Monday, October 2, 2023

Is Psoriatic Arthritis Considered An Autoimmune Disease

What Are Autoimmune Diseases

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Your immune system is made up of organs and cells meant to protect your body from bacteria, parasites, viruses and cancer cells. An autoimmune disease is the result of the immune system accidentally attacking your body instead of protecting it. It’s unclear why your immune system does this.

There are over 100 known autoimmune diseases. Common ones include lupus, rheumatoid arthritis, Crohns disease and ulcerative colitis.

Autoimmune diseases can affect many types of tissues and nearly any organ in your body. They may cause a variety of symptoms including pain, tiredness , rashes, nausea, headaches, dizziness and more. Specific symptoms depend on the exact disease.

How Is Psoriasis Diagnosed And Treated

Psoriasis often has a typical appearance that a primary care doctor can recognize, but it can be confused with other skin diseases , so a dermatologist is often the best doctor to diagnose it. The treatment of psoriasis usually depends on how much skin is affected, how bad the disease is , or the location . Treatments range from creams and ointments applied to the affected areas to ultraviolet light therapy to drugs . Many people who have psoriasis also have serious health conditions such as diabetes, heart disease, and depression. Some people with psoriasis also have an inflammatory condition which affects their joints, called psoriatic arthritis.

Psoriatic arthritis has many of the same symptoms as other types of arthritis, so a rheumatologist is often the best doctor to diagnose it. The treatment of psoriatic arthritis usually involves the use of drugs .

Psoriatic disease may be treated with drugs or a combination of drugs and creams or ointments.

Treatments That Target The Immune System

Treatment for psoriasis depends on the type and severity of the condition, your general health, and other factors.

Here are the various treatments that target specific factors in the immune system that cause inflammation. These are generally used when your psoriasis symptoms are moderate to severe. Note that the newer drugs are more expensive.

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Autoimmune Disease Risk Factors

Researchers dont know what causes autoimmune disease, but several theories point to an overactive immune system attacking the body after an infection or injury. We do know that certain risk factors increase the chances of developing autoimmune disorders, including:

  • Genetics: Certain disorders such as lupus and multiple sclerosis tend to run in families. Having a relative with autoimmune disease increases your risk, but it doesnt mean you will develop a disease for certain, says Orbai.
  • Weight: Being overweight or obese raises your risk of developing rheumatoid arthritis or psoriatic arthritis. This could be because more weight puts greater stress on the joints or because fat tissue makes substances that encourage inflammation.
  • Smoking: Research has linked smoking to a number of autoimmune diseases, including lupus, rheumatoid arthritis, hyperthyroidism and MS.
  • Certain medications: Certain blood pressure medications or antibiotics can trigger drug-induced lupus, which is often a more benign form of lupus, Orbai says. Our myositis center also discovered that specific medications used to lower cholesterol, called statins, can trigger statin-induced myopathy. Myopathy is a rare autoimmune disease that causes muscle weakness. Before starting or stopping any medications, however, make sure to talk to your doctor.

Psoriatic Arthritis Vs Rheumatoid Arthritis

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The first step in discovering if you could have a chronic inflammatory condition such as psoriatic arthritis or rheumatoid arthritis is to talk to your doctor.

Because you are an important part of your healthcare team, we’ve created this quick guide to help you understand the difference between PsA and RA, and spark more productive conversations between you and your rheumatologist.

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Psoriatic Arthritis Is A Lot Like Rheumatoid Arthritis But With A Nasty Skin Rash This Probably Sounds Terrible But I Was Secretly Happy When I Heard Phil Mickelson The Golfer Was Diagnosed With Psoriatic Arthritis Not That I Would Wish

Psoriatic arthritis is a lot like rheumatoid arthritis but with a nasty skin rash.

This probably sounds terrible but I was secretly happy when I heard Phil Mickelson the golfer was diagnosed with psoriatic arthritis. Not that I would wish the diagnosis on anyone! But I thought, wow, maybe it will increase awareness and maybe, just maybe, more studies and treatment options will become available.

I had worked for a rheumatologist/internal medicine doctor back in the early years of my nursing career. We had patients with rheumatoid arthritis, osteoarthritis, lupus, Sjogrens, a few cases of temporal arteritisI even saw my first HIV positive patient working in that clinic in the mid 80s. But I never once heard of psoriatic arthritis. I dont even remember hearing about it in nursing schooland I still hadnt heard of psoriatic arthritis when I was diagnosed in my late 40s. I was baffled by my diagnosis partly because I had no idea what it was but also it never even occurred to me since the psoriasis I had on my scalp had been diagnosed as just a bad case of dandruff and my sausage toes had been diagnosed as Mortons Neuroma.

How Do Autoimmune Diseases Affect You If You’re Trying To Get Pregnant

Some autoimmune diseases can affect your ability to get pregnant and some have adverse effects on pregnancy. You may need fertility treatments to get pregnant. You might also want to wait until your disease is in the remission stage to try to conceive.

There is a higher risk for stillbirth or preterm birth if you have lupus. If you have myasthenia gravis, you may experience trouble breathing.

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Psoriatic Disease: An Autoimmune Disease Experts View

Psoriatic disease is a condition you have your whole life. Skin plaques are the main symptom, but many people also get joint pain. It requires lifelong observation by medical professionals. Although there isnât a cure for psoriatic disease, there are great medications to help control the symptoms.

The news that you have it can sometimes come as a surprise. You may see your primary care doctor because youâre having joint pain, but be unaware of plaques because theyâre hiding on your backside, scalp, chest, or groin.

If your psoriasis is mild enough, a primary care doctor should be able to prescribe topical steroids or other topical medications to help, depending on how much of your body is involved.

But many people with psoriasis require more than just topical therapies, especially if they have joint pain and swelling. If your psoriasis care goes beyond the scope of a primary care doctor, youâll need to see other specialists to get the treatment you need.

People With Psa May Not Have Psoriasis Or May Not *realize* They Have Psoriasis

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In about 70 percent of PsA cases, psoriasis symptoms come first. In about another 15 percent, psoriasis and PsA symptoms strike at the same time and in another 15 percent, the arthritis-like symptoms come first.

When patients dont have obvious psoriasis symptoms, it can lead doctors to not suspect PsA, says Daytona Beach, Florida, rheumatologist and CreakyJoints medical advisor Vinicius Domingues, MD. Patients have zero skin manifestations, but they have an inflammatory pattern of pain, and then just because they dont have psoriasis, doctors dont diagnose them with psoriatic arthritis.

Or you may have psoriasis, but not realize or think about it much. Its not always easy to diagnose the psoriasis or see the psoriasis, Dr. Haberman notes. Patients think, Oh, Ive had this one little area behind my ear that sometimes itches, but otherwise they never notice it. Or they could have a little fleck in their scalp, which they just think is dandruff.

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Psoriatic Arthritis And Your Lungs

The inflammation associated with psoriatic arthritis can also harm your lungs and increase the risk of chronic obstructive pulmonary disease a group of lung conditions that cause breathing difficulties.

A Taiwanese study published in the Journal of the European Academy of Dermatology and Venereology showed the risk for COPD was even higher in men and those over age 50 with psoriasis.

If you have psoriatic arthritis, you might want to avoid smoking, lung irritants, and dust, which could raise your chances of developing COPD.

How Are Autoimmune Diseases Treated

There are no cures for autoimmune diseases, but symptoms can be managed. Everyones immune system, genetics and environment are different. That means that your treatment must be unique.

Some examples of medications used to treat autoimmune diseases include:

  • Painkillers.
  • Limiting processed foods from your diet.

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How Does It Affect Cartilage

In arthritis, the cartilage at the end of the bones becomes damaged and breaks down. In PsA, this damage results from persistent inflammation. As the cartilage erodes, the bones rub together, causing further pain and joint damage. Inflammation can also lead to bone erosion and extra bone growth.

Chronic inflammation can also affect the ligaments and tendons around the joint.

What Are Common Symptoms Of Autoimmune Disease

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Between taking care of yourself and family members and trying to manage a social life and career, its common for women to feel tired and achy. But are these symptoms of a stressful life, or could they be tied to an underlying condition like autoimmune disease?

Ana-Maria Orbai, M.D., M.H.S., is a rheumatologist at the Johns Hopkins Arthritis Center. Rheumatologists specialize in diagnosing and treating musculoskeletal diseases and autoimmune conditions . Orbai talks about how to recognize common autoimmune disease symptoms and when you should see a doctor.

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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.

How To Get The Right Arthritis Diagnosis

There is no single test for psoriatic arthritis, says Azar. Along with a physical exam, youll likely need a series of both imaging procedures and blood tests for a diagnosis, and to rule out other forms of arthritis, such as rheumatoid arthritis or gout.

Theres no one test to diagnose rheumatoid arthritis either, but, as with PsA, blood tests are part of the workup. The presence of autoantibodies in the bloodstream, either rheumatoid factor or cyclic citrullinated peptide antibodies, will suggest an RA diagnosis. These antibodies tend to be less typical in people with psoriatic arthritis, according to an article published in Rheumatic and Musculoskeletal Diseases in August 2018.

As part of the physical exam, the doctor will closely evaluate the affected joints. RA involves the joints in a symmetrical fashion, and often, when rheumatoid factor is very high, there may be nodules under the skin, Azar says. According to the National Rheumatoid Arthritis Society, 20 percent of patients with RA develop these firm lumps.

Psoriatic arthritis, on the other hand, can reveal itself in a variety of ways, affecting a large joint or a single small finger joint of the hand, says Azar.

Another notable difference between the two diseases is bone involvement. RA is characterized by bone loss or erosion near the joint, while PsA is marked by both bone erosion and new bone formation, Azar says. An X-ray or other imaging method can help reveal whats going on.

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The Importance Of Early Diagnosis

Given all these factors, its no wonder that a 2018 study conducted by our parent non-profit organization, the Global Healthy Living Foundation, found that 96 percent of people who were ultimately diagnosed with psoriatic arthritis received at least one misdiagnosis first. For about 30 percent of PsA patients, it took more than five years to get diagnosed.

These diagnosis delays could lead to irreversible joint damage, which is why its key to identify the problem early and start treating it.

Here is a list of the most common health issues that can have symptoms that are similar to psoriatic arthritis. If you suspect you have any of them, share your concerns with your doctor or dermatologist and ask if further testing is right for you.

Effects On The Digestive System

8 Signs You May be at Risk for Psoriatic Arthritis

There is a link between inflammatory bowel disease , such as Crohns disease, and PsA because inflammation underlies both conditions. IBD causes diarrhea and other gastrointestinal symptoms.

People with PsA have a significantly increased risk of developing IBD, according to research from 2017. Other studies suggest that psoriasis is eight times more common in people with Crohns disease.

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What Questions Might A Healthcare Provider Ask To Help Diagnose An Autoimmune Disease

When your healthcare provider interviews you, they might ask you one or more of the following questions:

  • What medications are you taking?
  • What are your symptoms?
  • How severe are your symptoms?
  • Have you had to go to the emergency department because of your symptoms?
  • How long have you had these symptoms?
  • In what ways are your symptoms affecting your quality of life?
  • Is there anything that triggers your symptoms? Anything that makes them worse?
  • Is there a history of autoimmune diseases in your family?
  • Which autoimmune diseases run in your family?
  • What over-the-counter or alternative medicines have you tried, if any?

Most Rheumatologists And Public Health Experts Want People Living With Rheumatic Diseases Like Psoriatic Arthritis To Get The Vaccine As Soon As They Can

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

If you live with psoriatic arthritis, an inflammatory and autoimmune form of arthritis that affects about 30 percent of people with psoriasis, you may understandably have many questions and concerns about getting the COVID-19 vaccine.

Heres the bottom line: Especially if you have an autoimmune condition like psoriatic arthritis, most rheumatologists and public health experts recommend you get vaccinated against COVID-19. In its COVID-19 Task Force Guidance, the National Psoriasis Foundation says that in most cases, patients with psoriatic disease who dont have contraindications should take the first authorized COVID-19 vaccine that becomes available to them.

Similarly, the American College of Rheumatology states that autoimmune and inflammatory rheumatic disease patients , which includes people with psoriatic arthritis, should receive the vaccine when theyre eligible.

The ACR also states that disease activity and severity should not delay you from getting the vaccine except in extreme cases . That said, vaccination would ideally take place in the setting of well-controlled disease.

Heres everything you need to know about getting the COVID-19 vaccine if you have psoriatic arthritis.

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Do You Need To Modify Psoriatic Arthritis Medications Before Or After Getting The Vaccine

Temporarily stopping certain immunosuppressant medications after receiving the vaccine, or timing when you get the vaccine in the course of your treatment, might help increase the effectiveness of the COVID-19 vaccine if you have PsA.

But this only applies to a select few psoriatic arthritis medications. It is recommended, in most cases, that PsA patients who are to receive a COVID-19 vaccine continue their biologic or oral therapies for psoriatic arthritis, says Dr. Gupta.

The American College of Rheumatology and National Psoriasis Foundation guidance differs on this matter, which is why its important to discuss this with your doctor and make a decision thats right for your situation.

Here are the psoriatic arthritis drugs for which the ACR guidance suggests changes may be recommended:

  • Methotrexate: Skip for 1 week after each vaccine dose
  • JAK inhibitor : Skip for 1 week after each vaccine dose
  • Abatacept , injectable form: Skip one week before and after the first vaccine dose only
  • Abatacept , IV form: Get COVID-19 vaccine 4 weeks after your last infusion, then skip a week and get next infusion

The NPF guidance recommends that patients continue their biologic or oral therapies for psoriatic arthritis in most cases. For the Johnson & Johnson COVID-19 vaccine, which is only one dose, the guidance says that certain patients can consider holding methotrexate for two weeks after getting the vaccine:

The Role Of Inflammation

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Inflammation is an important reaction to infection, injuries, and toxins. When the immune response of the body is triggered in cases of psoriatic disease, it can lead to inflammation that can cause skin and/or joint symptoms to flare , along with systemic inflammation that can affect other parts of the body.

Normally, it takes 21 to 28 days for cells on the surface of the skin to grow and shed it may take as few as four days in skin affected by psoriasis, due to the increased immune response. For psoriasis, a flare may include new psoriasis plaques or the return of plaques to a prior location, itch, irritation, or burning.

With PsA, a flare may include new or increased pain, tenderness, swelling, or stiffness in joints. Flares may last for various amounts of time and may vary in level of severity.

However, having skin affected by psoriasis or joints affected by PsA can be a sign of inflammation occurring in other parts of the body. Even people living with mild psoriasis may have inflammation in the body.

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What Can You Do At Home

You can do things at home to help protect your joints and ease pain. Try these tips:

  • Rest your joints when they are sore or overworked. Ask your doctor or therapist about using braces, splints, or shoe supports to help protect your joints.
  • Try to limit or avoid activities that may cause joint pain or swelling. Writing down these triggers may help you keep track of them.
  • Try ice or a cold pack on the joint area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. Or try using heat to ease pain.
  • Try to reach and stay at a healthy weight. Regular exercise and a healthy diet will help you do this. Extra weight can strain the joints. Losing even a few kilograms may help.

Stay active

Keeping an active lifestyle can also help you manage arthritis. Talk to your doctor about exercises that may be safe and helpful for you. These may include:

  • Walking.
  • Swimming or doing other water exercise.
  • Riding a stationary bike.

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