Undertreatment Of Psoriasis Is Common
Dr. Yamauchi points out that many patients with moderate-to-severe psoriasis are undertreated. This may be less true of people with PsA, who now often begin therapy with a biologic however, diagnosis is often delayed, which is also an issue.
âIn psoriasis, undertreatment may happen because patients or providers arenât comfortable with biologics,â Dr. Yamauchi says. âSome think biologics are dangerous because thereâs the perception that they suppress the immune system. I explain that these agents target immune system pathways that contribute to psoriasis and its comorbidities and that biologics normalize them to control psoriatic disease and inflammation.â
Dr. Ogdie also emphasizes that treating psoriatic disease improves quality of life. âMany patients assume theyâre fine, but until their inflammation is under control, they donât know how good they can feel,â she says.
If your skin isnât clear or nearly clear, or you continue to have joint symptoms or fatigue from PsA that interferes with your daily life, your systemic inflammation may not be well-controlled, says Dr. Yamauchi.
Talk with your health care provider about medications that can bring your psoriatic disease â and the inflammation associated with it â under control.
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.
The Bodys Defenses Gone Rogue
Researcher Nehal N. Mehta, M.D., MSCE, is a senior investigator in the Section of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute in Bethesda, Maryland. For the past six years, he and other scientists in his NHLBI lab have followed a group of 350 people with plaque psoriasis, looking into how chronic inflammation affects their risk of heart disease and metabolic conditions such as diabetes.
âInflammation is simply a collection of immune cells trying to put out a fire, and that fire is usually an infection or some sort of virus,â says Dr. Mehta, a cardiologist and internist.
Setting off this inflammatory response, infiltration of immune cells and release of factors, is what the immune system evolved to do. In psoriatic disease, however, this primal defense has gone awry.
âIn psoriasis, immune cells attack places they shouldnât,â Dr. Mehta says. âThey go to the skin and cause psoriatic plaques, but they can also go to the joints and cause psoriatic arthritis. When they infiltrate blood vessels of the heart, they inflame the cells that line blood vessels. These fill with immune cells that donât belong there and cause inflammation. Thatâs the beginning of cardiovascular disease.â
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You Might Want To Rethink Hitting Happy Hour
Have you noticed your psoriasis gets worse after chomping a cheeseburger? Perhaps you can’t eat eggplant parmigiana without having a flare-up. Or maybe it’s red wine that seems to worsen your red patches.
An estimated 7.4 million Americans have psoriasis. Its an immune disease that often results in scaly, itchy blotches appearing around your knees, elbows and scalp, though they can pop up anywhere on your skin. Many things can trigger or exacerbate psoriasis symptoms, including your diet.
The science on food and psoriasis is developing, but these eats are frequently named as no-nos.
Control your weight to ease symptoms
It’s believed that being obese increases your risk of psoriasis. Often, the more someone weighs, the worse the condition is. Dropping pounds can ease symptoms and may help make treatments work better. To lose weight, improve your health overalland perhaps relieve your itchtry the following:
No specific diet has been proven to reduce psoriasis symptoms. But some research suggests the Mediterranean diet may help some people. Perhaps this is because it can lead to weight loss and reduce inflammation.
Foods linked to inflammation
Obesity And Psoriasis Severity
Obesity is not only a risk factor for developing psoriasis, but it also aggravates psoriasis in people already living with the disease. Research has indicated a positive correlation between different measures of body fat and the severity of psoriasis.
One 2017 study of 42 hospitalized individuals with psoriasis found that there was no significant relationship between BMI or waist size average and the severity of psoriasis. However, other research tells a different story. One 2015 review of psoriasis-related studies analyzed the relationship between psoriasis severity and obesity. Most of these studies used the Psoriasis Area and Severity Index to measure disease severity. According to the review, seven of the nine studies included found a statistically significant association between higher BMI and increased psoriasis severity. Obese or overweight individuals with psoriasis were more likely to have severe psoriasis requiring systemic therapy.
In the same vein, research has found that losing weight may improve psoriasis severity in those who are overweight.
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Fatty Acids And Inflammation
Long chain SFAs such as palmitate are enriched in states of nutrient excess and obesity . SFAs can produce insulin resistance, endoplasmatic reticulum stress, oxidative stress, and cell death, a phenomenon referred to as lipotoxicity . They can bind to cell surface molecules such as CD36, free fatty acid receptors and intracellular receptors/sensors that control inflammatory cell signaling and gene expression . SFAs are able to induce pro-inflammatory cytokines in human macrophages via pathways involving de novo ceramide synthesis . SFAs, but not unsaturated FAs, bind to E-FABP which activates retinoid acid receptor resulting in differentiation of CD11c+ macrophages and expression of proinflammatory cytokines . It has been suggested that SFAs, via binding to TLR2 and TLR4, stimulate the expression of pro-inflammatory signaling pathways . Current findings indicate that SFAs are not TLR4 agonists, but instead provide a second hit of activation that is dependent on prior TLR4 activation . Consistently, several studies did not detect any direct FFA-mediated activation of myeloid cells . However, amplification of the pro-inflammatory response of myeloid cells in the presence of SFAs has been described in many studies . How can SFAs amplify the pro-inflammatory response?
Taken together, SFAs can amplify the pro-inflammatory response via direct and indirect actions . Thus, restriction of dietary SFAs might be helpful to suppress psoriatic inflammation.
Can Zero Calorie Beverages Cause Weight Gain
We all want to be slimmer and healthier, right? Thats why millions of us are switching from sugary sodas to zero calorie beverages that seem to offer all the rewards of those sugary sodas without the price.
The question is…Does zero calorie REALLY mean zero risk?
Sadly, the answer is a big NO. In fact, it looks like these drinks can sabotage your health AND put pounds on you. And heres why.Recently, a group of scientists dug up every study they could find on the effects of artificial sweeteners like aspartame and sucralosethe chemicals that make zero-calorie drinks sweet. Pooling the data to do what we call a meta-study, they discovered that these sweeteners cause weight GAINnot weight loss. Whats more, the results show that theyre culprits in high blood pressure, metabolic syndrome, type 2 diabetes, and cardiovascular problems.Are you wondering how a food with no calories can put pounds on your belly? Well, scientists dont know yet, but they have some good guesses.
- One theory is that the sweeteners mess with your gut microbiome and change how it metabolizes sugar. Research shows that after just FOUR DAYS of adding sugar substitutes to their diet, about half of people have higher blood sugar levels. It looks like this happens because artificial sweeteners boost your levels of gut bugs that hoard energy and lower the levels of microbes that help keep you slim.
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Obesity And Psoriasis Onset
Although there is ongoing debate about the exact correlation between psoriasis and obesity, evidence suggests that the relationship is bidirectional: obesity may be a risk factor for psoriasis, or psoriasis may lead to obesity.
The association between psoriasis and obesity is believed to arise, in part, from the fact that both diseases involve chronic inflammatory processes. A network of inflammation-causing proteins known as cytokines, particularly tumor necrosis factor-alpha , is thought to play a key role in the development of obesity and psoriasis. In obesity, TNF- is believed to come from certain inflammatory cells found in body fat, whereas in psoriasis, its thought to be derived from activated T cells .
Obesity is common in people with psoriatic disease , and obesity is even more common in those with psoriasis alone.
Extra Pounds Could Up Your Risk Of Psoriatic Arthritis
About 10% to 30% of psoriasis patients eventually develop psoriatic arthritis, an autoimmune disease that causes painful, swollen joints. But overweight or obese psoriasis patients may be particularly at risk. In a study published in the journal Annals of the Rheumatic Diseases, researchersfound a link between obesity and increased chance of developing the condition. The study looked at data collected over a 15-year period of more than 75,000 people in the UK, and found that psoriatic arthritis incidence rates increased along with BMI.
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Treating Psoriatic Disease Is Key
Untreated inflammation is dangerous, stresses Dr. Mehta.
âYou need to treat psoriasis no matter what its severity,â he says. âIf youâre ignoring it, your body is doing things on the inside that you donât know about until later. People who donât treat severe disease, for example, are growing coronary plaque at an alarmingly fast rate.â
Those with mild disease also need treatment, says Dr. Mehta. âItâs my personal opinion, and not yet part of the guidelines, but I think even one psoriatic plaque is too much,â he says.
Thereâs evidence that treatment with biologics reduces incidences of heart disease and heart attacks, says Dr. Mehta. He, Dr. Yamauchi and Dr. Ogdie say they also suspect treatments that control systemic inflammation may lower the risk of other comorbidities of psoriasis, including PsA.
âWe think itâs probably true that if you treat your psoriasis, youâre more likely to prevent psoriatic arthritis, delay its onset or reduce its severity if it does develop,â Dr. Ogdie says. âBut we still donât yet have the data to say that definitively.â
The Challenge: Being Overweight Can Lead To Inverse Psoriasis
People with psoriasis who are overweight or obese may experience heightened discomfort in areas of the body where we have skin folds, such as under the breasts and in the groin area, due to the constant friction. Being overweight actually puts you at risk for inverse psoriasisa form of the disease characterized by red, shiny lesions that appear in the skin folds. Having symptoms in these sensitive areas can be especially debilitating because of the continual friction, which makes it more difficult to manage and treat.
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Your Rx: Minimize Your Intake Of Inflammatory Foods
Foods and bevs that are high in sugar can spark inflammation in the body, so do your best to save sweet treats and alcohol for special occasions. Speaking of alcohol: Dr. Sodha highly recommends avoiding it. You definitely want to minimize your alcohol intake as it can induce immune dysfunction, which can worsen psoriasisplus it causes weight gain, she says. If youre someone whos accustomed to drinking fairly often, try experimenting with making fun mocktails, as there are so many delicious and refreshingly alcohol-free recipes out there that are also low on sugar.
Ways To Manage Weight Gain With Psoriatic Arthritis
The best way to lose weight is to adopt a healthy lifestyle that includes a balanced diet & exercise. People who suffer from Psoriatic Arthritis will benefit from low impact activities that decrease pressure on the joints.
Michael Schuster, M.D., Ph.D.ARBDA Rheumatologist & Physician Partner
Research has shown that people who are overweight or obese have a greater likelihood of developing Psoriatic Arthritis. Even without a chronic illness, though, managing your weight can be difficult and changes in weight can have an impact on the rest of your overall health.
Managing your weight isnt easy, especially when you have to contend with psoriatic arthritis at the same time. Your joints are swollen and in pain why would you want to exercise? It might be understandable if you wouldnt want to even go out at all.
However, research has proven that a lack of activity contributes to weight gain. However, you might not know that being overweight can have an effect on your psoriatic arthritis symptoms as well. Meaning that, being overweight will contribute to greater inflammation in your joints. This will, in turn, cause greater pain and disability over time. Additionally, being overweight can cause some psoriatic arthritis medications to not work as well.
1. Identify Your Triggers
2. Diet, Diet, and oh yeah Diet.
3. Keep It Moving
4. Low-impact Exercises
5. Learn About Your Medications
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Find Your Support System
Living with a chronic condition like psoriasis can be a challenge. But remember, youre not alone.
MyPsoriasisTeam is the social network for people with psoriasis. Here, more than 89,000 members discuss the ins and outs of life with psoriasis, including their different health concerns alongside psoriasis. Join the conversation today by sharing your story in the comments below, or by creating a post on MyPsoriasisTeam.
The Psoriasis And Obesity Connection
Psoriasis is an autoimmune disease, meaning your immune system reacts to healthy cells in your body as if they were a threat. In the case of psoriasis, this reaction leads to the overproduction of skin cells, which pile up into thick, red patches of skin called plaques. Its not contagiousits genetic, so you can only get if you inherited certain genes from your parents.
Think of your genes as switches on a control panel. Just because you have some switches marked psoriasis doesn’t mean they’re always turned onif you have psoriasis, you wont have plaques at all times. The psoriasis switches turn on when factors in your environment trigger them. By regulating your environment and getting the right treatment, you can keep those big red switches in the off position and keep your psoriasis symptoms under control.
Environmental triggers for psoriasis include , stress, infections, cuts, and burns. Avoiding these triggers can prevent your psoriasis from flaring up. But if youre obese, your excess weight can also be a trigger, and your doctor will likely add weight loss to your prevention plan.
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If I Take Stelara For A Long Time Will I Have Withdrawal Symptoms When I Stop Using It
Its possible that your condition may return or worsen if you stop taking Stelara. This can lead to symptoms that may be confused with withdrawal symptoms.
Dont stop taking Stelara unless your doctor recommends that you stop treatment. Once you stop taking Stelara, your doctor will monitor you closely to determine if you can safely remain off the medication.
How Does Cosentyx Compare To Humira
Cosentyx and Humira are both injections used to treat plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. Humira is also prescribed to treat other conditions. These include rheumatoid arthritis, inflammatory bowel disease, and hidradenitis suppurativa.
Cosentyx and Humira each contain different active drugs. Cosentyx contains the active drug secukinumab, but Humira contains the active drug adalimumab. Cosentyx doses are typically given every 4 weeks. But Humira doses are usually given every other week.
If youd like to know more about the differences between Cosentyx and Humira, talk with your doctor.
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You’ll Have More Energy
It’s common for people with psoriatic arthritis to feel fatigue, and being overweight can magnify that feeling. When you’re tired, it’s harder to feel motivated to exercise. On the other hand, exercise increases energy. So, start moving, make the effort to prepare healthier meals, and work on leading a healthy lifestyle. Vigorous walking, bicycling, swimming, and playing tennis are all good exercise choices to get your heart rate up. Exercise can help you lose weight, lower inflammation, and feel better all around.
Impact Of Obesity On The Treatment Of Psoriasis
There are numerous difficulties when treating obese patients with psoriasis. Obesity has been associated with a decreased response to systemic and biological treatment. Also, obesity is associated with certain conditions such as metabolic syndrome and hepatic steatosis which may increase the risk of adverse treatment effects. Treatment cost is potentially also affected by obesity when drugs are prescribed in weight-adjusted doses.
Treatment with methotrexate may be complicated by obesity since nonalcoholic hepatic steatosis can contribute to the hepatotoxicity of MTX. In fact, studies have shown that, in overweight patients with psoriasis treated with MTX, obesity is a greater risk factor for hepatotoxicity than viral hepatitis, alcohol, and cumulative dose of MTX. Steatosis of the liver probably adds to the risk, and therefore liver transaminases should be monitored more closely in these patients . Little is known about the effect of obesity on the response to treatment with MTX, but 1 study showed that loss of response over time was more likely in obese patients treated with MTX .
In psoriasis, treatment with acitretin is often associated with hypercholesterolemia with decreased high-density lipoprotein. Corbetta et al. studied the effects of acitretin on lipid metabolism after 1 and 3 months of treatment with acitretin in 10 patients with psoriasis and found only transient changes in lipid and glucose metabolism which were not associated with changes in BMI.
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