Psoriatic Arthritis And Heart Disease: Understanding Your Risk
The term heart disease refers to several different conditions that affect the heart. Research has indicated that people with psoriatic arthritis have an increased risk of developing heart disease particularly coronary artery disease . This condition is characterized by a buildup of plaque in the arteries. Over time, this plaque buildup can restrict blood flow in the body, eventually causing heart attacks and even heart failure.
Its easy to feel anxious after a diagnosis of psoriatic arthritis. Thinking about how psoriatic arthritis can affect the body beyond the joints can be overwhelming. However, its important to understand how psoriatic arthritis affects the whole body. You and your health care team can determine the right treatments and preventive measures to help you stay healthy and minimize your risk of heart disease.
Increased Risk Of Pancreatitis And Diabetes
A study published in July 2016 in the journal PLoS One found that psoriatic disease is associated with a significantly increased risk of chronic pancreatitis, an inflammatory disease of the pancreas.
The researchers found that the incidence of chronic pancreatitis was roughly twofold in people with psoriasis compared with those without psoriasis. They also determined that psoriasis patients using nonsteroidal anti-inflammatory drugs and Trexall , commonly used to treat psoriatic arthritis, had a lower risk of developing chronic pancreatitis.
The pancreas produces insulin, which helps maintain the bodys blood glucose levels. If the pancreas isnt functioning properly, it can lead to type 1 or type 2 diabetes. A study published in February 2017 in the Journal of Rheumatology found that the prevalence of diabetes mellitus is higher in patients with psoriatic arthritis. The risk of developing diabetes was shown to increase with elevated levels of psoriatic arthritis activity.
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.
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How Can I Help My Child Live With Psoriatic Arthritis
Help your child manage his or her symptoms by sticking to the treatment plan. This includes getting enough sleep. Encourage exercise and physical therapy and find ways to make it fun. Work with your child’s school to make sure your child has help as needed. Work with other caregivers to help your child take part as much possible in school, social, and physical activities. Your child may also qualify for special help under Section 504 of the Rehabilitation Act of 1973. You can also help your child find a support group to be around with other children with pediatric arthritis.
How To Manage Psa In The Feet
People cannot take direct action to prevent PsA from developing, but they can take some steps to limit flare-ups and the impact of this condition on their lives.
For example, people may find it helpful to work with a doctor or podiatrist to help them find the right sort of footwear for their condition. Using shoe inserts may provide symptom relief and make it easier to walk.
Strengthening exercises and stretches may also prevent more severe symptoms. Doing exercises that involve slow, gentle, strength building movements, such as yoga and tai chi, can be safer for the joints than higher impact exercises such as running.
Trying physical therapy can also help build strength, work through stiffness, and maintain mobility in the feet.
When a person is experiencing pain, treatment can help them feel more comfortable, slow down the progression of the condition, and prevent joint injury.
The sections below look at some treatments and home remedies in more detail.
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Key Points About Psoriatic Arthritis In Children
Psoriatic arthritis is a rare form of arthritis or joint inflammation that affects both skin and joints. It can occur in people who have the skin disease psoriasis.
It is most common in adults ages 30 to 50. But it can start in childhood.
This condition causes inflamed, swollen, and painful joints. It also causes eye pain and fatigue.
Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.
Early treatment can help the disease go into remission. Delayed treatment may lead to long-term disability.
Changing Your Diet Wont Cure Psoriatic Arthritis
There is no known cure for psoriatic arthritis, and making dietary changes like going paleo or gluten free isn’t a remedy. The good news, however, is that a healthy diet with plenty of anti-inflammatory fruits and vegetables that’s low in fats and sugars can help keep psoriatic arthritis symptoms under control. Also try to steer clear of dairy and caffeine, which may aggravate psoriatic arthritis symptoms, says Dr. Markenson.
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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.
Wear Gloves When Working With Your Hands
This includes housework, yard work, and home repairs. Any time you irritate your skin or nails, psoriasis can flare. When doing wet work like washing dishes, its best to wear a cotton glove and then place a vinyl or nitrile glove over it. According to the American Academy of Dermatology, latex gloves dont give your nails enough protection. Keeping nails dry can also make infections less likely.
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Brain Fog Dementia And Inflammation Are Also Linked To Psa
Many people with PsA report experiencing brain fogtrouble concentrating and memory loss . But its not just momentary mental lapses that can occur. A large 2020 study from South Korean researchers found that the risk of developing Alzheimers disease was slightly and significantly higher in people with psoriasis and other untreated immune disorders, likely tied to chronic inflammation. While not everyone with psoriasis develops PsA, roughly a third do. The good news? Those who took disease-modifying treatments had lower rates of AD than those who did not.
How Is Psoriatic Arthritis Treated
Treatment will depend on your symptoms, age, and general health. It will also depend on the severity of your condition.
Boththe skin condition and the joint inflammation are treated. Early diagnosis andtreatment helps prevent joint damage. Some medicines used to treat psoriatic arthritisinclude:
- Nonsteroidal anti-inflammatory medicines to ease symptoms
- Corticosteroids for inflammation
- Immunosuppressive medicines such as methotrexate to reduce inflammation if NSAIDs don’t work
- Biologic medicines to ease inflammation
- Vitamins and minerals such as calcium and vitamin D to slow bone deformation
Other treatment may include:
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As Can The Words Youre Too Young To Have Arthritis
When you say the word arthritis, every older person you meet has it, too, Dishner says. While well-meaning people may sympathize by comparing their own ailment with yours, psoriatic arthritis is a much different form of arthritis and does not develop because of aging. It can occur at any age but typically begins to cause symptoms among those between 30 and 50 years old, according to the NPF.
How To Treat Psoriatic Arthritis
The main goals in managing PsA are to stop disease progression, reduce inflammation, treat skin symptoms, relieve pain, and keep your joints moving as much as possible.11 A dermatologist and rheumatologist should coordinate your treatment plan. A physical therapist may also be helpful to help increase your flexibility and strength.11
For those people with psoriatic arthritis and psoriasis, your doctor will design a treatment plan that addresses both conditions.
The foundation of PsA treatment includes medications that control inflammation in the body and reduce pain. Medications may include the following and are usually recommended based on the severity of your PsA symptoms.
Mild Disease: The goal of treating mild PsA is primarily to ease pain and reduce inflammation. A number of anti-inflammatory drugs may be recommended, such as:
- Nonsteroidal anti-inflammatory drugs : NSAIDs include drugs like ibuprofen and naproxen sodium that can be purchased over-the-counter as well as prescription-grade NSAIDS, such as celecoxib or diclofenac.
- Corticosteroids: These are more powerful anti-inflammatory drugs that are prescribed by a doctor and can be taken either by mouth or injected in the doctors office. These medications are only used for brief periods of time for disease flare-ups because of their adverse long-term side effects.
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Psoriatic Inflammation And The Brain
Studies have shown that people with psoriatic disease are at an increased risk for anxiety and depression.
A survey published in the April 2014 issue of the Journal of Rheumatology found that more than 36 percent of people with psoriatic arthritis had anxiety and about 22 percent had depression. These numbers were much higher than what people with only psoriasis reported.
Patients with psoriatic arthritis really have a sort of dysmorphic view of themselves, Ritchlin says. This is a disease thats hard to hide. Other people can see it, and the patient can feel it.
There is growing evidence that the inflammation that causes psoriatic disease can affect the brain. Inflammatory proteins called cytokines are associated with psoriatic arthritis and also commonly found in people with depression.
We used to think inflammation was only in joints and skin, says Theoharis Theoharides, MD, PhD, a professor of immunology at Tufts University in Boston. The type of inflammation present in psoriatic arthritis is probably in action in the part of the brain that regulates mood, given that psoriatic arthritis has a strong nervous system component.
What Organs Does Psoriatic Arthritis Affect
Due to widespread inflammation, psoriatic arthritis can affect your internal organs but this occurs only in very rare cases and should not be a major concern. More common symptoms to watch out for beyond joint pain and inflammation are fatigue and anemia, mood changes or depression, high blood pressure/cholesterol, diabetes, and obesity.
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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.
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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How Does This Condition Affect The Tendons & Ligaments
Enthesitis occurs in up to 50% of people with PsA.4 Symptoms of PsA in the tendons and ligaments include pain and inflammation. When enthesitis affects the heel of the foot, it is known as Achilles tendonitis.
At the bottom of the foot, enthesitis can cause plantar fasciitis. Enthesitis can also occur in the fingers, toes, pelvis, knees or upper body.5,6
PsA can be asymmetrical, occurring on only one side of the body. For example, all the joints in one finger on the left hand may be affected while the same finger on the right hand is unaffected. PsA can also be symmetrical, with the same joints affected on both sides of the body.2
PsA and enthesitis are chronic and can have periods of remission and flares.6
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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Can Psoriatic Arthritis Cause Hearing Loss
Studies have looked at hearing in people with psoriatic arthritis. Researchers have found that hearing loss is more common in psoriatic arthritis patients compared to those without the disease.
One group of researchers used data from NHANES to look at the link. They compared people of the same age with and without psoriatic arthritis to control for age-related hearing loss. They found psoriatic arthritis patients were more likely to report problems with their hearing. But this type of study is limited because it only describes what is going on in a population. It cant show cause and effectif psoriatic arthritis causes hearing loss.
Other researchers have conducted case-control studies on the link. A case-control study directly compares people with a disease to those without it. It aims to see if the disease is associated with a certain outcome.
They matched people for age. But they actually tested hearing levels instead of only relying on people reporting hearing problems . The results were striking. About 60% of people with psoriatic arthritis had measurable hearing loss compared to only 8.3% of those without the disease. Whats more, about 23% of patients had problems with balance compared to none without the disease. When researchers looked at inner ear tests, 27% of psoriatic arthritis patients had inner ear damage. None of the controls showed damage.
Living With Psoriatic Arthritis
There is no cure for psoriatic arthritis. But you can reduce your symptoms by stickingto your treatment plan. Manage pain with medicine, acupuncture, and meditation. Getenough exercise. Good exercises include yoga, swimming, walking, and bicycling. Workwith a physical or occupational therapist. He or she can suggest devices to help you withyour daily tasks.
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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
What Are The Treatment Options For 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.
Heat and cold therapy
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