Psoriatic Arthritis

What is Psoriatic Arthritis (PsA)

Did you know that if you suffer from Psoriasis, you have a 1 in 3 chance of developing Psoriatic Arthritis (PsA)? These common conditions come from the same issue – your immune system attacks your healthy tissues and joints, causing a psoriatic rash alongside swelling, pain and stiffness of the joints. Mild Psoriatic Arthritis usually affects 1-2 joints, but the more severe cases can attack the whole body and without treatment leave you with permanent joint damage and deformity. If you’re concerned you might have PsA, or have recently been diagnosed, this is the ultimate guide to Psoriatic Arthritis, with all of the latest research and information you need.

What Symptoms Should You Look Out For?

On average, it takes between 5-10 years after your initial diagnosis of Psoriasis to develop Psoriatic Arthritis, if you’re the 1 in 3 people who do. At that time, the first symptoms you might experience include stiffness, pain and swelling in your joints. Particularly you would feel this in the knees, toes, fingers and lower back. Regular symptoms of established PsA include:

  • Pain: Swollen, stiff and inflamed joints mean that pain is the most common complaint
  • Joint Warmth: Inflammation can make your joints feel hot and tender
  • Pitted / Separated Nails: Dented nails, or nails that separate from the nail bed
  • Eye Inflammation: Red, itchy and swollen eyes, or even changes to your vision
  • Swollen Digits: Fingers and toes can appear entirely swollen, unlike other forms of arthritis
  • Fatigue: Being in constant pain can bring a tiredness that isn’t like regular tiredness

The nature of auto-immune disorders means that although this is a chronic condition, you are likely to experience periods of less symptoms (remission) and periods of more severe symptoms (flare-ups). Medication and other treatments will be able to help keep these periods stabilised, but it’s important to keep your medical team informed of any changes.

What Causes Psoriatic Arthritis?

Despite ongoing research, we still have no idea why some people develop Psoriatic Arthritis and others do not. There are certain risk factors that seem to be at play, including:

  • Irregular Immune Activity: Some people have faulty immune systems that turn on themselves and cause a range of auto-immune disorders, including Psoriasis and PsA.
  • Genetics: 40% of those with Psoriatic Arthritis have a family member with either Psoriasis or PsA.
  • Environmental Factors: Illness, Injury and lifestyle all play a role in the development of long-term conditions, and Psoriatic Arthritis is no exception. The way we live and what we are exposed to has a profound effect on how we develop.

How Do You Get A Diagnosis?

If you already have a diagnosis of Psoriasis, your doctor may have informed you about the chances of developing Psoriatic Arthritis in the future. If you have been experiencing the symptoms as described above, particularly swollen and painful joints, it is imperative that you contact a physician as soon as possible. As with all arthritic conditions, early diagnosis and treatment give you the best chance of maintaining a good quality of life.

Your doctor will likely refer you to a Rheumatologist. This is a doctor that specialises in disorders of the joints. So, what can you expect from a visit to a Rheumatology specialist?

  1. Medical History: The doctor will want to understand your background, so expect to give a full medical history as best you can.
  2. Physical Examination: In order to assess your range of movement, pain levels and the condition of your joints, the doctor will perform a physical exam to get a clear picture of your condition at this time.
  3. Blood Tests: There are a variety of blood tests available to check for inflammation and antibodies in your blood. These will be able to confirm if you have an arthritic condition, as well as how much it is affecting you.
  4. X-Ray/Scan: It is likely you’ll be asked to get a scan of some sort, in order for your physician to be able to see what is happening within your affected joints, or to look for signs of damage.

If you receive a positive diagnosis of Psoriatic Arthritis, rest assured that you will be in good hands. Your doctor is part of a team of specialists who have a great understanding of the treatment plans available. They will talk you through this, and feel free to ask questions at any time.

Untreated, Psoriatic Arthritis can cause a range of other symptoms, including stomach problems, heart and lung problems and even Metabolic Syndrome, so it’s vital you get checked out if you have any concerns.

What Treatment is Available to You?

Your treatment for Psoriatic Arthritis will be individualised for you alone. Auto-immune disorders affect people on a very personal and unique level and close monitoring of your symptoms and condition will be required. Being an active patient will help you take back control.

With PsA, your doctor will attempt to provide one medication only for both your Psoriasis and the accompanying Arthritic symptoms. There are a number of medications, some traditional and a lot that are new, but all which have been thoroughly tried and tested. Side effects are common with any medication, but your doctor will provide all of the information you need on anything you are prescribed. These could include:

  1. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): These medications reduce inflammation. Ibuprofen is a very well-known and traditional form of this, but there are also newer versions called “Coxibs”, which you may be offered. You will likely be started on the lowest dose to lessen side effects. NSAIDs can affect the stomach quite badly if not monitored, so your doctor may also prescribe medicine to help maintain a healthy digestion.
  2. DMARDs (Disease Modifying Anti-Rheumatic Drugs): These medications target the chemicals that produce an immune response that attack your healthy cells and are relatively new but well-established. These treat the cause of your arthritis, rather than the symptoms.
  3. Corticosteroids: These medications are a type of steroid and therefore long-term use is not usually recommended as they can cause damage in other areas. But they are highly effective in the short-term for reducing pain and swelling.
  4. Biological Therapies: These medications are known as Biologics and are the newest treatment available for arthritic conditions such as PsA. They are officially a type of DMARD but are generally used when normal DMARDs haven’t worked. They are highly efficient in targeting specific areas of your immune system that cause you inflammation.

How Do You Maintain A Good Quality of Life with Psoriatic Arthritis?

Although your doctor will be able to expertly manage your medications, there are lots of ways you can help in your treatment plan. Learning to manage your symptoms and maintain your quality of life will help you in the long-term. There are several ways you can start to do this.

Exercise is always recommended. Whilst you might not be able to do the activities you once enjoyed all the time due to flare-ups; low-impact exercise offers a benefit to your symptoms. Keeping active however you can will help to maintain your joints, reduce stress and promote good movement.

Alongside exercise, eating a healthy, balanced diet low in sugar, fat and salt, can help. Arthritic conditions can become worse if you are overweight, so it might be time to change your lifestyle and include more fresh, natural foods in your daily meals.

Your skin also needs as much protection as you can provide. Ensure you get into the habit of moisturising every day- after warm baths, swimming, in the morning and at night.

Looking after your mental health is also very important. Stress can exacerbate chronic pain conditions and finding ways to alleviate anxiety in your life can improve your symptoms. Meditation, counselling, establishing a support network and reaching out to services when you are feeling overwhelmed are all recommended. Living with a chronic condition like Psoriatic Arthritis can be scary, lonely and leave you without hope. But you can get through it and getting help does not mean you are failing.

In Conclusion

Psoriatic Arthritis unfortunately affects 30% of people with Psoriasis and as such is very common. Getting a diagnosis as soon as possible is very important. Working with your doctor and clinical team to work out a treatment plan will allow you to maintain a good quality of life. Being an active patient and changing your habits and lifestyle will give you a fighting chance at stabilising your symptoms. Reach out to your friends, family and experts, keep up to date with the latest research and never give up.

 

References

https://www.nhs.uk/conditions/psoriatic-arthritis/

https://www.healthline.com/health/psoriatic-arthritis-early-signs

https://www.medicalnewstoday.com/articles/316841

https://www.arthritis.org/drug-guide/biologics/biologics

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