Treating Pain And Fatigue With Psa
Fatigue is another common symptom of PsA. âIn one study of 499 patients with PsA attending the University of Toronto PsA clinic, 49 percent had at least moderate fatigue, while severe fatigue occurred in 28.7 percent,â Dr. Gladman says.
Fatigue is more common in women with PsA and in patients who have a higher degree of pain, Dr. Gladman says. About 22 percent of people with PsA also have fibromyalgia. âFibromyalgia is a condition which includes both chronic pain and fatigue,â she explains. Pain from fibromyalgia is not confined to the joints and is often described as âpain all over.â
Like joint pain, the fatigue associated with PsA is due to inflammation, Dr. Gladman says. âFatigue will come and go with the inflammation. If fatigue is due to lack of sleep, it will improve when you get enough sleep. If fatigue is due to fibromyalgia, it may persist unless the fibromyalgia is managed appropriately,â she says. Treating fibromyalgia involves a program of medication, exercise and relaxation, she adds.
According to the joint American College of Rheumatology and NPF guidelines for treating PsA, âIt is recommended that patients with active PsA use some form or combination of exercise, physical therapy, occupational therapy, massage therapy, and acupuncture over not using these modalities as tolerated.â
Diagnosing and treating PsA early can help prevent or at least limit the joint damage that can occur in later stages of the disease, Dr. Gladman says.
What Causes Muscle Pain With Psoriatic Arthritis
Psoriatic arthritis can be connected to muscle pain in several ways.
PsA is characterized by inflammation due to an errant immune system response. Sometimes, inflammation in the joints also spreads to the places where the tendons and the ligaments connect to those affected joints . This results in a condition known as enthesitis. Because tendons and ligaments connect muscles to bones, enthesitis pain can feel like muscle pain, especially during psoriatic arthritis flares.
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Many MyPsoriasisTeam members experience enthesitis. One shared, I am experiencing enthesitis in both of my shoulders, so I have to sleep on my back , and Im still in pain.
Another wrote, I have enthesitis everywhere: in my neck, both shoulders, my left wrist, etc.
Psoriatic arthritis can also lead to muscle pain in other ways. Many people diagnosed with PsA find that they dont want to move as much because they are in pain. However, lack of exercise can cause the muscles to weaken. Muscle weakness may cause any amount of movement or exercise to lead to muscle aches and pains.
Some MyPsoriasisTeam members resonate with this struggle to exercise. One explained, People say, You just need to exercise more. They seriously have no idea how bad the pain is!
Another shared that they definitely lost muscle over four years without any treatment for psoriasis or psoriatic arthritis.
Three Signs Point To A Diagnosis Of Psoriatic Arthritis
LOS ANGELES, California If a patient with psoriasis presents with dactylitis, inflammatory back pain, and/or tendon inflammation, think psoriatic arthritis until proven otherwise.
Amanda Mixon speaks at the 19th Annual Fall Dermatology Conference of the Society of Dermatology Physician Assistants .
At the annual fall meeting of the Society of Dermatology Physician Assistants, Amanda Mixon, PA-C, said that psoriatic arthritis occurs in 20% to 30% of individuals with psoriasis, but my guess is that number is higher than that. Mixon practices at the Colorado Center for Arthritis and Osteoporosis, Longmont, Colorado. Psoriasis usually precedes PsA by 8 to 10 years, and PsA affects both genders equally, usually in the fourth decade of life. Genetic and environmental factors play a role.
On clinical presentation, 95% of patients with PsA have peripheral joint disease in the form of synovitis, tenosynovitis, dactylitis, and/or enthesitis, often asymmetric. They can have little psoriasis and terrible arthritis, or vice versa, Mixon said. They dont automatically correlate with each other. The one thing that does, though, is nail psoriasis. That will correlate with dactylitis, which is basically an inflamed sausage-like finger or toe, which happens for no apparent reason. That is a classic finding of psoriatic arthritis, a slam dunk. Its important to refer those patients to a rheumatologist.
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Other Symptoms Of Psoriatic Arthritis
In addition to joint pain, a person with psoriatic arthritis may experience:
DactylitisAbout 40% to 50% of people how have psoriatic arthritis notice significant swelling in toes or fingers.1 The skin over the joints may appear purple. This condition is called dactylitis, and may also be referred to as sausage digits.
Joint stiffnessInflammatory joint pain is often accompanied by stiffness. Like joint pain, joint stiffness is typically worse in the morning and improves during the day.
EnthesitisTendons connect muscles to bones, and ligaments attach bones to other bones. The point where a tendon or ligament attaches to a bone is called an enthesis. If an enthesis becomes inflamed, it is called enthesitis. About 30% to 50% of the people who have psoriatic arthritis also have enthesitis in one or more places.2
The most common tissues affected by enthesitis are the Achilles tendon, located on the back of the leg near the ankle, and the plantar fascia, located on the sole of the foot.
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Fingernail and toenail problemsUp to 87% of people experience changes in their fingernails and toenails.1 They may notice small holes in their nail surfaces, called pitting. They may also notice ridges that travel horizontally across the nail, cracking, and/or discoloration. Sometimes nails may crack or separate from the nail bed.
What Organs Does Psoriatic Arthritis Affect
Yes, psoriatic arthritis can wreak havoc on your joints and skin, but it can also cause problems in other parts of your body. Thats because psoriatic arthritis causes systemic inflammationfrom your eyes to your heart, says Dr. Askanase. It can involve the eyes with uveitis, the gut with inflammatory bowel disease, your heart with early cardiovascular disease, lung inflammation, and liver and kidney problems. In other words, psoriatic arthritis can be a disease of the whole body, she says.
That said, while psoriatic can increase your risk for these other conditions, it doesnt mean that you will get them. Its a good idea to talk with your healthcare team about how to reduce any risk factors you might have, including getting your PsA under control and tweaking your treatment plan, if necessary. These things will help reduce your risk of complications.
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Differential Diagnosis Of Ibp Versus Mbp
Fibromyalgia, characterized by chronic, widespread pain, reportedly occurs in up to 22% of patients with PsA . The presence of comorbid fibromyalgia may mask PsA disease severity, especially when subjective measures and patient-reported outcomes are being considered . Accordingly, distinguishing fibromyalgia from PsA may be addressed using screening instruments such as the Widespread Pain Index and Symptom Severity Score .
Warning Signs Of Psoriatic Arthritis
Psoriatic arthritis is a type of arthritis that affects 30% of people with psoriasis, according to the National Psoriasis Foundation. With PsA, your immune system attacks your own body, especially the skin and joints. PsA can mimic other forms of arthritis, such as gout, rheumatoid arthritis and osteoarthritis, says Dr. H. Kevin Jones, FAAOS,, a board-certified orthopedic surgeon at Beaufort Memorial Orthopaedic Specialists. Blood tests can point to other similar conditions and check for signs of inflammation. We can also order X-rays to look for bone and joint changes.
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How Is Psoriatic Arthritis Diagnosed
There is no single test to diagnose psoriatic arthritis. Healthcare providers make the diagnosis based on a patient’s medical history, physical exam, blood tests, and X-rays of the affected joints. Magnetic resonance imaging is generally not needed except in unusual circumstances.
Laboratory tests that may be helpful in diagnosis or used to monitor disease activity include:
- Rheumatoid factor and anti-CCP – types of blood tests to help diagnose rheumatoid arthritis.
- HLA-B27 – blood test to help diagnose, may also be indicated with a family history of psoriasis or psoriatic arthritis.
- Sedimentation rate and C-reactive protein – may indicate inflammation.
X-rays are not usually helpful in making a diagnosis in the early stages of the disease. In the later stages, X-rays may show changes that are more commonly seen only in psoriatic arthritis. One such finding is called the “pencil-in-cup,” which describes the finding where the end of the bone gets whittled down to a sharp point. This finding indicates more severe inflammatory changes to joints, which may require more aggressive treatment.
Medications For Pain Relief
If your muscle pain is negatively affecting your quality of life or causing you significant discomfort, medications may help relieve it. Over-the-counter non-steroidal anti-inflammatory drugs like ibuprofen or naproxen could help. However, if you are already taking NSAIDs for psoriatic arthritis, you should consult your rheumatologist before taking more.
You may also ask your doctor about muscle relaxants. Although muscle relaxants have not been shown to help with psoriatic arthritis itself, they could help reduce your muscle pain especially if it is extreme.
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Swollen Fingers And Toes
They can get so puffy, they look like sausages. Your doctor may call it dactylitis, or sausage digits. This painful swelling happens to more than a third of people with the disease. It results from joint inflammation and usually affects a few fingers and toes. You might mistake it for gout if it shows up only in your toes. Be sure you get the right diagnosis, because gout and PsA have different treatments.
How Did I Get Toenail Psoriasis
It is not known exactly what causes psoriasis. The disease is known to have a strong genetic componenta third of all sufferers have a family history of psoriasis, and if an identical twin develops the disease it is 70% likely that the other twin will also develop itbut other factors also seem to have an effect.
Certain drugs and medications have been reported to cause psoriasis, and lifestyle factors such as drug and alcohol abuse, stress, smoking, and obesity are all known to exacerbate existing cases. Environmental factors such as excessive heat or dryness can also have this effect.
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Other Early Symptoms Of Psoriatic Arthritis
Psoriatic arthritis can cause other signs and symptoms. Elbow pain, reduced range of motion, and digestive problems are other common symptoms.
Pain in the elbow that is caused by arthritis may gradually become worse and radiate to your forearm and wrist. Your grip may also feel weak, and your pain may become more intense when you lift things, open jars, or squeeze objects.
A reduced range of motion could make it difficult for you to bend your knees or extend your arms without feeling pain. If the arthritis is in your fingers, you may have difficulty with typing, writing, and drawing.
Digestive problems caused by this type of arthritis may include bloating, gas, diarrhea, and constipation. Some people even develop inflammatory bowel disease , digestive tract inflammation.
Chest And Back Pain At The Same Height
Chest and back pain at the same height, such as the one that occurs between the shoulder blades, specifically in the upper back and chest, can have many causes, ranging from a muscle strain, which is the cause more common, even an organic problem.
However, the main cause of chest and back pain at the same height is stress, anxiety and being subjected to depressive symptoms . These alterations contribute to the appearance of anxiety, nervousness, tightness and pain in both the upper back and the chest.
These discomforts can be controlled as the necessary treatment to manage stress and anxiety is carried out.
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What Are The Symptoms Of Psoriatic Spondylitis
The usual patients with psoriatic spondylitis are usually men who have onset of psoriasis late in life. Back pain may involve one, or both sacroiliac joints. Back pain may exist with or without sacroiliac pain. Low back pain is indistinguishable from the pain associated with the other spondyloarthritis. Back pain is worse in the morning, getting out of bed, and is associated with spine stiffness. Spondylitis may affect the low back, chest, and/or the neck. In the cervical spine, limitation of motion is a primary manifestation of neck involvement. The activity of skin and nail disease does not necessarily correlate with joint or spine involvement.
Pregnancy Fertility And Breastfeeding
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 treatments must be avoided when trying to start a family, during pregnancy and when breastfeeding:
- retinoid tablets and creams.
Theres growing evidence that some other drugs for psoriatic arthritis are safe to take during pregnancy. Your rheumatology department will be able to tell you which ones.
It will help if you try for a baby when your arthritis is under control.
Its also important that your arthritis is kept under control as much as possible during pregnancy. A flare-up of your arthritis during pregnancy can be harmful for you and your baby.
Psoriasis and psoriatic arthritis can run in families. If you have either condition, you could pass on genes that may increase your childrens risk though its difficult to predict.
As treatments continue to improve, people with psoriatic arthritis in years to come can expect a better outlook. If you have any questions or concerns, talk to your doctor.
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What Does Psa In The Knees Feel Like
Many MyPsoriasisTeam members have shared how it feels to have PsA affect their knees. One MyPsoriasisTeam member wrote that their left knee was hot to the touch and that pain had spread to the area behind their knees. Another member with psoriasis and PsA commented, I dont know which is worse the knee pain or the psoriasis.
Some members have shared what its like to deal with a limited range of motion as a result of their PsA. One member, describing the stiffness they felt while walking, wrote: I felt like I was walking like a robot because my knees were so stiff and wouldnt bend right. This member added that although they made it through, they still experienced stiffness and some back-of-knee pain on one side the next day. Another member reported experiencing similar symptoms, writing: There are days my knees and legs lock up.
Many MyPsoriasisTeam members have expressed frustration while waiting to have surgery to help alleviate their symptoms. As one member wrote, The pain in my knees is getting worse every day. Im not sure how much longer I can keep putting off knee replacement surgery. I was told a year ago that was pretty much my last option.
Treatment Options For Ankylosing Spondylitis Vs Psoriatic Arthritis
There is no cure for either AS or PsA. However, in the case of either condition, medication is critical to treat symptoms, protect joints, slow disease progression, and improve quality of life. Your rheumatologist will best determine the best treatment plan for your specific symptoms and health needs, says Dr. Norton.
Some of the treatments for AS and PsA overlap, though certain medications are better for certain symptoms.
For AS patients: Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen are considered a first-line treatment for ankylosing spondylitis. If these medications dont adequately relieve symptoms, doctors frequently turn to biologics, which are targeted therapies that act on the immune system to stop inflammation. They are either infused with an IV or injected with a syringe or auto-injector pen.
Different biologics act on different parts of the immune system. In AS, commonly used biologics include those that block the protein tumor necrosis factor as well as those that block a protein called interleukin-17 .
FDA-approved anti-TNF biologics for AS include adalimumab , certolizumab pegol , etanercept , golimumab , and infliximab . FDA-approved IL-17 inhibitors for AS include secukinumab and ixekizumab .
PsA patients may also benefit from phototherapy or topical creams to treat skin plaques.
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How To Tell If Back Pain Is Related To Psoriatic Arthritis Or Something Else
If your back is bothering you, its important to check in with your doctor to get to the root cause.
Ankylosing spondylitis is one condition thats often confused with psoriatic arthritis. Both psoriatic arthritis and ankylosing spondylitis are in the family of spondyloarthritis and are highly related, explains Davis. Ankylosing spondylitis is another type of inflammatory arthritis. It causes the vertebrae in the spine to fuse, resulting in back pain.
People with ankylosing spondylitis are more likely to lose spinal mobility than those with axial-psoriatic arthritis, although the latter may lose range of motion. Most people with axial-psoriatic arthritis also have pain in their peripheral joints hands, feet, ankles but its possible to experience back pain only.
Ultimately, imaging of your back will help your doctor determine whether you have axial-psoriatic arthritis or ankylosing spondylitis. Although there is overlap, there are some subtle differences in the appearances of X-ray changes in both the sacroiliac joints and the spine, explains Davis.
That said, its easy to mistake symptoms of one condition for the other. What appears to be mechanical pain could be inflammatory pain, and what appears to be inflammatory pain could be mechanical pain, says Bhatt.
People who have psoriatic arthritis may also have back pain linked to a number of other causes, says Davis, including: