What Is The Treatment For Psoriatic Arthritis

How Will Psoriatic Arthritis Affect Me

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.

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.

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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Treatment For Psoriatic Arthritis

There are many treatments available for psoriatic arthritis. Your PsA treatment plan may include medications, physical therapy and/or occupational therapy, exercise, rest, and complementary therapies like massage and acupuncture. Following your treatment plan can help reduce the symptoms of the disease and prevent joint damage caused by arthritis.

What Is Psoriatic Arthritis

Psoriatic arthritis is a form of inflammatory arthritis characterized by joint pain, swelling, and morning stiffness. It is associated with having psoriasis or a family history of psoriasis. Both psoriasis and psoriatic arthritis are chronic autoimmune diseases meaning, conditions in which certain cells of the body attack other cells and tissues of the body.

Psoriatic arthritis can vary from mild to severe, it can present in the following ways:

• Oligoarticular, affects four or fewer joints in the body.
• Polyarticular, affecting four or more joints.
• Spondylitis, less common and affecting the spine, hips, and shoulders.

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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
• Eggs
• 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.

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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Where Research Is Now

Psoriatic arthritis is a multifaceted disease that affects both the skin and joints. Researchers are currently working to understand the causes of PsA and the multiple ways it affects the body. Other studies are working to identify biomarkers for PsA that can be used to predict a persons response to certain medications. Also, new medications may be developed that can better treat the disease and promote long-term remission.

The knowledge gained from this research may lead to better diagnostics, improved treatments, ways to prevent PsA, and a potential cure. For now, the goal is to help PsA patients achieve long-term remission.

What Are New Psoriatic Arthritis Treatments

There are several approved new treatments for Psoriatic Arthritis. Here are some of them:

Tremfya is an interleukin-23 antagonist indicated for the treatment of adult patients with:

• active psoriatic arthritis
• moderate-to-severe plaque psoriasis who are candidates for systemic therapy or light therapy

Tremfya was approved for the treatment of adult patients with active psoriatic arthritis by:

• The Food and Drug Administration , USA on July 14, 2020.

Taltz is an interleukin-17A antagonist indicated for the treatment of people with:

• active psoriatic arthritis in adult patients who have responded inadequately to, or who are intolerant to one or more disease-modifying anti-rheumatic drug therapies.
• moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Taltz was approved for the treatment of adult patients with active psoriatic arthritis by:

• The Food and Drug Administration , USA on December 1, 2017.
• The European Medical Agency on January 11, 2018.

Cosentyx is an interleukin-17A antagonist indicated for the treatment of adults with:

• active psoriatic arthritis
• moderate to severe plaque psoriasis
• active ankylosing spondylitis

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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.

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.

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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.

Psoriatic Arthritis: Is It Time For A Biologic

These therapies have been used in the treatment of psoriasis for over 15 years, says the National Psoriasis Foundation, and most are administered by injection or intravenous infusion. Janus kinase inhibitors have emerged as a new type of biologic treatment for psoriatic arthritis, and unlike most biologics, these drugs come in pill form.

Biologics come with some risks, according to Matteson. In general, theres concern about any drug that modifies the immune system because of the possibility of infections or cancer development, he says.

While these concerns are valid, Matteson says that the benefits of biologic medications outweigh the risks, even for people whose cases are not severe. People who have mild pain or swelling in a single joint may do just fine with NSAIDs alone. For people who have more joint swelling and pain, the use of biologics is justified, Matteson says.

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What Are The Types Of Psoriatic Arthritis

There are different types of psoriatic arthritis, which tend to affect different parts of the body. These include:

• asymmetric arthritis usually affects one side of the body, or different joints on each side
• symmetrical polyarthritis often affects several joints on both sides of the body
• distal interphalangeal arthritis affects the joints closest to the fingernails and toenails
• spondylitis affects the spine, particularly the lower back
• arthritis mutilans a rare condition that severely affects the bones in the hands

There is also a type of psoriatic arthritis that affects children, although the symptoms are usually mild.

Living With Psoriatic Arthritis

There is no cure for psoriatic arthritis. However, by understanding the disease and knowing what to expect, you can learn different ways to complete daily tasks or plan activities at times of the day when you are least bothered by its effects. Once you understand and learn to predict the ways in which your body responds to the disease, you can use exercise and therapy to help decrease discomfort, stress and fatigue.

There is a significant list of comorbidities related to PsA. These include these 11 conditions:

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What Are The Symptoms Of Psoriatic Arthritis

The symptoms of psoriatic arthritis may be gradual and subtle in some patients in others, they may be sudden and dramatic. It may be mild, affecting only one joint or can be severe, affecting multiple joints. Not all patients experience all symptoms.

The most common symptoms of psoriatic arthritis are:

Joint symptoms

• Pain or aching, tenderness, and/or swelling in one or more joints – most commonly hands, feet, wrists, ankles, knees.
• Joint stiffness most notable in the morning or with prolonged inactivity such as sitting for a long time.
• Reduced range of motion in affected joints.
• Pain or stiffness in the lower back.
• Tenderness, pain, or swelling where tendons and ligaments attach to the bone , such as the Achilles tendon of the heel.
• Swelling of an entire finger or toe with a sausage-like appearance .

Skin symptoms

• Silver or gray scaly spots on the scalp, elbows, knees, and/or the lower spine.
• Small, round spots called papules that are raised and sometimes scaly on the arms, legs and torso.
• Pitting of the nails.
• Detachment or lifting of fingernails or toenails.

Other symptoms

• Anemia.

Chronic Nature Of Psoriatic Arthritis

Psoriatic arthritis is an autoimmune condition in which the immune system mistakenly attacks healthy tissue, leading to pain and inflammation. PsA is chronic, which means that it is persistent and long-lasting, with no current cure. PsA requires ongoing medical attention and may require you to limit your daily living activities.

PsA symptoms can come and go and tend to vary from mild to severe. The onset of symptoms is called a flare, or flare-up. If left untreated, PsA inflammation can cause health problems, including damage to the joints, uveitis , gastrointestinal problems, lung problems, weak bones, and damage to the cardiovascular system.

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Myth : Psoriatic Arthritis Is Curable

There is no cure for psoriatic arthritis, says Luk. However, we do have many options for medications that can suppress it.

What does remission look like? According to the Arthritis Foundation, there isnt a specified criteria for defining remission in psoriatic arthritis, and it can be difficult to know if youve achieved it. Typically, experts define remission as being in a minimal disease activity state.

For many people with psoriatic arthritis, reaching remission requires working closely with a doctor to find the appropriate treatment and then sticking to that treatment. Meanwhile, scientists continue to search for a psoriatic arthritis cure, Dr. Matteson says.

What Are The Treatments For Psoriatic Arthritis

Disease-modifying antirheumatic drugs are the most widely used drugs in this disease. Treatment is done based on the degree of infection to the person.

• Pain Killers: Pain killers like NSAIDs are seen as very effective in reducing the pain of Psoriatic Arthritis.
• Biological Response Modifier: These are the agents that modify the body’s response in specific conditions. These agents can increase the risk of infection in a person.
• Oral Medication: Agents that reduce the activity of enzymes are also very helpful in the treatment of Psoriatic Arthritis. Apremilast is widely used as an oral medication for treating this. It acts as an anti-inflammatory agent in the body and reduces the pain and inflammation in joints.
• Injection: Steroids are injected directly into inflamed joints to reduce pain.
• Surgery: As a last option, knee replacement surgery is done. Replacement surgery is done on the joint that is affected.

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Are There Any Side Effects

Side effects of using the medicinal drugs may include stomach irritation, heart problems, and liver and kidney damage. While biologics are very effective, they suppress the immune system and increase the risk of infections. Bone marrow suppression and severe lung infections have also been noted in patients as adverse effects of this treatment. Side effects also include nausea, diarrhea, hair loss etc.

Treatment For Psoriatic Arthritis<

There are different psoriatic arthritis medications. Together with your doctor you will decide what the best psoriatic arthritis treatment is for you. The main treatments for psoriatic arthritis include:2

• Non-steroidal anti-inflammatory drugs , which are used for psoriatic arthritis pain management and which help reduce inflammation.
• Corticosteroids, which work anti-inflammatory.
• Disease-modifying anti-rheumatic drugs , which help reduce inflammation and can stop psoriatic arthritis from worsening.
• Biological therapies are psoriatic arthritis meds that can stop particular chemicals in the blood from causing the immune system to attack the lining of the joints.

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Psoriatic Arthritis Risk Factors

• Psoriasis. Up to 30% of people with psoriasis get psoriatic arthritis. It affects men and women equally.
• Age. You can get PsA at any age, but it usually affects people between 30 and 50.
• Family history. As many as 40% of people with psoriatic arthritis have a family history of skin or joint disease.

What Can I Do

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How Can I Care For Myself If I Have Inflammatory Arthritis

Although there’s no cure for inflammatory arthritis, there are many things you can do to reduce pain and stiffness and to help prevent joint damage and disability.

• Have regular check-ups with your GP. Your doctor can advise you on treatment options and other things you can do to help reduce pain, swelling and inflammation. Your doctor will monitor you after you start on preventative maintenance treatment, and you’ll need to have regular blood tests.
• Try some non-drug treatments, such as physiotherapy, hydrotherapy and occupational therapy. Ask your GP or rheumatologist about these options, and how you can access them.
• Stop smoking as this can increase your risk of inflammatory arthritis.

What Is The Treatment

Psoriatic arthritis is a chronic form of inflammatory arthritis that can cause inflammation of the spine . Psoriasis is a skin condition that patches of red and scaly skin. Psoriatic arthritis is a systemic rheumatic disease that can also cause inflammation of tendons, cartilage, eyes, lung lining, and, even the aorta.

Symptoms of psoriatic arthritis include joint pain, stiffness and swelling. These swellings may flare and subside on its own. Morning stiffness is a common phenomenon occurring in people with psoriatic arthritis. Even mild skin psoriasis can cause a significant degree of arthritis in people depending on the age.

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