Does The Severity Of Skin Or Nail Psoriasis Matter
- Nail changes are found in 2 out of 5 individuals with psoriatic arthritis, compared with around half in those with psoriasis alone.
- Nail changes include pitting and discolouration of the nail due to abnormalities in the growth of tissue in the nailbed.
- The risk of developing psoriatic arthritis is greater in individuals with severe psoriasis, yet severe psoriatic arthritis may occur with minimal skin disease.
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.
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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Swollen Fingers Or Toes
PsA may begin in smaller joints, such as those of the fingers or toes, and progress from there.
Spondylitis may be accompanied by dactylitis, or swelling of the toe or finger joints. This is sometimes called sausage fingers.
Dactylitis is estimated to affect up to 50 percent of patients with PsA, and is uncommon in other types of arthritis, except gout or pseudogout.
When caused by PsA, dactylitis may affect individual digits differently. For example, your left hand may be swollen while your right is not.
Unlike other types of arthritis, PsA tends to make your entire finger or toe appear swollen, rather than just the joint.
People with PsA may experience eye problems, such as inflammation and redness. Symptoms of eye inflammation include:
- red eyes
- dry eyes or feeling of grit or sand in the eyes
- difficulty focusing or blurred vision
- pain or sensitivity, especially to bright light
- floaters, or small specks, lines, or other shapes in your field of vision
If you develop new or large floaters along with flashing lights in your field of vision, it may be a sign of a medical emergency. Seek immediate treatment from a qualified medical professional.
You may also experience uveitis, or inflammation of the middle layer of the eye called the uvea. Between 7 and 25 percent of people with PsA develop uveitis.
Symptoms of uveitis include:
When To Get Medical Advice
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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The Effects Of Psoriasis And Psa
The most common form of psoriasis is plaque psoriasis, also known as psoriasis vulgaris. It affects 80 to 90 percent of all people with psoriasis. Its characterized by plaques. These may come and go, even though psoriasis is a chronic, or long-term, disease.
Like psoriasis, PsA is chronic. PsA is also a progressive condition. It gets worse over time. The inflammatory response that PsA triggers in joints can lead to the gradual destruction of joint cartilage and bone.
If left untreated, this process can result in twisted, painful, or swollen joints that no longer function. Joint pain may be widespread or may only occur on one side of your body.
If you have psoriatic disease, youre also at risk for other conditions. This includes:
What Causes Psoriatic Arthritis
The cause of psoriatic arthritis is unknown. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma play a role in determining who will develop the disease. Psoriasis itself is neither infectious nor contagious.
Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with psoriatic arthritis.
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Past Research And Achievements In This Area
In 2015, research led by our centre for genetics and genomics at the University of Manchester identified genetic variants associated with psoriatic arthritis, but not with psoriasis or rheumatoid arthritis. This helped to establish psoriatic arthritis as a condition in its own right. The findings could lead to the development of drugs specifically for psoriatic arthritis.
Later in the same year, our TICOPA trial looked at the benefits of early aggressive drug treatment for people with psoriatic arthritis followed by an increase in drug dosage if initial treatment isnt working. The trial found that patients treated this way, required fewer hospital- and community-based services than patients receiving the standard care.
Spondylitis With Or Without Sacroiliitis
This occurs in approximately 5% of patients with psoriatic arthritis and has a male predominance.
Clinical evidence of spondylitis and/or sacroiliitis can occur in conjunction with other subgroups of psoriatic arthritis.
Spondylitis may occur without radiologic evidence of sacroiliitis, which frequently tends to be asymmetrical, or sacroiliitis may appear radiologically without the classic symptoms of morning stiffness in the lower back. Thus, the correlation between the symptoms and radiologic signs of sacroiliitis can be poor.
Vertebral involvement differs from that observed in ankylosing spondylitis. Vertebrae are affected asymmetrically, and the atlantoaxial joint may be involved with erosion of the odontoid and subluxation . Therapy may limit subluxation-associated disability.
Unusual radiologic features may be present, such as nonmarginal asymmetrical syndesmophytes , paravertebral ossification, and, less commonly, vertebral fusion with disk calcification.
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Where Can I Get More Information
Around 9 out of 10 UK adults have access to the internet which is the easiest place to find more information. For those without internet access or who cannot get online, the options are becoming limited. A good place to start is the local public library, which often holds useful information. It may not be on immediate display, however, so try asking at the main desk. It is also worth asking your local GP surgery or hospital, which should have information in an accessible format.
What You Eat Might Have An Impact
When it comes to diet and symptoms of psoriatic arthritis, Ogdie-Beatty says, its really an individual thing. Some people say tomatoes, some say gluten, or sugar can cause symptoms to worsen.
Adds Bekele, Diet is interesting, because we know that in some ways, it affects inflammation in the body globally, but though many people are doing research, we dont yet have a clear idea of what foods are best or worst for people with PsA.
For instance, given that psoriatic arthritis is linked to gut health, there have been many claims that probiotics supplements for gut health might help reduce symptoms of psoriatic arthritis.
Yet a study published in May 2020 in ACR Open Rheumatology found that there were no differences in health outcomes between people with PsA who took probiotics and those who didnt.
On the positive side, there is evidence that certain foods seem to fight inflammation in the body, including turmeric, flaxseed, olive oil, and kale, though again, We really dont know how much impact eating these foods has on inflammation and PsA, Bekele says.
But its not a bad thing to include these foods in your diet. Usually, we tell patients to try a Mediterranean diet, and tailor it depending on how they feel, whether that means reducing sugar or gluten, Bekele says.
How to avoid this trigger Bekele recommends keeping a food journal and seeing if certain foods correlate with symptom flares: Then you can try a process of elimination to see if that helps.
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Why Do I Feel Tired All The Time
People with psoriasis or psoriatic arthritis often feel tired all the time. Some people who develop this symptom think there must be something psychologically wrong with them. There isnt fatigue is a common and recognised symptom of the conditions. It is also acknowledged that doctors underestimate fatigue as a component of psoriasis and in particular of psoriatic arthritis. People often feel frustrated about the lack of support and understanding they get when presenting with a debilitating and invisible symptom.
It appears that fatigue is more severe in people with psoriatic arthritis than those who have psoriasis alone, with studies suggesting that three out of every ten people with psoriatic arthritis have symptoms of fatigue. Fatigue may be an early symptom or sign of inflammatory activity in people who may have psoriasis and or psoriatic arthritis both are classed as long-term inflammatory conditions. Inflammation is linked with the release of powerful chemicals. These include:
- inflammatory proteins which increase the stickiness of blood platelets
- proteins which bind to antibodies and circulate as immune complexes
- immune system chemicals that help immune cells communicate with each other, such as interleukins, especially interleukin 1.
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.
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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.
What Causes Fatigue In Psoriasis And Psoriatic Arthritis
Psoriasis and psoriatic arthritis are both inflammatory diseases involving molecules called cytokines. The immune system uses cytokines as signals to tell other immune-system cells what to do. Cytokines do not function properly for individuals with inflammatory conditions like psoriasis and PsA. This causes the immune system to attack when it doesnt need to, increasing inflammation throughout the body.
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Psoriasis And Fatigue: Why Am I So Tired
People diagnosed with psoriasis or psoriatic arthritis often experience fatigue mental or physical exhaustion that occurs regardless of how much rest a person gets. Fatigue is more common in psoriatic arthritis, affecting at least 3 out of every 10 people with the condition.
Feeling tired after physical exertion, a busy day, or a night of insufficient sleep is normal. Having fatigue, however, is different from simply being tired. Understanding this fatigue, how it affects ones physical and emotional state, and how to manage it can help minimize its effects.
How Do Psoriasis And Psa Overlap
For every 10 patients who walk in the door with psoriasis, about three or four of them will eventually get PsA, says Elaine Husni, MD, MPH, vice chair of the department of rheumatic & immunologic diseases at the Cleveland Clinic in Ohio. Most cases almost always start with the skin condition and then within seven to 10 years later, joint pain symptoms start to develop.
However, skin and joint symptoms can develop at the same time and, more rarely, joint symptoms can appear before skin involvement, says Dr. Haberman. While estimates vary, one study showed that up to 3 percent of patients developed joint disease before skin disease, she notes.
In some cases, there may have been skin involvement that went unnoticed or undiagnosed. For example, psoriasis can be sneaky and show up in hidden or private areas like the scalp, intergluteal cleft , belly button, and inside the ear, explains Dr. Husni. Since people dont really examine their scalp or buttocks very often, small psoriasis patches can get missed and delay diagnosis, she says.
Adds Dr. Haberman: You might have a small fleck in your scalp that you just think of as dandruff that is actually psoriasis.
Whats more, people with psoriasis in some of these hidden areas may actually be more prone to PsA. Studies have shown that you may be at higher risk of developing PsA if you have scalp, nail, or inverse psoriasis, says Dr. Haberman.
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What Is Psoriatic Arthritis Video
Psoriatic arthritis can cause pain, swelling and stiffness in and around your joints.
It usually affects people who already have the skin condition psoriasis . This causes patches of red, raised skin, with white and silvery flakes.
Sometimes people have arthritis symptoms before the psoriasis. In rare cases, people have psoriatic arthritis and never have any noticeable patches of psoriasis.
Psoriatic arthritis and psoriasis are autoimmune conditions. Our immune system protects us against illness and infection. In autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body.
Both conditions can affect people of any age.
Its estimated that around one in five people with psoriasis will develop psoriatic arthritis.
People with psoriasis are as likely as anyone else to get other types of arthritis, such as osteoarthritis or rheumatoid arthritis. These conditions are not linked to psoriasis.
Psoriatic arthritis is a type of spondyloarthritis. These are a group of conditions with some similar symptoms.
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:
- Obesity
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How Psoriatic Arthritis Treatment Prevents Disease Progression
The primary way to slow the progression of PsA is through medications that modify the immune system. It may take trial and error to find the treatment that works best for a given patient, notes Dr. Haberman. While we have a lot of medication options for PsA, we dont know which ones a patient will respond to, so sometimes we need to try more than one medication to find the one thats right for that patient, she says.
In addition, medications that have been effective for you can stop working over time. If this happens, your doctor may recommend a medication that works differently say, targets a different part of the immune system to control disease activity.
There are many drugs used to treat PsA. The ones that you will use will depend on the type and severity of symptoms as well as the most problematic areas .
Medications use to treat PsA include:
Work And 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.
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