Is Psoriatic Arthritis An Inflammatory Disease

What Is Cdc Doing About Psoriasis

In 2010, CDC worked with experts in psoriasis, psoriatic arthritis, and public health to develop a public health perspective that considers how these conditions affect the entire population. The resulting report is Developing and Addressing the Public Health Agenda for Psoriasis and Psoriatic Arthritis pdf icon. You can read a short article about the agendaexternal icon in The American Journal of Preventive Medicine.

CDCs National Health and Nutrition Examination Survey , an intermittent source of national psoriasis data, has included questions about psoriasis as late as the 2013-2014 cycle. A recent analysis of NHANES data estimates that 7.4 million adults had psoriasis in 2013external icon.

• Psoriasis causes patches of thick red skin and silvery scales. Patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places . The most common type of psoriasis is called plaque psoriasis.
• Psoriatic arthritis is an inflammatory type of arthritis that eventually occurs in 10% to 20% of people with psoriasis. It is different from more common types of arthritis and is thought to be related to the underlying problem of psoriasis.
• Psoriasis and psoriatic arthritis are sometimes considered together as psoriatic disease.

Who is at risk for psoriasis?

Anyone can get psoriasis. It occurs mostly in adults, but children can also get it. Men and women seem to have equal risk.

Can I get psoriasis from someone who has it?

What Are Options For Pain Management

Minor pain and stiffness of mild PsA can be alleviated with non-steroidal anti-inflammatory drugs . In addition, injections of corticosteroids may be used.5

For moderate to severe disease, treatments that target joint disease in PsA frequently can reduce symptoms and prevent disease progression. Recommended treatments include disease-modifying anti-rheumatic drugs .

The first step for treatments is usually DMARDs such as methotrexate, leflunomide, or sulfasalazine. Other treatments include medicines that target tumor necrosis factor , a chemical that produces a wide range of inflammation in PsA.

Examples of TNF blockers include etanercept , adalimumab , infliximab , golimumab , and certolizumab pegol . Other DMARDs that have proven effective in clinical trials include ustekinumab , and secukinumab .1

The FDA has also recently approved Inflectra , a biosimilar to infliximab, for the treatment of psoriatic arthritis.7Physical and occupational therapy can be critical treatment approaches to both protect the involved joints and maintain function.5

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Early Stages Of Psoriatic Arthritis

Recognizing the signs of psoriatic arthritis can be tricky since symptoms differ from patient to patient. For example, one person can experience psoriasis skin involvement and peripheral arthritis, another may experience axial disease , and someone else could have a combination of all three.

Whats more, especially during early disease, you may confuse your symptoms with other conditions. People can mistake enthesitis, inflammation of the entheses for tennis elbow or dactylitis for an infection, explains Dr. Mikulik.

If you have psoriasis and are having pain in your tendon and musculature and you think maybe Ive been too active lately, that may be the first sign of PsA, says Dr. Haberman. Doctors commonly hear people chalk up their symptoms to overuse, such as getting more exercise than usual or doing work around the house.

If you experience any of the following signs of early psoriatic arthritis its important to see your doctor as soon as possible:

• Changes in your fingernails or toenails, including holes, pitting, discoloration, or softness
• Eye inflammation
• Sausage-like swelling of an entire finger or toe
• Scalp psoriasis
• Tendon or ligament pain at the Achilles tendon, bottom of the foot , or elbow

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Loss Of Significant Joint Mobility

For example, you were able to flex your wrist 60 degrees, and two years later, you lost 50 percent of that range of motion. Its possible to feel okay and still experience loss of range of motion, says Dr. Domingues. But the idea is to prevent joint damage and to make you have less pain. If you have less pain and are still progressing, that means your treatment could be working better.

Psoriatic Arthritis And Sleep

Is your PsA causing you sleepless nights? Heres why and how to get the rest you need.

People with psoriasis and psoriatic arthritis are more likely to have trouble sleeping. The authors of a study published in the International Journal of Dermatology in 2016 found obstructive sleep apnea was so common in people with psoriasis that they suggested patients should be screened for it.

If youre having trouble sleeping, you already know about the fatigue it causes. You may be feeling effects like trouble concentrating, remembering things or mood changes. Poor sleep increases the risk of weight gain and obesity, which puts extra stress on your joints. As if that werent enough, disrupted sleep can worsen joint pain, and some experts think it may increase inflammation, too.

Recognizing the issues that are affecting your sleep can help you find relief.

Symptom Control is Critical

Painful joints or itchy skin may make it hard to fall asleep or stay that way. Chronic pain is associated with disruptive and un-refreshing sleep, says John Davis III, MD, rheumatologist at the Mayo Clinic in Rochester, Minnesota. To stop the vicious cycle of pain interrupting sleep which leads to more pain act quickly. If youre having trouble sleeping or experiencing a flare, talk to your rheumatologist and dermatologist. Adjusting your medications and making lifestyle changes may help to relieve symptoms.

Diagnosing and Treating Sleep Disorders

Reviewed 3/15/22

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Risks Associated With Treatment Strategy

Early recognition and intervention with therapy is key to controlling disease progression in patients with PsA . The tumor necrosis factor inhibitors etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol have been shown to improve signs and symptoms of PsA . Additionally, apremilast , abatacept , ustekinumab , and secukinumab have also shown varying degrees of efficacy in the treatment of PsA . Approved agents are discussed in more detail in the following section.

Treat-to-target is a therapeutic concept derived from RA and other diseases , which has been proposed for all forms of SpA . With this approach, a clear target, such as remission or low disease activity, is identified and the goal is to sustain this response over time, with an understanding of the need to treat flares and keep tight control of disease activity . A universal definition of the target is required for the treat-to-target approach and, in SpA, remission and sustained low disease activity have been suggested as possible targets . Although definitions of remission or MDA in SpA have been proposed, none have been widely accepted or endorsed and given the multifaceted nature of SpA, a composite of outcome measures may be most useful .

Classification Of Psoriatic Arthritis

Psoriatic arthritis is a form of spondyloarthritis. Spondyloarthritis is an umbrella term used to describe a family of disorders, including ankylosing spondylitis, non-radiographic axial spondyloarthritis, psoriatic arthritis, reactive arthritis, enteropathic arthritis and undifferentiated spondyloarthritis. These different forms of spondyloarthritis share several clinical features:

• Axial joint inflammation
• Asymmetric oligoarthritis
• Dactylitis: ‘sausage digits’
• Enthesitis: pain and swelling at the insertion of tendons and ligaments, commonly at the heel, tibial tuberosity and humerus this affects up to 53% of patients with psoriatic arthritis
• Negative Rheumatoid Factor
• HLA-B27 positivity: HLA-B27 is a specific protein involved with immune regulation. 57% of psoriatic arthritis patients with axial involvement are positive for HLA-B27
• Geneticsusceptibility to the condition/family history
• Distinctive radiological features.

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Types And Patterns Of Psa

PsA is defined by 5 clinical patterns:2

• Distal interphalangeal predominant pattern Primarily affects the joints closest to the nails in the fingers and toes
• Oligoarticular asymmetrical Only a few joints are affected and do not match on both sides of the body
• Polyarticular RA-like Multiple joints are affected on both sides of the body in a symmetric pattern, similar to rheumatoid arthritis
• Spondylitis Joints in the spine are affected
• Arthritis mutilans Severe form of the disease that causes deformity of the hands, fingers, or toes

Prognosis Of Psoriatic Arthritis

Estimating prognosis in PsA is difficult due to a lack of evidence and significant individual variability. PsA can evolve over time with variable joint and extra-articular involvement, according to multiple investigations. The pattern of peripheral joint disease appears to evolve with time, with oligoarthritis being more common in early disease patients than late disease individuals. In majority of the cases, increasing disease duration leads to increased joint involvement, with a large proportion of individuals with monoarthritis or oligoarthritis progressing to polyarthritis. Axial involvement becomes more likely as the disease progresses.1

PsA is a disease that can cause severe morbidity and have a negative impact on patients quality of life. Some characteristics are thought to indicate a severe disease course and a poor prognosis. A high number of actively inflamed joints or polyarticular presentations, raised ESR, clinical or radiographical damage, loss of function and a lower quality of life are all indicators.11

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Management Of Psa With Consideration Of Extra

Given the heterogeneity in manifestations, enhanced collaboration between disciplines are required to deliver optimal care for PsD . While collaborations between rheumatologists and dermatologists are increasing , collaborations with gastroenterologists and ophthalmologists have traditionally been weaker. Apart from setting up combined clinics, collaborations between disciplines can take other forms as determined by needs and circumstances of different institutions. Minimally, identifying key stakeholders specializing in the care of PsA patients and keeping them in close communication over the management plan is essential. These collaborations serve both clinical and educational needs. Close collaboration between the various disciplines will help in early diagnosis of the various manifestations, providing expert advice on choice of therapeutics to create a patient-centric, individualized care plan for the heterogeneous manifestations. Often, the therapeutics will need to cover multiple domains, but the predominant domain should drive the therapeutic option of choice in the shared decision-making process.

All in all, detailed considerations of all domains and extra-articular manifestations are necessary to formulate the best therapeutic option. Multi-disciplinary collaborative care models are advocated for optimal care for patients with PsA, and especially so for those who present with co-morbidities.

Chair Selection Is Important

It can be extremely difficult to get in different types of seats, depending on their height, width, and design, because of pain or stiffness. Luckily, I was a chemistry teacher, so I had lab stools, which were much easier for me, Dishner says. But outside school, I would find myself scanning a room to find the right chair.

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Develop An Arthritis Pain Management Strategy

A person can work with a doctor to develop a plan for managing arthritis pain.

Where possible, it is important to avoid going to bed in pain. A doctor can recommend an appropriate pain relief medication to prevent pain before bedtime. They might suggest:

• nighttime release arthritis drugs
• drugs that work for 24 hours
• an evening dose of pain medication

Identifying and managing arthritis triggers can also be helpful. A person can try keeping a pain and sleep log to determine and address any patterns that seem to worsen sleep or pain.

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Monitoring For Psoriatic Arthritis Side Effects

Though Abatacepts effects are modest, one benefit of the drug is its comparatively low risk of side effects.1 Apremilast has a low risk of major side effects, such as infection, and does not require laboratory tests.1 The potential of serious infection, the requirement for laboratory monitoring of liver function tests and blood counts, and the rare side effect of lymphoma are all included in JAK inhibitors safety profile, which is comparable to that of rheumatoid arthritis treatment. Data shows that taking the medication at a larger dose than indicated increases the risk of thromboembolic episodes, which could be a class effect.1

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Treatment Options For Ra And Psa

Because of the differences in disease pathogenesis, clinical manifestations and response to therapy between RA and PsA, treatment strategies may differ. provides a summary of current Food and Drug Administration -approved treatments for RA and PsA. Agents targeting more upstream factors are effective in both PsA and RA, while agents targeting more downstream cytokines are more disease-specific, demonstrating significant efficacy in either RA or PsA , but not in both diseases.

Who Gets Psoriatic Arthritis

Psoriatic arthritis has an incidence of approximately 6 per 100,000 per year and a prevalence of about 12 per 1000 in the general population. Estimates of the prevalence of psoriatic arthritis among patients with psoriasis range between 4 and 30 per cent. In most patients, arthritis appears 10 years after the first signs of skin psoriasis. The first signs of psoriatic arthritis usually occur between the ages of 30 and 50 years of age. In approximately 1317% of cases, arthritis precedes the skin disease.

Men and women are equally affected. The symptoms of psoriatic arthritis come and go but it is a lifelong condition that is usually progressive.

Patients with psoriasis who are more likely to subsequently get arthritis include those with the following characteristics:

• Elevated C-reactive protein at baseline.

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Fatty Liver And Psoriatic Disease

Theres a much higher prevalence of fatty liver disease in people with psoriatic arthritis, says Ritchlin.

A review of studies in the Journal of Clinical and Aesthetic Dermatology found that up to 47 percent of psoriatic patients develop nonalcoholic fatty liver disease a condition that causes fatty deposits to develop on the liver and can lead to permanent scarring or damage. According to a study published in the journal Gastroenterology Review, NAFLD is frequent in patients with psoriasis and is also associated with the duration and severity of the disease.

Researchers believe the inflammation triggered by psoriatic arthritis may also affect different areas of the body, including the liver. Additionally, people with psoriatic arthritis are more likely to have obesity, diabetes, and metabolic syndrome, which are all NAFLD risk factors.

Drugs used to treat psoriatic arthritis, including NSAIDs and methotrexate, can adversely affect your liver. If youre taking these drugs, your doctor will want to monitor your liver function.

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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Risk Factors For Developing Psoriasis

Both psoriasis and CD have genetic risk factors and are linked to an increased prevalence of each of these conditions among first-degree family members parents, children, and siblings. Some other risk factors for developing psoriasis, with or without IBD, include:

• Some viral and bacterial infections

Comorbidities Of Psoriatic Arthritis

PsA is linked to a number of chronic illnesses that can shorten life and reduce the quality of life. Even though most studies suggest that overall mortality in individuals with psoriatic arthritis is not greater than in the general population, obesity and cardiovascular comorbid conditions are more common, which might affect lifespan and quality of life.

When compared to the general population, the prevalence of cardiovascular risk factors such as hypertension, hyperlipidemia, type 2 diabetes mellitus, and the combination of these is higher in psoriatic arthritis. Even after adjusting for established risk variables, psoriatic arthritis is linked to an elevated risk of cardiovascular events like myocardial infarction. Similarly, people with psoriatic arthritis have a higher chance of developing type 2 diabetes and fatty liver.1

PsA has also been linked to extra-articular symptoms such as uveitis and inflammatory bowel disease, such as Crohns disease and ulcerative colitis. In patients with psoriatic arthritis, a meta-analysis found a 3% prevalence of uveitis and a 3% prevalence of inflammatory bowel disease. Because not all psoriatic arthritis treatments cover various manifestations, these conditions can have a significant impact on treatment choices.1

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Epidemiological Characteristics Of Ra And Psa

RA is more common than PsA, affecting more than 1 million in the USA. PsA affects roughly half a million people in the USA and approximately 30% of patients with psoriasis. Worldwide prevalence estimates for RA and PsA are variable. In many populations, RA prevalence is estimated to be 0.5%1.0% however, prevalence is much higher in Native American Indian populations but lower in China and Japan . PsA prevalence estimates in the USA and Europe range from 0.1% to 0.4%, whereas in Japan, PsA prevalence is lower. This variability in prevalence suggests that both environmental and genetic factors affect risk for disease.

Jaw Pain And Psoriatic Arthritis

Psoriatic arthritis can affect any joint, including the temporomandibular joint that connects the jawbone to the skull. The TMJ is linked to the masseter the strongest muscle in your body based on its weight. Because it works so hard, the TMJ is at risk for damage.

About 35 percent of people with psoriatic arthritis will have symptoms in their TMJ, according to the National Psoriasis Foundation.

Rheumatologists are encouraged to perform a 66-68 joint count, which essentially measures swelling in 66 joints and tenderness and pain in 68 joints. Still, doctors often miss signs of TMJ damage.

In clinical practice, rheumatologists arent necessarily used to looking at the TMJ. They are part of the 66-68 joint count, which was endorsed as a mandatory measure for clinical trials and longitudinal studies, Ana-Maria Orbai, MD, an assistant professor of rheumatology at Johns Hopkins University in Baltimore, and an NPF medical board member, told the National Psoriasis Foundation. But most people in practice will just look at patients hands. Because practitioners arent doing the full joint count, they may miss the TMJ.

Treatment options, such as biologics and disease-modifying anti-rheumatic drugs , can help prevent or slow TMJ damage. Additionally, you should try to avoid chewing hard foods to reduce pressure on your jaw.

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