Friday, January 27, 2023

What Is Associated With Psoriatic Arthritis

Work And Psoriatic Arthritis

What is 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.

Add Exercise To Your Daily Routine If You Can

Keeping your joints moving can ease stiffness. Being active for at least 30 minutes per day will also help you lose excess weight and give you more energy. Ask your doctor what type of exercise is safest for your joints.

Biking, walking, swimming, and other water exercises are gentler on the joints than high-impact exercises like running or playing tennis.

Why Some People With Psoriasis Develop Psa

Although psoriasis and PsA may appear unrelated, both conditions reflect underlying immune system problems.

In psoriasis, your overactive immune system causes your bodys skin cells to develop too rapidly. This can be triggered by many environmental factors, such as stress or smoking.

One thing these triggers have in common is that they stimulate your bodys inflammation response. This same inflammation response can happen in your joints. Inflamed joints are what cause PsA.

In PsA, white blood cells target your bodys tissues instead of protecting your body against foreign substances. Though PsA is connected to psoriasis, it has very distinctive symptoms of its own. For this reason, some researchers have referred to PsA as a disease within a disease.

The Centers for Disease Control and Prevention calculates that 10 to 20 percent of people with psoriasis will go on to develop PsA. This is slightly lower than the figures provided by the National Psoriasis Foundation, which put the risk at about 1 in 3, or 30 percent.

Psoriasis is typically diagnosed by the onset of plaques. These are scaly patches of raised, silver-white or reddish skin. PsA affects your joints, typically those in your fingers, toes, and lower back.

PsA can come in many forms. It can trigger other side effects such as fatigue and decreased range of motion. Because psoriasis is more visibly apparent, its often easier to diagnosis than PsA.

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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.

The Genetics Of Psoriatic Arthritis And Psoriasis

Psoriatic Nail Dystrophy Associated With Erosive Damage at ...

A genetic predisposition and a triggering event are thought to cause certain types of arthritis. For example, researchers have determined that about 40% of people with psoriasis or psoriatic arthritis have a family history of the diseases involving first-degree relatives. Family studies have shown that psoriatic arthritis is 55 times more likely to develop in first-degree relatives of people with the disease compared to unrelated controls.

In genetic studies, the term concordance refers to the degree of similarity in a set of twins regarding the presence or absence of a disease or trait. The concordance rate for psoriatic arthritis is significantly higher than for psoriasis . Twin studies in psoriasis have demonstrated a high rate of concordance among identical twins versus fraternal twins.

Identifying genes that are associated with susceptibility to a specific disease is no small task. It may involve:

Sound complicated and confusing? It is, as can be the nomenclature. But, let’s peek at what has been found.

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Common Symptoms Of Psoriatic Arthritis May Include:

Sausage-like swelling along the entire length of fingers and toesalso called dactylitisis often a telltale sign of psoriatic arthritis, as opposed to rheumatoid arthritis, in which the swelling is usually confined to a joint. In PsA, it is possible to have swelling in your hands and feet before developing joint symptoms.

Psoriatic arthritis typically affects the ankles, knees, fingers, toes, and lower backand can cause joint damage if not treated appropriately. People with PsA may experience joint pain, swelling, and tenderness in one or more joints, as well as stiffnessparticularly in the morning or after a period of rest.

The skin symptoms of psoriatic arthritis include a rash, thick, red skin, or flaky, silver-white scaly patches, as in plaque psoriasis. The skin may itch and be painful. Up to 85% of people with PsA experience skin problems associated with psoriasis before having psoriatic arthritis symptoms.

Difficulty moving joints and limbs as freely as before is a sign of PsA.

In PsA, joints tend to be stiff and inflexible either first thing in the morning or after a period of rest.

Some people may develop back pain as a result of psoriatic arthritis, including a condition called spondylitis. Spondylitis causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis .

Many patients with PsA experience fatigue . Managing the level of inflammation can help lessen fatigue.

Immunopathological Findings Of Autoimmunity In Psa

Genetic predisposition and triggers such as dysbiosis, mechanical stress and injury, obesity, and infections were proposed to cause aberrant immune cell activation and secretion of inflammatory cytokines leading to inflammation in the skin, synovium, entheses, tendons, periosteum, bone, and gut . Key effector cells and cytokines change according to the tissue involved and chronology of the disease. Th1 and Th/c17-mediated inflammation is the hallmark of PsA with the key cytokines TNF-, IL-1, -9, 23, -17, and -22 . Although these cells and cytokines have pathogenetic impacts in any autoimmune disease, findings of clear autoreactivity presumable to reflect immunity to self antigens and loss of tolerance will be reviewed here.

2.2.1. Potentially autoreactive T cells in PsA

2.2.2. Autoantibodies in PsA

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Who Is At Risk For Psoriatic Arthritis

Psoriasis affects 2-3 percent of the population or approximately 7 million people in the U.S. and up to 30% of these people can develop psoriatic arthritis. Psoriatic arthritis occurs most commonly in adults between the ages of 35 and 55 however, it can develop at any age. Psoriatic arthritis affects men and women equally.

It is possible to develop psoriatic arthritis with only a family history of psoriasis and while less common, psoriatic arthritis can occur before psoriasis appears. Children of parents with psoriasis are three times more likely to have psoriasis and are at greater risk for developing psoriatic arthritis. The most typical age of juvenile onset is 9-11 years of age.

What Are The Treatment Options For Psoriatic Arthritis

What is psoriatic arthritis?

The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:

Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs . Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.

DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.

Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.

Exercise

Heat and cold therapy

Splinting

Surgery

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Enhancing Healthcare Team Outcomes

Patients with psoriatic arthritis have a heterogeneous clinical presentation with the involvement of various domains and are best managed with an interprofessional approach to the treatment of articular disease, skin disease, other manifestations, and medical comorbidities. Patient education is vital to ensure that the symptoms are under control. The physical therapist should encourage exercises to restore joint function. The pharmacist should educate the patient on different medications, their benefits, and adverse reactions, as well as monitoring agent selection, dosing, and checking for potential drug-drug interactions. Nurses should educate patients on the importance of abstaining from alcohol and discontinuing tobacco, answer questions, and help monitor treatment progress. The dietitian should encourage a healthy diet and weight. A mental health nurse and psychiatrist should be involved, as many patients do develop severe anxiety and depression. Patients should be encouraged to seek stress relief. The social worker should assess the home to ensure it can accommodate the patient’s lifestyle. All of these various disciplines need to chart and share their perspectives with the rest of the team so that all members of the healthcare team are operating from the same information base.

Consider Natural Supplements And Spices

Omega-3 fatty acids have anti-inflammatory properties. These healthy fats, found in many supplements, reduce inflammation and stiffness in joints.

While research suggests there are health benefits, the Food and Drug Administration doesnt monitor the purity or quality of supplements. Its important to talk with your doctor before you begin taking supplements.

Turmeric, a potent spice, also serves up a dose of anti-inflammatory properties and may help reduce inflammation and PsA flare-ups. Turmeric can be added to any dish. Some people even stir it into tea or lattes, like golden milk.

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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.

When To Get Medical Advice

Psoriasis, Psoriatic Arthritis Associated With Increased ...

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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Treatment For Psoriatic Arthritis Differs From Other Forms Of Arthritis

The main goals of all arthritis treatment are to reduce symptoms and improve quality of life. Methods vary depending on the type of arthritis.

Rheumatoid arthritis can be very destructive if its not treated, which is why we treat it aggressively with biologics, says Ruderman. But psoriatic arthritis doesnt manifest that way. Fewer than half of people with psoriatic arthritis develop a particularly aggressive form, which makes treatment challenging because we dont want to over-treat it.

Even so, the pain and discomfort associated with psoriatic arthritis can be significant. A study published in 2015 in the journal PLoS One found that the overall pain, joint pain, and fatigue reported by psoriatic arthritis patients was significantly greater than that reported by people with rheumatoid arthritis.

Unless someone has an existing condition, such as elevated blood pressure or kidney disease, nonsteroidal anti-inflammatory drugs are recommended for joint symptoms in milder forms of psoriatic arthritis, says Husni.

Topical creams, ointments, and lotions are often used to address the scaly, itchy skin rashes that occur with psoriasis.

If there are signs of joint damage, doctors treat psoriatic arthritis more aggressively with medications like the ones used to treat rheumatoid arthritis, says Ruderman. These include disease-modifying anti-rheumatic drugs and biologics.

Additional reporting by Becky Upham.

What Tests To Perform

Laboratory testing

The most important role of lab testing is to exclude other considerations in the differential diagnosis. Anti-cyclic citrullinated peptide antibodies and antinuclear antibodies may be helpful in some patients if there are symptoms that suggest a diagnosis of RA or systemic lupus erythematosus . However, some patients with psoriatic arthritis alone may have positive tests. Acute phase reactants may provide insights into disease activity, although many patients with active PsA have normal acute phase reactants.

It is also important to check a comprehensive metabolic and lipid profile since obesity, metabolic syndrome, type 2 diabetes, fatty liver, and hyperlipidemia are very common features in PsA and the presence of these conditions will influence treatment considerations. In patients who are under consideration for a DMARD, such as methotrexate of leflunomide, it is recommended to check hepatitis B and C serologies and baseline transaminases testing for exposure to tuberculosis should be done if a biologic, such as an anti-TNF agent, is anticipated. An increased rate of progressive liver fibrosis based on serial biopsies was reported in psoriasis patients with obesity or type II diabetes treated with methotrexate. It is also critical to ensure that women of child-bearing age are not pregnant so a pregnancy test may be required.

Imaging
Skin biopsy
Controversies in diagnostic testing

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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 Will Psoriatic Arthritis Affect Me

6 Facts about Psoriatic Arthritis

Starting the right treatment as soon as possible will give you the best chance of keeping your arthritis under control and minimise damage to your body.

Psoriatic arthritis can vary a great deal between different people. This makes it difficult to offer advice on what you should expect.

It will usually have some effect on your ability to get around and your quality of life, but treatment will reduce the effect it has.

Psoriatic arthritis can cause long-term damage to joints, bones and other tissues in the body, especially if it isnt treated.

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Risks Associated With Poor Compliance

Patient compliance to therapy is an underlying concern in the management of PsA. In patients treated with TNF inhibitors, age has been associated with increased compliance and female sex, comorbidity, and poor clinical condition at baseline have been associated with decreased compliance . Poor adherence can reduce therapeutic efficacy and increase medical costs due to the need for more aggressive treatments . In general, there is the potential for reduced compliance if a patient cannot observe their disease directly, although this is less likely in patients with PsA because skin involvement is more common.

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.

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What Is Psoriatic Arthritis Again

Lets make one thing clear: Psoriatic arthritis and psoriasis are two relatedbut separatesystemic autoimmune conditions, both of which are driven by an out-of-whack inflammatory response. In psoriasis, your skin is the primary target, which leads to those uncomfortable, itchy rashes. In PsA, the immune system mistakenly zeroes in on the joints, ligaments, and tendons, causing joint pain, swelling, and stiffness. If left untreated, PsA can permanently damage the joints, seriously interfering with your ability to move or function normally.

About 30% of people with psoriasis will go on to develop PsA, and while we dont know the exact cause, scientists believe genetic susceptibility, an overactive immune system, and environmental factors all play a role.

Genetic And Epigenetic Findings Of Autoimmunity In Psa

Structural Entheseal Lesions Associated With Increased ...

2.1.1. Human leukocyte antigen associations

Given their strong risk association, explaining the functional role of the HLA risk alleles, particularly the HLA-C*06:02, is essential for elucidating the pathogenesis of PsA. A fascinating case study with a unique methodology identified ADAMTS-like 5 as an HLA-C*06:02-presented melanocytic autoantigen to the lesion-infiltrating autoreactive CD8+ T cells in psoriasis . More interestingly, peptide motifs of the HLA-C*07:01, -C*07:02, and -B*27, which are three of the other psoriasis risk-related leukocyte antigens, utilize the same anchor residues with the HLA-C*06:02, have overlapping peptide-binding properties, and belong to the same HLA supertype . Synovial/entheseal counterpart of this picture is yet to be studied but seems to be more complicated since different disease phenotypes in PsA exhibit different HLA associations and contribution of the HLA-C*06:02 polymorphism to PsA risk is lesser compared to psoriasis .

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