Thursday, July 11, 2024

Does Psoriasis Lead To Psoriatic Arthritis

Symptoms Are Often Slow To Show

Psoriasis, Psoriatic Arthritis and Weight

According to Dr. Fernandez, the majority of people whodevelop psoriatic arthritis have psoriasis first.

Up to 30 percent of people with psoriasis will develop PsA, but that can take an average of 10 to 12 years after the skin disease appears. It is not known exactly why the condition takes so long to appear, he says.

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.

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.

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Psoriasis And Psoriatic Arthritis Overview

Alan Menter, MDSupplements and Featured Publications

Psoriasis and psoriatic arthritis are chronic immune-mediated diseases that primarily affect the skin and joints, respectively these diseases are also associated with high rates of cardiovascular and other comorbidities. Despite over 40 genes proven to be related to the disease, the exact causes of psoriasis and PsA are still to be determined. Recent insights into the underlying pathophysiology of these diseases have revealed novel therapeutic targets. Effective management requires timely diagnosis and initiation of treatment. Yet, both psoriasis and PsA remain underrecognized and undertreated in current clinical practice. Recognizing the true physical, social, and emotional burden of psoriasis and PsA, as well as their associated comorbidities, is the first step to improving the prognosis for affected patients.

Am J Manag Care. 2016 22:S216-S224


Psoriasis is a chronic, multifactorial, immune-mediated skin disease. The characteristic erythematous plaques of psoriasis are often painful and disfiguring, leading to a substantial decrease in quality of life.1 Cardiovascular disease , diabetes, and other autoimmune disorders are common among patients with psoriasis, contributing to the overall burden of disease and increasing healthcare

resource utilization.1


Immunologic Mechanisms

Genetics of Psoriasis

Environmental triggers

Other immune-mediated diseases

Disease Classification


Inflammation And Heart Disease

Psoriatic arthritis and nails: Changes, pictures, and ...

Inflammation can take many forms. These may include reddened patches of skin on your body and psoriatic arthritis. Symptoms can also include conjunctivitis, inflammation of the lining of your eyelids.

Psoriasis may also take different forms. Generally, people with any type of psoriasis have a risk of heart attack that is almost three times greater than in people without psoriasis.

Blood vessels can also become inflamed. This can cause the development of atherosclerosis. Atherosclerosis is the buildup of a fatty substance called plaque inside your artery walls. Plaque slows or interrupts the flow of blood to your heart. This heightens your risk of heart disease and heart attack.

Some psoriasis treatments can result in irregular cholesterol levels. This can harden the arteries and make a heart attack even more likely. People with psoriasis have also been found to have an increased risk of coronary heart disease, according to the

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Treat Your Psoriatic Arthritis

If your muscle pain is tied to your PsA diagnosis, treating the condition could reduce your enthesitis and help you stay active. This, in turn, could potentially prevent muscle aches and pains.

You have many options when it comes to treating psoriatic arthritis. In addition to NSAIDs, you may be prescribed medications including:

  • Immunosuppressants
  • Corticosteroids

These medications can all have side effects, so talk to your health care provider to develop your treatment plan. Although none of these PsA treatments will take your muscle pain away immediately during flare-ups, they can be very helpful in providing relief.

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Do We Know What Causes Psoriatic Arthritis

  • The cause of psoriatic arthritis is the subject of much research.
  • You cannot catch psoriatic arthritis or psoriasis from someone else. Therefore they are not contagious.
  • The cause of psoriatic arthritis is not proven but experts believe it to be a combination of genetic, immunological and environmental factors. 2 out of 5 people with psoriasis or psoriatic arthritis have a first-degree relative with the condition. This means you have a higher chance of developing psoriasis or psoriatic arthritis if you have relative who has the condition. Some experts believe infections such as streptococcal infections may provoke psoriatic arthritis, though this is not proven.
  • The role of bacteria in the gut and developing psoriatic arthritis is the subject of current research.
  • Trauma and stress may be contributing factors, although this is not proven.
  • The genetic make-up of an individual is likely to determine the risk of developing psoriasis and psoriatic arthritis and probably influences the severity.
  • Being overweight is now understood to be linked to developing psoriatic arthritis and is the subject of ongoing research.
  • There are certain genetic markers linked to the immune system which are now being used to predict the severity of psoriatic arthritis. Much more is known about the mechanisms that lead to inflammation in other conditions and it is likely advances in science will lead to much more effective treatments with fewer side effects.

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Screen For And Treat Comorbidities

If you have psoriasis, your dermatologist or primary care physician should screen you regularly â at least once a year â for PsA, says Dr. Ogdie.

âThe earlier you catch it and start treatment, the more likely you are to respond to therapy,â she says, noting that early treatment also potentially lowers the chances of permanent joint damage.

Dr. Ogdie advises people with psoriasis to understand the signs and symptoms of PsA. These include joint pain, swelling and tenderness â particularly in fingers and toes â and enthesitis, or inflammation at the points where tendons insert into bones. In addition, having psoriasis in the nails, scalp or skinfolds should raise suspicion for PsA, as should a family history of the disease.

âIf you have new symptoms, tell your doctor,â Dr. Ogdie says. âRemind them you have psoriasis and ask if these changes could mean you have psoriatic arthritis.â

Comorbidities such as CVD and metabolic syndrome can start developing at young ages in people with psoriasis and PsA, and sometimes health care providers arenât looking for them, Dr. Mehta says.

âPeople with psoriasis should ask their doctors to screen them for heart and metabolic disease. They can do this by checking the three âBs,â which are blood pressure, body mass index and blood levels of glucose and cholesterol,â he says.

Spondylitis With Or Without Sacroiliitis

Living With Psoriatic Arthritis and Psoriasis

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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Treatments For Psoriasis And Psoriatic Arthritis

Many medications can help treat both the skin and joints, but there are definitely medications that work better for one than the other, explains Dr. Haberman. When treating PsA, we focus on both domains. We may start with one medication if your skin is worse that is better on the skin, but it should still have effects on the joints, she says.

According to the clinical treatment guidelines by the American College of Rheumatology and the National Psoriasis Foundation , your personal treatment plan should depend on how PsA is impacting your body as well as the severity of your symptoms.

Since patients with psoriatic arthritis may have different degrees of involvement of skin, joint pain, finger and toe swelling , and pain where tendons and ligaments attach to bone , its important to identify the most problematic areas and choose treatment options that are best suited for them, says Dr. Husni.

For example, if you have little joint pain and a lot of skin involvement, your rheumatologist might try newer biologics called IL-17 inhibitors, like secukinumab and ixekizumab , notes Dr. Haberman.

While we have a lot of medication options for PsA, sometimes it is more of trial and error to see which medication the patient will respond to, she says. Sometimes we need to try more than one medication to find the one that is right for that patient.

Medications use to treat both psoriasis and PsA include:

Diagnosing Psoriasis And Psa

Unfortunately, theres no one simple diagnostic test to check for psoriasis or psoriatic arthritis. This means your doctor will need to make a clinical diagnosis, which requires taking into account your symptoms, risk factors, as well as the results of bloodwork and X-rays or other imaging scans to assess any joint involvement.

During the physical exam, your doctor might look for signs of psoriasis on the elbows and knees as well as less visible places like the scalp, belly button, intergluteal cleft, palms of hands, and soles of feet. Theyll also check for any fingernail or toenail abnormalities, like pitting or ridging, as well as swollen fingers or toes .

The presence of dactylitis and finger and toenail changes are evidence of psoriasis that can be used to aid in the diagnosis of psoriatic arthritis if there is no evidence of skin disease, says Dr. Haberman.

Here are some common steps used to diagnose psoriasis and PsA:

  • A medical exam to discuss family history, risk factors, and symptoms
  • Blood tests to check for markers of inflammation and antibodies , which can help rule out other types of arthritis, including rheumatoid arthritis
  • Imaging tests to detect any joint damage, dislocation of small or large joints, disfiguration , new bone formation, and inflammation in the enthesis
  • Skin biopsy of a skin plaque, if you have previously undiagnosed psoriasis

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How Will Psoriatic Arthritis Affect Me

Starting the right treatment as soon as possible will give you the best chance of keeping your arthritis under control and minimise damage to your body.

Psoriatic arthritis can vary a great deal between different people. This makes it difficult to offer advice on what you should expect.

It will usually have some effect on your ability to get around and your quality of life, but treatment will reduce the effect it has.

Psoriatic arthritis can cause long-term damage to joints, bones and other tissues in the body, especially if it isnt treated.

Key Points About Psoriatic Arthritis In Children

Does Psoriasis Lead to Psoriatic Arthritis?
  • 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.

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Treatments Target Markers In The Blood

Generally, dermatologists treat mild psoriasis in patientswithout PsA with a topical cream or phototherapy that only penetrates the topskin layers.

However, for someone who has PsA and/or moderate to severe psoriasis, pills or injected medications often biologics are needed to control systemic inflammation. There are now many treatment options that effectively control psoriasis inflammation in both the skin and joints.

Topical medications have no way to control systemicinflammation, Dr. Fernandez says. Thats why pills and injectables are soimportant. They can access the bloodstream and can reduce inflammation all overthe body.

While glucocorticoids are a help, injecting them can carry asmall risk of serious joint infection, and side effects make long-term useundesirable. Your doctor will likely screen for active infections or a historyof frequent infections when deciding whether to use this therapy.

Some pills may stimulate liver inflammation. They can alsoreduce blood counts or impair kidney function, he says.

Lifestyle Changes Can Help

If you have PsO, there are things you can do to try to lower your chances of developing PsA, too. One modifiable risk factor is being overweight or obese, says Dr. Orbai. A possible explanation is that there might be more wear and tear on joints when someone is carrying more weight, which leads to inflammation. It could also be because inflammation is amplified by the fatty cells in the tissue.

Regular exercise and smart food choices based on the Mediterranean diet can help you reach a healthy weight and lower inflammation in your body.

Other ways to reduce your chances of developing PsA? If you smoke, quit. Moderate your alcohol intake, avoid cold weather , and find ways to boost your mood: A 2017 Canadian study found that psoriasis patients who reported depression were at a 37% greater risk of developing psoriatic arthritis.

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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.

Getting A Diagnosis Of Psoriatic Arthritis

Psoriatic Arthritis: Types, Symptoms, Diagnosis & Treatment – Dr. Chaithanya K S | Doctors’ Circle

The presence of psoriasis may provide an indication of psoriatic arthritis when someone develops joint symptoms. Psoriatic arthritis can develop in people with a lot or a little of psoriasis, and may be more common in people with nail psoriasis. As well as joint symptoms, psoriatic arthritis can lead to feeling tired. Many people become frustrated by a lack of diagnosis psoriatic arthritis tends to have periods of improvement and worsening, which may also be attributed to mechanical joint problems and not inflammatory arthritis.

If you have the symptoms of inflammatory arthritis, such as psoriatic arthritis, your doctor will often refer you to a rheumatologist. In some cases, further tests and imagery may be sought, although this will depend on the individual circumstances and level of confidence in the initial diagnosis.

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Fatty Liver And Psoriatic Disease

Theres a much higher prevalence of fatty liver disease in people with psoriatic arthritis, says Ritchlin.

A review of studies published in March 2015 in the Journal of Clinical and Aesthetic Dermatology found that up to 47 percent of psoriatic patients develop nonalcoholic fatty liver disease a condition that causes fatty deposits to develop on the liver and can lead to permanent scarring or damage. According to a study published in February 2016 in the journal Gastroenterology Review, NAFLD is frequent in patients with psoriasis and is also associated with the duration and severity of the disease.

Drugs used to treat psoriatic arthritis, including NSAIDs and methotrexate, can adversely affect your liver. If youre taking these drugs, your doctor will want to monitor your liver function.

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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