The Psoriatic Arthritis And Heart Health Connection
According to a meta-analysis in the journal Arthritis Care and Research, people with psoriatic arthritis were 43 percent more likely to have or develop heart disease compared with the general population. They also had a 31 percent higher risk of heart failure.
The reason patients are at risk is not entirely known, says Dr. Ritchlin. People with psoriatic arthritis more commonly develop metabolic syndrome a cluster of conditions that increase the risk of heart disease and other health problems. But there are patients with psoriatic arthritis who do not have metabolic syndrome and are still at an increased risk for heart events, he says.
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Six Symptoms You Shouldnt Ignore
The symptoms of psoriatic arthritis can vary in severity, from person to person and can even come and go . Here are six symptoms you should watch out for.
1. Its hard to move in the morning
Psoriatic arthritis can make getting up in the morning a challenge, especially after you havent moved around for a while. It can cause stiffness and pain in one or more joints, from your toes to your fingers. It can even cause pain and swelling in the tendons and surrounding structures that connect to your bone, a condition called enthesitis.
2. Your fingers look like warm sausages
About 30 to 50 percent of patients with psoriatic arthritis will experience the symptoms of dactylitis, or extreme swelling in their fingers and toes, Dr. Aquino said. This is when the entire fingers and toes swell to resemble sausages.
You may notice your swollen joints feel warm to the touch because inflammation and swelling cause heat.
3. You have lower back pain
When you think of psoriatic arthritis, you typically think about skin symptoms, but many people experience lower back pain as well. About 20 percent of those with psoriatic arthritis will develop a subtype called spinal involvement or psoriatic spondylitis, which may result in pain and stiffness in the back and hips, Dr. Aquino said.
4. Your nails have grooves and ridges
5. You experience eye problems
6. Youre always tired
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Obesity Metabolic Syndrome And Diabetes
Obesity is the most common comorbid condition in people with both psoriasis and PsA, says Dr. Ogdie. It sets the stage for insulin resistance and type 2 diabetes.
Insulin resistance means the body is less able to move glucose, a type of sugar your body uses for energy, from the blood into cells. Glucose builds up in the blood and begins the processes that cause type 2 diabetes, another risk factor for heart disease and stroke.
âIn addition, in people with psoriatic disease, obesity is linked to not responding well to treatment and to worse quality of life and function,â Dr. Ogdie says. âIn people with psoriasis, itâs the single greatest risk factor for development of psoriatic arthritis. For those with psoriatic arthritis, obesity creates an extra burden for joints already affected by disease.â
The relationship among inflammation, obesity and related comorbid conditions is complicated, says Dr. Mehta.
âWe think inflammation from the overactive immune system is getting into the adipose, or fat, tissue,â he says. âOur bodies have insulin receptors on adipose tissue, and when you have more fat, youâre more likely to become insulin resistant â and thatâs prediabetes.â
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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.
Home Remedies And Self Care
Some home remedies can help you to prevent and relieve hand and nail symptoms of PsA.
For relieving hand and finger joint pain, try:
- Applying ice to hand joints for ten minutes at a time as needed to reduce pain and swelling
- Massaging affected areas
- Wearing hand splints to support and protect wrist, hand and finger joints
- Taking breaks from writing and typing
- Performing hand exercises to stretch and strengthen the muscles and joints of the hand and fingers
For managing nail symptoms:
- Treat nail fungus infections with antifungal creams
- Avoid fake nails as they can injure nail beds
- Trim cuticles, and avoid pulling at the cuticles to avoid injuries and flares
- Keep fingernails trimmed and clean to prevent injuries
- Wear gloves when doing household chores or gardening
- Use clear nail polish in order to notice nail changes quickly
- Dont use nail polish if you have an active nail infection
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What Is Psoriatic Arthritis In Children
Psoriatic arthritis is a rare form of arthritis or joint inflammation that affects both skin and joints. Psoriasis is an ongoing condition that causes a red, scaly, itchy rash. It also causes nails to become thick and pitted with tiny holes.
Psoriatic arthritis causes painful joint pain and swelling, along with skin rashes. It most often affects finger and toe joints. But it can also affect wrists, knees, ankles, and the lower back.
This condition is most common in adults ages 30 to 50. But it can start in childhood. In many cases, the skin disease starts before the arthritis.
Early diagnosis and treatment helps to ease pain and prevent joint damage from getting worse.
Loss Of Significant Joint Mobility
For example, you were able to flex your wrist 60 degrees, and two years later, you lost 50 percent of that range of motion. Its possible to feel okay and still experience loss of range of motion, says Dr. Domingues. But the idea is to prevent joint damage and to make you have less pain. If you have less pain and are still progressing, that means your treatment could be working better.
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How Is It Treated
There is no cure for psoriatic arthritis, but treatment can be very effective in controlling symptoms. The challenge is to diagnose early so treatment can begin as soon as possible.
Painful symptoms are treated with non-steroidal anti-inflammatory drugs such as ibuprofen, but these are generally insufficient to control the arthritis alone.
The clinician may then add a disease modifying anti-rheumatic drug . These immunosuppressant drugs aim to control the inflammatory flare ups. Methotrexate is usually used first, while is an alternative for milder cases.
If these are not sufficient, so-called biological treatments must be used. These target certain inflammation proteins and are often administered via injection using an easy-to-use pen, as diabetics do with insulin. They are generally very effective, well tolerated and have the advantage of easing both joint and skin symptoms.
More recently, innovative treatments have been developed that patients take as a tablet, known as JAK inhibitors. These drugs work by blocking a key pathway involved in inflammation.
There is a risk of side effects when using drugs that suppress the immune system. Primarily, they can leave patients more vulnerable to infections.
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In addition to medication, its important for patients to maintain regular physical activity and a balanced diet.
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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Digestive Disorders And Psoriatic Arthritis
Did you know having psoriatic arthritis might also affect your gut?
A study published in Clinical Rheumatology found people with psoriatic arthritis are at risk for having the following conditions:
- Crohns disease, a chronic inflammatory bowel disease that affects the lining of the digestive tract
- Ulcerative colitis, a chronic inflammatory bowel disease that causes inflammation in the digestive tract
- Reflux esophagitis, a condition where inflammation damages the esophagus
- Peptic ulcer disease, a condition that causes painful sores or ulcers in the lining of the stomach or small intestine
Another study, published in JAMA Dermatology, revealed people with psoriasis were around 2 times more likely to develop Crohns and ulcerative colitis compared with the general population.
The authors concluded: These findings suggest that psoriasis is significantly associated with IBD. Gastroenterology consultation may be indicated when patients with psoriasis present with bowel symptoms.
Scientists believe that the same gene mutations that are associated with psoriasis may also be related to the gut disorders.
Types Of Psoriatic Arthritis And Where Psa Shows Up On The Body
Most people will experience psoriatic arthritis in a few joints but there are different types and locations on the body where it may show up.
In fact, you may be told you have a specific type of PsA based on where the inflammation occurs. Some people experience asymmetric symptoms in which joints on one side of the body are affected, such as one wrist or one knee, while others have symmetricsymptoms, involving the same joints on both sides of the body, such as both knees.
The most common types are:
- axial spondyloarthritis which mainly affects your back, including your sacroiliac joints . About 40% of those with PsA joint pain experience spine and sacroiliac joint pain.4
- distal, small joint polyarthritis, especially involving what are called the distal interphalangeal joints thats your first knuckle from the top of the finger. About 50% of people with PsA experience inflammation in the entire finger this is clinically termed dactylitis you may hear people call it sausage digit or sausage finger. Toes may also be affected.
- symmetric, small joint polyarthritis, which affects multiple joints on both sides of your body and can be very similar to rheumatoid arthritis a rheumatologist can help to differentiate
- asymmetric oligoarthritis, meaning a few joints are affected on one side of your body, usually your lower body such as the knee, ankle, or foot.
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Psoriasis Can Affect Internal Organs As Well As The Skin
Not only can psoriasis affect the skin, but it can have devastating effects that can affect your internal organs.
The systemic inflammation inside the body that accompanies the disease is often overlooked.
Patients may think that they are having success with their treatments if they cannot see the thick psoriasis plaques on their skin.
However, patients can have serious consequences on their joints, arteries and other organs if not properly treated early to decrease the inflammation.
It is important to know that psoriasis is an autoimmune disease. It is not contagious and is caused when the immune system attacks the skin.
As a result, scaly red patches or plaques occur on the skin.
In addition to skin problems, some patients can develop psoriatic arthritis. Signs and symptoms of this are painful, stiff and swollen joints that can come and go.
Psoriatic arthritis can affect any joint in the body, including the back or neck.
An early and accurate diagnosis of psoriatic arthritis is essential because persistent inflammation can cause damage to the joints.
Nobody knows exactly what causes psoriatic arthritis, but it can affect anyone.
Psoriatic arthritis typically occurs in people with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis.
Sometimes certain heart medications like B-blockers can cause a psoriasis flare on the skin or it may be triggered by a streptococcal throat infection.
What Joints Are Most Affected By Psoriatic Arthritis
Mainly occurs in the fingers , wrists, ankles and knees. Symptoms such as pain, tenderness, warmth and swelling, may affect different sides of the body . This may be referred to as peripheral arthritis.
Considering this, What does a psoriatic arthritis flare feel like? Often when a psoriatic arthritis flare-up begins, you feel very off. Personally, I feel like I have the flu. I get achy all over, chills, and feel like Im running a fever . This can feel very different in each of us, but a general feeling of discomfort and uneasiness is common.
What triggers psoriatic arthritis? Psoriatic arthritis occurs when your bodys immune system attacks healthy cells and tissue. The immune response causes inflammation in your joints as well as overproduction of skin cells. It seems likely that both genetic and environmental factors play a role in this immune system response.
Furthermore, Is psoriatic arthritis itchy? Psoriatic arthritis can cause different symptoms from person to person. But there are several common symptoms: Psoriasis and pitting of your nails. Painful, swollen joints, most commonly in your hands, feet, wrists, ankles and knees.
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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.
The Clinical Manifestation Of Psa
In the 60s and 70s five clinical forms of PsA were distinguished by Moll and Wright:
X-ray of hands: The destructive form of psoriatic arthritis . Numerous destructive changes in joints of both hands. Ankylosis of the right wrist. Typical for PsA changes called pencil-in-cup involving metacarpophalangeal joints.
A group of diseases with similar clinical manifestation called seronegative spondyloarthropathies has also been defined . The group includes:
To support the diagnosis of seronegative spondyloarthropathies, the European Spondyloarthropathy Study Group created some clinical criteria. Basing on these criteria the assessment includes the following features:
Patient with PsA X-ray of forefoot. Shows a form of the disease involving distal interphalangeal joints. Margin erosions and periostosis in DIP joint of the first finger of the left foot are visible.
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What Can I Do Right Now
Trigger: You Skip Your Meds
If your disease is well-controlled, and you miss only a dose of a long-acting medication, like methotrexate , you may be okay, Dr. Bose says. But if you have ongoing symptoms or an aggressive disease course, missing doses may lead to an increased risk of worsening symptoms or disease activity. A 2018 study published in the Journal of Rheumatology found that 73 percent of psoriatic arthritis patients who stopped their biologic medication after disease activity decreased experienced a recurrence in symptoms. If your treatment isnt working for you or you have a hard time sticking to your regimen, talk to your rheumatologist about other options and ideas to help you stay on track. And to help avoid forgetting a dose, set a reminder on your smartphone or link taking your meds to part of your daily or weekly routine, like brushing your teeth or doing the laundry.
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Unpredictable Flares Can Make Planning Hard
One of the biggest challenges of dealing with psoriatic arthritis is not being able to anticipate when flares will strike. These unwelcome episodes can affect both your personal and professional life.
In a study presented at the 2018 Annual Perspectives in Rheumatic Diseases Conference, researchers found about 80 percent of participants with psoriatic arthritis said they were partially or totally unemployed due to their condition.
More than half of respondents reported having difficulty spending time with friends.
I never know, day to day, what Im going to feel like or what my body will be able to do, Donaldson says.
The erratic nature of the disease can make planning problematic.
The hardest part of living with this disease is the unpredictability, Covert agrees. How many naps will I need? Will I even need a nap, or will I be able to get out of bed? Will I be able to walk today? And if so, how long and how far?