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.
Contact Beverly Hills Rheumatologist And Internal Medicine Specialist Today
Susan A. Baker is an experienced internal medicine specialist and rheumatologist with a thriving practice in Beverly Hills. Considered an expert in her field, Dr. Baker has helped countless individuals suffering from psoriatic arthritis manage their symptoms and return to everyday activities. To schedule a one-on-one consultation or address any questions you may have, feel free to call 271-7770 at your earliest convenience or fill out the;online contact form.
You Have Vision Problems
Psoriatic arthritis doesnt just affect your jointsthe condition can also cause problems in other tissues throughout the body. Some people living with psoriatic arthritis develop vision problems, such as painful, . For others, becomes a significant issue. If you experience any , be sure to let your doctor know immediately so your treatment can be adjusted if necessary.
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Symptoms Of Psoriatic Arthritis
The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in 1 or 2 joints.
There may be times when your symptoms improve ;and periods when they get worse .
Relapses can be very difficult to predict, but can often be managed with medicine when they do occur.
I Feel At A Loss Sometimes Depressed Is This Normal
Yes, this is a very normal process, a form of mourning and coming to terms with the fact that you have arthritis, and some things may have to change in your lifestyle to compensate, making things easier for you. Dont panic, try to work through your feelings, talking with a partner or someone close to you, If the feelings don’t pass, see your doctor who may be able to refer you to some form of short-term counselling.
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What To Expect On Your First Visit
The diagnosis of psoriatic arthritis is largely a clinical one there are no;lab or imaging findings that necessarily make the diagnosis for us, says Craig.;In addition to answering many questions, you will usually undergo a detailed joint exam, with particular focus on the areas that you have mentioned are symptomatic, he says.;What we are generally looking for in psoriatic arthritis is swelling or tenderness of the joints or the areas where tendons insert into bone, called the enthesis, says Craig. We will usually want to do a thorough skin exam, so you may be asked to put on a gown for this, he adds.
You shouldnt necessarily expect a solid diagnosis at your first visit, which is common in rheumatology, says Craig. This is for any number of reasons: Some treatments may interfere with our interpretation of findings, we may need further testing or imaging, or possibly the symptoms or findings are not specific enough to make a conclusion, he says.
In these cases, your rheumatologist will collect more information, or follow you closely and observe for changes in your symptoms and test results over time, says Craig.;It is usually better to have an uncertain picture than to be treated for an incorrect diagnosis, he adds.
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
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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.
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.
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Caspar Criteria For Diagnosis
Diagnosing psoriatic arthritis relies on markers in an established system called the Classification Criteria for Psoriatic Arthritis .
The criteria are each assigned a point value. Each one has a value of 1 point except for current psoriasis, which has a value of 2 points.
The criteria are as follows:
- current psoriasis outbreak
- personal or family history of psoriasis
- swollen fingers or toes, known as dactylitis
- nail problems, like separation from the nail bed
- bone growths near a joint that are visible on an X-ray
- absence of rheumatoid factor
A person must have at least 3 points based on the CASPAR criteria to be diagnosed with psoriatic arthritis.
Will Drug Treatments For Psoriatic Arthritis Make My Psoriasis Worse
Some drug treatments may make psoriasis worse, but then again, some can also make it better too. Before you start any treatments offered, discuss this both with your dermatologist and rheumatologist. DONT FORGET to politely request that both consultants let each other know of your treatment regimes, this helps both of them evaluate your treatment and any side effects that you may be likely to experience. Some people find that when their psoriasis is bad their arthritis is also bad and as one improves, so does the other. This most often occurs when the skin and joint disease start simultaneously. Some of the arthritis treatments also help the skin and this is can help the doctors decide which is the best drug to use.
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If You Notice Symptoms Suggestive Of A Heart Attack Or Stroke Seek Emergency Medical Attention Immediately
- Take action! Do not smoke. If you are a smoker, take steps to reduce the amount you smoke.
- Maintain a healthy weight. If your waist measures more than 102 centimetres for men or 88 centimetres for women, talk to your GP about weight loss strategies.
- Eat a balanced diet, including whole grains, cereals, vegetables, fruit, lower-fat dairy products, leaner meats and food prepared with little to no fat. Avoid saturated and trans-fats; instead use olive oil, which is high in desirable monounsaturated fats.
- Control your portion sizes. An easy method for determining meal portions is to use two open hands as your measure for vegetables; one closed hand for carbohydrates, such as pasta or rice; one closed hand for fruit; the palm of your hand for meat or protein alternative; and the tip of your thumb for fats, such as oil, margarine or butter.
- Limit alcohol intake.
- Deal with stress in a healthy way.
- Be physically active for at least 30 minutes most days of the week.
Drink more water. Although there is no strict guideline, replacing fluids is important and you should aim to drink at least 2-3 litres of water a day, particularly during warm or hot weather.
This article is adapted from the Psoriasis and the heart leaflet.
Your Lower Back Hurts
We all experience lower at some point, but if you live with psoriatic arthritis, this can be a sign of a bigger problem. In some cases, psoriatic arthritis causes a condition known as spondylitis. Spondylitis causes inflammation between the joints in the spine, which are known as vertebrae. This condition may also cause inflammation between your pelvic bones and your spine. Without prompt treatment, these problems can interfere with your ability to stand and move properly.
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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.
What If Youre Not Satisfied With Your Doctor
McIlwain says that if youre not feeling better after a few months of treatment, you should consider reevaluating your medical team.
There is very good treatment available for psoriatic arthritis, and most patients should begin to feel some improvement within a month or two,” he says. But if you arent getting better, talk openly and honestly with your doctor to make sure youre on the right track and if youre not, find another physician.
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Things To Look Out For
Angina
- Pain: Discomfort or pain, generally in the chest, neck, jaw and/or shoulder that can be triggered by physical activity but eased by rest. The pain may feel like a heaviness, tightness or pressure.
- Shortness of breath : Generally triggered by physical activity and relieved by rest.
If you notice these symptoms seek the attention of your GP as soon as possible.
Heart attack:
- A heart attack may begin with the angina-like symptoms described above . The pain is usually very severe, comes on suddenly and does not go away with rest.
- Nausea, indigestion or vomiting.
- Sweating or cool, clammy skin.
- Feelings of fear or anxiety.
Stroke:
- Sudden weakness or sudden numbness in the face, arm or leg, especially on one side of the body, even if temporary.
- Sudden confusion or difficulty speaking or understanding, even if temporary.
- Trouble seeing with one or both eyes.
What Is A Rheumatologist
A rheumatologist is a doctor who treats conditions related to the bones, joints, and muscles. These often include autoimmune diseases such as gout, lupus, and various forms of arthritis.
Though the precise underlying causes of autoimmune diseases arent fully understood, they are thought to be related to the body attacking its own healthy tissues. Over time, untreated autoimmune diseases can also damage your organs, eyes, and nervous system. The goal of a rheumatologist is to come up with a treatment plan to reduce the damaging inflammation caused by related autoimmune diseases.
Its important to note that while autoimmune diseases, like arthritis, can cause symptoms of the skin, rheumatologists work to treat the underlying inflammation that causes them. This differs from a dermatologist, who can treat the skin problems at the surface level. Rheumatologists use drugs that target inflammation so the body stops attacking healthy tissues. These come in the form of biologics, corticosteroids, and nonsteroidal anti-inflammatory drugs .
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What To Expect At The Doctors Office
You may be seeing various health care providers during your journey to figure out whats causing your symptoms. Its common for people to see their internist/general practitioner, a dermatologist to treat their psoriasis, or other types of doctors to manage specific areas that are causing pain, such as a podiatrist to treat foot pain. However, if you or any of the health care providers you are currently seeing suspect it could be psoriatic arthritis, ask for a referral to a rheumatologist. These doctors specialize in arthritis and have the training to determine whether your joint symptoms are due to PsA or could be something else.
Psoriatic arthritis can be challenging to diagnose for a number of reasons, including:
Whats The Procedure Like For A Psoriatic X
During the X-ray procedure, your doctor or a technician will place the part of your body being examined beneath or in front of an X-ray machine. When they turn on the machine, the X-rays travel through the targeted part of the body to produce images within minutes.
Bone and joints will appear white in color against a black background. Surrounding tissues and organs will appear gray.
While X-rays may be a necessary step in diagnosing PsA, its important to discuss any concerns with radiation exposure, particularly in children. Your doctor will order X-rays only when needed to decrease any risk from the small amounts of radiation used.
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Laboratory Tests For Diagnosing Psoriatic Arthritis
Your rheumatologist will likely order a series of laboratory tests, the results of which will help check for other conditions or point to psoriatic arthritis. These studies will examine factors such as the following:
- Complete blood count
- Erythrocyte sedimentation rate and C-reactive protein , which are inflammatory markers that might be elevated in PsA but should not be elevated in wear-and tear osteoarthritis or arthritis
- Rheumatoid factor and anti-cyclic citrillunated peptide , which are antibodies often present in cases of rheumatoid arthritis, but not commonly found in cases of PsA
- Blood urea nitrogen, creatinine, uric acid, and urinalysis
How To Prepare For Your First Visit To The Rheumatologist
If its your first time seeing a rheumatologist, its likely that your visit will involve a lot of fact-finding on their part. It will help if youre prepared to answer questions about your medical history and your condition, says Orbai.
These questions will help in diagnosing and understanding the extent and impact of your disease, says Orbai. Typical questions could include:
- Do you have a family history of psoriasis or psoriatic arthritis?
- Do you have a family history of autoimmune diseases, immunodeficiency or cancer?
- Do you have back pain or stiffness?
- Do you have joint pain or stiffness?
- Which joints are affected?
- What triggers a flare for you?
- What makes your psoriatic arthritis better?
- Has psoriatic arthritis impacted your function and lifestyle?
In addition to being prepared to answer questions, youll want to bring along some information as well, says Craig.
- Results from other evaluations you have had. That includes labs results, prior X-rays or imaging studies , initial consult notes and most recent progress notes from any other physicians you are seeing.
- A list of your current and past physicians and their specialties.
- A full list of your current medications, including over-the-counter medications and supplements.
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What You Can Do
Before your appointment, you may want to write a list of answers to the following questions:
- What types of symptoms are you having? When did they begin?
- Do you or any of your close family members have psoriasis?
- Has anyone in your immediate family ever had psoriatic arthritis?
- What medications and supplements do you take?
You may want to bring a friend or family member with you to your appointment. Its hard to remember everything about a complicated condition, and another person may remember information that you miss.
Can Psoriatic Arthritis Attack Other Organs Of The Body
Apart from the skin, nails and joints, increased cardiovascular morbidity is considered part of psoriatic disease, as is the association with inflammatory bowel disease.; An itchy, red eye due to conjunctivitis is more common in people with psoriatic arthritis and some people occasionally develop a painful, red eye caused by inflammation around the pupil of the eye, which is called iritis or uveitis. Anaemia may also be found but this is the result of long-term inflammation and is not a specific feature of psoriatic arthritis.
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Physical Therapists And Other Healthcare Providers
Depending on a persons particular needs, their healthcare team may involve other healthcare professionals, such as:
- Physical therapists: These professionals can teach a person special exercises and stretches that help with pain management and joint mobility.
- Occupational therapists: Occupational therapists provide customized treatment plans to enable people to perform daily activities and better manage their physical limitations and pain. Part of their work may include adapting a persons environment or tasks to fit their needs.
- Chiropractors: These practitioners manually adjust the spine, muscles, and joints. They use special hands-on techniques to restore joint mobility, which may help improve joint function in addition to reducing pain.
When To Seek Medical Advice
You should speak to your GP if you experience constant pain, swelling or stiffness in your joints even if you haven’t been diagnosed with psoriasis.
If you have been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let your doctor know if you’re experiencing any problems with your joints.
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