Lifestyle Changes For Psoriatic Arthritis
You can make some changes that will improve your quality of life:
- Eat healthy food. Focus on a healthy eating plan like the Mediterranean diet. Opt for foods that may ease inflammation, like:
- Coldwater fish
- Exercise: When your joints are sore, you may not want to move. But doing so can:
Keep your joints and tendons loose
- Keep the inflammation that comes with this disease in check
- Lessen the workload on your joints
- Lower your risk of other conditions that come with PsA, like heart disease, diabetes, and Crohnâs disease
Walking, biking, and swimming are all good options.
- Get to, and stay at, a healthy weight. Almost half the people with PsA are overweight. Studies show that losing just 10% of your body weight can improve your response to medications for psoriasis and psoriatic arthritis.
- Manage your stress. Things that make you worry can also make your PsA worse. Exercise, medication, and talk therapy can all help.
- Rest. Give an achy joint a break. You can go back to what you were doing when you feel better.
- Donât drink. Mixing some PsA medications with alcohol can lead to liver damage. Your doctor can let you know if you should quit.
Psoriatic Arthritis Treatment Injection Options
There are several different kinds of biologic injections used to treat psoriatic arthritis. These include:
There are additional forms of biologic injections available, but they are typically only used for the treatment of psoriasis and not psoriatic arthritis. These include:
The frequency of injections will depend on the specific type of medication that you are prescribed. Remicade is delivered intravenously at a hospital, infusion center, or another medical facility, and repeated every eight weeks.
All the other types of medication are injected subcutaneously, or under the skin, in your abdomen or thigh. Many of these injections can be done by yourself at home. Some medications require a frequent injection schedule, such as Enbrel, which has to be done every week, and Cimzia every other week.
Other medications require less frequent injections after initial doses, such as Cosentyx, Taltz, and Simponi and Skyrizi and Stelara every 12 weeks.
Conventional Or Traditional Disease
DMARDs are indicated for the treatment of moderate to severe or refractory cases of PsA. Patients with active disease, defined globally as one or more tender and swollen joints and poor prognostic factors, particularly those with elevated acute phase reactants, radiographical damage or clinically relevant extra-articular manifestations, who have failed to respond to NSAIDs within 3 months, should be treated with DMARDs.
Delay in the start of DMARDs may lead to worse outcome. MTX, sulfasalazine and leflunomide can be effective for peripheral but not for axial disease, enthesitis or dactylitis. Observational controlled studies with sulfasalazine have shown no reduction in long-term joint damage. Similarly, the use of antimalarials and gold salts is not recommended, and there is little convincing evidence regarding the efficacy of cyclosporine in PsA. It has been shown that the probability of continuing to take cyclosporine is significantly lower and the rate of adverse events is higher when compared with MTX or antimalarials .
Before starting DMARD therapy patients should be screened and have regular blood monitoring, usually every 3 months, including blood counts, liver function tests and serum creatinine .
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Who Develops Psoriatic Arthritis
About 1 person in 10 with psoriasis develops psoriatic arthritis. About 2 in 100 people develop psoriasis at some stage in their lives.
In most cases, the arthritis develops after the psoriasis most commonly within 10 years after the psoriasis first develops. However, in some cases the arthritis develops much later. In a small number of cases the arthritis develops first, sometimes months or even years before the psoriasis develops. Men and women are equally affected.
Psoriasis most commonly first occurs between the ages of 15 and 25 and psoriatic arthritis most commonly develops between the ages of 25 and 50. However, both psoriasis and psoriatic arthritis can occur at any age, including in childhood.
Note: people with psoriasis also have the same chance as everyone else of developing other types of arthritis such as rheumatoid arthritis and osteoarthritis. Psoriatic arthritis is different, and is a particular type of arthritis that occurs only in some people with psoriasis.
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What Treatment Is Right For Me
The type of treatment will depend on how severe your symptoms are at the time of diagnosis with the goal being to control the disease to the point of remission and avoid complications. Medications may need to be changed over time to continue to maintain control and avoid disease progression and systemic effects. Some early indicators of more severe disease include onset at a young age, multiple joint involvement, and spinal involvement. Good control of the skin is important in the management of psoriatic arthritis. In many cases, you may be seen by two different types of healthcare providers, one in rheumatology and one in dermatology.
Early diagnosis and treatment can relieve pain and inflammation and help prevent progressive joint involvement and damage. Without treatment psoriatic arthritis can potentially be disabling, cause chronic pain, affect quality of life, and increase risk of heart disease. It is important to update your healthcare provider when you have a change in symptoms or if your medication regimen is no longer effective.
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Sex Fertility And Pregnancy
Sex can sometimes be painful for people with psoriatic arthritis, particularly a woman whose hips are affected. Experimenting with different positions and communicating well with your partner will usually provide a solution.
Psoriatic arthritis wont affect your chances of having children. But if youre thinking of starting a family, its important to discuss your drug treatment with a doctor well in advance. If you become pregnant unexpectedly, talk to your rheumatology department as soon as possible.
The following must be avoided when trying to start a family, during pregnancy and when breastfeeding:
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Complementary And Alternative Therapies
You can try:
- Acupressure and acupuncture: These ancient Chinese treatments involve putting pressure on or inserting needles into the bodyâs healing points or energy lines. Acupressure isnât proven to help, but studies show that acupuncture can ease your pain.
- Curcumin: Thereâs some proof that this substance, the active ingredient in the spice turmeric, can help curb inflammation.
- Massage: It can help stretch your muscles and joints, promote circulation in your lymph system, and help you relax.
- Reiki: This Japanese relaxation technique can help you manage stress.
- Tai chi: This gentle Chinese exercise helps with relaxation and can ease sore, stiff joints.
- Yoga: The controlled movements can relax stiff muscles, ease sore joints, and boost your range of motion. It can also help with pain.
- Vitamin D: As an ointment, itâs been used to treat psoriasis for years. You can also get it from foods like:
- Cod-liver oil
- Coldwater fish like Sockeye salmon, mackerel, tuna
- Vitamin D-fortified products like nonfat milk, orange juice, yogurt
- Swiss cheese
Always talk to your doctor before you add any supplement or treatment. Look for a practitioner who is certified and, if possible, has experience with people who have psoriasis and psoriatic arthritis.
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Finding The Right Fit
After youve been taking a new drug for a few months, your doctor will check in to see if youre responding to the medication or experiencing side effects , says Dr. Shoor. If a treatment isn’t working or it’s causing you to feel ill, your doctor will suggest an alternativelikely drawing from one of these nine common treatment types for psoriatic arthritis.
Future Approaches To Finding A Psoriatic Arthritis Cure
Psoriatic arthritis research is constantly evolving, and new medications and therapies that show promise for reducing symptoms and disease activity are currently being studied. In order to develop a cure, scientists must first understand the underlying causes of PsA. As more treatments become available, the medical community can fine-tune approaches to treatment, creating a treatment plan for every person with PsA.
While there is not yet a cure for PsA, continued research and advancements are paving the way for more effective treatments. Research is helping healthcare providers better understand the causes and mechanisms that lead to PsA, offering promise for a cure in the future.
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Infection Rates In People With Psa Are Declining
Biologic therapies are currently used to treat people with PsA, as they may help prevent joint damage and control disease activity. However, biologics are known to increase the risk of infection, including the potentially life-threatening sepsis and urinary tract infections . The risk of infection makes many people hesitant to take these medications.
However, new research shows that infection rates have actually gone down in people with PsA who take biologics. These findings show that infection rates are declining, and people can feel more comfortable knowing that the increased use of biologics has not translated into a growth of serious infections.
Myth : A Dermatologist Can Treat Psoriatic Arthritis
Psoriasis and psoriatic arthritis are typically related autoimmune disorders, but that doesnt mean the approaches to treating and managing the conditions are identical. Some people think, My psoriasis is doing well, so my arthritis isnt a big deal or vice versa, Matteson says. The truth: The two dont always correlate.
Thats why its important to also see a rheumatologist for psoriatic arthritis, according to the National Psoriasis Foundation. Per CreakyJoints, in 85 percent of cases, skin symptoms of psoriatic disease occur before joint pain, so a dermatologist may be the first one to identify psoriatic arthritis. But because psoriatic arthritis treatment can be complex and often requires adjustments over time, a rheumatologist is best suited to develop your individual treatment plan.
What Is Psoriatic Arthritis
Psoriatic arthritis is a form of inflammatory rheumatism in which you also have the skin disease psoriasis. Most of the time, psoriatic arthritis starts with psoriasis.
The exact cause of psoriatic arthritis is unknown.
It is, however, certain that T lymphocytes are involved. T lymphocytes are certain white blood cells that play an important role in the immune system. They detect everything in your body that is foreign and destroy it.
For example, they ensure that you do not get sick from bacteria and viruses. In psoriatic arthritis, the T lymphocytes also attack cells that belong. You then speak of an autoimmune disease.
In an autoimmune disorder, your immune system runs wild, as it were, causing your immune system to think that good body cells are evil invaders.
Your immune system subsequently wants to expel these intruders. It releases certain substances which cause inflammation in your joints, tendons, muscles, or organs. Your immune system turns against your own body, as it were.
Psoriatic arthritis is more common in certain families . If you have psoriatic arthritis, your children may get it too, but they dont have to. There are also people with a genetic predisposition to psoriatic arthritis who do not get the condition.
Other factors that can play a role in psoriatic arthritis are stress and infections that weaken the immune system.
In addition, alcohol, smoking, and certain medicines can also play a role.
Odds Of Going Into Remission
Remission in PsA means that there are no signs of disease activity, including inflammatory blood markers and symptoms. In PsA, the two types of remission are:
- Drug-induced: Low disease activity when you are actively taking medications, such as biologics
- Drug-free: Low disease activity, relief from symptoms without medication, or both
The standard treatment approach for PsA is a treat to target strategy, with the goal being minimal disease activity. This typically involves adjusting medication over time to achieve remission. The process is ongoing and may require you to have close contact with your healthcare provider over time so they can closely monitor your condition and responses to medication. They may adjust your therapies/medications so you can achieve remission or low disease activity.
You and your healthcare provider will come up with a treatment plan to get you into remission. How quickly remission occurs depends on how mild or severe your PsA is. Most experts agree that an early and accurate diagnosis and starting treatment as early as possible increase the chances of remission and make it last.
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Reducing Signs And Symptoms
Both of these drugs reduce the signs and symptoms of psoriatic arthritis and most exciting they also can slow down damage to your joints, Dr. Smith says
DMARDs slow down psoriatic arthritis and improve quality of life for most people, Dr. Smith says. Some patients will even achieve a remission while taking them. But more typically, disease activity continues, but at a slower, less intense rate.
If your doctor prescribes DMARDs, here, according to Dr. Smith, are three things you should know about these powerful medicines.
1. All DMARDs may have side effects
Because DMARDs are a systemic treatment, they may have side effects, such as stomach upset, liver problems or blood issues, Dr. Smith says. It may take some tinkering for your physician to find the right regimen for you.
Possible long-term complications include liver damage with methotrexate and leflunomide. Some dormant long-term infections such as tuberculosis, can be re-activated by DMARDs.
DMARDs change your immune system, so you may get more intense viral or bacterial infections. Make sure to let your doctor know about any serious infections, Dr. Smith says.
You also should check with your doctor before getting any vaccines, Dr. Smith says. Live vaccines, like the shingles vaccine, may be dangerous with certain of medications, he says.
Some biologics also have been linked to a very small increased risk of cancer. You should ask your doctor about it, Dr. Smith says.
Lifestyle And Other Nonpharmacologic Approaches And Therapies
Some simple habits may improve your pain and joint damage.
Eating a healthy diet is vital for good health. Try to avoid foods that trigger inflammation, such as sugar, refined carbs, alcohol, and saturated fats. Eat plenty of vegetables, fruits, and lean meats.
Keep taking your medications, unless your doctor tells you otherwise. Stopping treatment can cause worsened symptoms.
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There Are Many Drug Options For Managing Active Psa Heres What Happened When A Study Compared Them With Each Other
New psoriatic arthritis treatment guidelines from the American College of Rheumatology say that most people with active psoriatic arthritis should choose an anti-TNF drug, such as adalimumab or infliximab , as their first line of therapy.
If a patient doesnt respond well to one or more of these drugs or cant take them for some reason, they might then consider a newer type of biologic an interleukin inhibitor like ustekinumab or secukinumab .
Although interleukin inhibitors have also been proven to help patients with psoriatic arthritis, there havent been many large studies directly measuring them against anti-TNF drugs.
A new study published in the Journal of Rheumatology aimed to compare these classes of medication in terms of how well they work for two specific complications of psoriatic arthritis: enthesitis and dactylitis .
This study, a literature review that analyzed data from 18 previous trials, included information on a total of nearly 7,000 psoriatic arthritis patients who had enthesitis and dactylitis. Researchers determined that both types of drugs beat out placebos and that they worked equally well for PsA patients with enthesitis and dactylitis.
After 24 weeks, the anti-TNF drugs demonstrated significant resolution of these complications, the authors reported. The two classes also worked similarly in terms of improving disease activity scores as well as quality of life scores.
Living With Psoriatic Arthritis
Living with psoriatic arthritis is all about maintaining the right treatment plan. With the right treatment plan in place, you can live a life free of pain and inflammation. Most doctors prescribe a combination of therapies to patients with psoriatic arthritis. This can include drug therapies, home remedies, and lifestyle changes to increase mobility, treat psoriasis symptoms, and minimize joint pain.
Even though psoriatic arthritis is a lifelong, chronic, autoimmune disorder, this does not have to impact your quality of life. Get diagnosed early, have your doctor develop a treatment plan, and stick to it. These are the keys to living a healthy life with psoriatic arthritis.
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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.
Natural Remedies For The Treatment Of Psoriatic Arthritis
Treating psoriatic arthritis naturally involves both lifestyle and dietary changes. You might also use some of the more common drug treatments in conjunction with these natural remedies to get the most relief from arthritis symptoms.
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