where you have very few symptoms and flares in which your symptoms are worse.
Does The Severity Of Skin Or Nail Psoriasis Matter
- Nail changes are found in 2 out of 5 individuals with psoriatic arthritis, compared with around half in those with psoriasis alone.
- Nail changes include pitting and discolouration of the nail due to abnormalities in the growth of tissue in the nailbed.
- The risk of developing psoriatic arthritis is greater in individuals with severe psoriasis, yet severe psoriatic arthritis may occur with minimal skin disease.
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Where Can I Get More Information
Around 9 out of 10 UK adults have access to the internet which is the easiest place to find more information. For those without internet access or who cannot get online, the options are becoming limited. A good place to start is the local public library, which often holds useful information. It may not be on immediate display, however, so try asking at the main desk. It is also worth asking your local GP surgery or hospital, which should have information in an accessible format.
Treatment Options For Psoriasis Only
The most common treatments for mild psoriasis are topical skin creams and ointments. These include vitamin D, salicylic acid, and a class of drugs called corticosteroids.
Vitamin D has been deemed an effective treatment for autoimmune problems in the body, including psoriasis.
Corticosteroids have been found to be at least as effective as vitamin D. The drawback of corticosteroids is that over time, using them on your skin might make your skin weaker. Other side effects of corticosteroids include:
- broken blood vessels
- irritation
- skin that bruises
Corticosteroids range from mild to extremely potent. The more potent the drugs, the higher the potential for side effects. Because psoriasis is a chronic disease, the best treatments are those that can be used long term without risk of injury to your body.
Certain home remedies may also help you relieve psoriasis symptoms. Daily baths using Epsom salts can soothe scaly patches on your skin. Topical aloe vera and Oregon grape have been found to help reduce irritation and inflammation.
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Diagnosing Psoriasis And Psa
Unfortunately, theres no one simple diagnostic test to check for psoriasis or psoriatic arthritis. This means your doctor will need to make a clinical diagnosis, which requires taking into account your symptoms, risk factors, as well as the results of bloodwork and X-rays or other imaging scans to assess any joint involvement.
During the physical exam, your doctor might look for signs of psoriasis on the elbows and knees as well as less visible places like the scalp, belly button, intergluteal cleft, palms of hands, and soles of feet. Theyll also check for any fingernail or toenail abnormalities, like pitting or ridging, as well as swollen fingers or toes .
The presence of dactylitis and finger and toenail changes are evidence of psoriasis that can be used to aid in the diagnosis of psoriatic arthritis if there is no evidence of skin disease, says Dr. Haberman.
Here are some common steps used to diagnose psoriasis and PsA:
- A medical exam to discuss family history, risk factors, and symptoms
- Blood tests to check for markers of inflammation and antibodies , which can help rule out other types of arthritis, including rheumatoid arthritis
- Imaging tests to detect any joint damage, dislocation of small or large joints, disfiguration , new bone formation, and inflammation in the enthesis
- Skin biopsy of a skin plaque, if you have previously undiagnosed psoriasis