What Are Other Types Of Psoriasis
Plaque psoriasis is the most common type. About 80% to 90% of people with psoriasis have plaque psoriasis.
Other, less common types of psoriasis include:
- Inverse psoriasis appears in skin folds. It may look like thin pink plaques without scale.
- Guttate psoriasis may appear after a sore throat caused by a streptococcal infection. It looks like small, red, drop-shaped scaly spots in children and young adults.
- Pustular psoriasis has small, pus-filled bumps on top of the red patches or plaques.
- Sebopsoriasis typically appears on the face and scalp as red bumps and plaques with greasy yellow scale. This type is a cross between psoriasis and seborrheic dermatitis.
Complete Medical History For Diagnosing Psoriatic Arthritis
Your road to a psoriatic arthritis diagnosis starts with talking to your rheumatologist in order to share symptoms and identify risk factors. While symptoms like joint pain could suggest a number of conditions, in psoriatic arthritis, joint pain often has specific characteristics, including the following:
- Joint pain that gets better with use
- Joint redness and swelling
- Swelling of an entire finger or toe as opposed to just one joint, called dactylitis or sausage digits
- Morning stiffness that lasts more than 30 minutes
- Changes in the nails of your fingers or toes, such as holes, pitting, discoloration or softness, which occurs in 80 to 90 percent of PsA cases
When patients talk about these psoriatic arthritis symptoms, rheumatologists like Dr. Kumar hear a number of common concerns, such as My shoes dont fit, I feel stiff all over in the mornings, and I have trouble opening jars or door knobs.
Along with listening to your symptoms, your rheumatologist will want to hear about any possible risk factors for psoriatic arthritis. While this condition can affect patients of both genders at a range of ages, the following can increase your risk:
- Having psoriasis
- Having a family history of PsA, psoriasis, or associated conditions, including ankylosing spondylitis, Crohns disease, ulcerative colitis, autoimmune uveitis, and reactive arthritis
How Is Psoriasis Diagnosed
There arent any special tests to help doctors diagnose psoriasis. Typically, a dermatologist will examine your skin and ask about your family history.
Youll likely be given a diagnosis based on this physical exam.
In some situations, doctors will remove a small sample of the skin and examine it under a microscope. This might allow them to get a better look at the affected area and make a more accurate diagnosis.
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What To Expect At The Doctors Office
You may be seeing various health care providers during your journey to figure out whats causing your symptoms. Its common for people to see their internist/general practitioner, a dermatologist to treat their psoriasis, or other types of doctors to manage specific areas that are causing pain, such as a podiatrist to treat foot pain. However, if you or any of the health care providers you are currently seeing suspect it could be psoriatic arthritis, ask for a referral to a rheumatologist. These doctors specialize in arthritis and have the training to determine whether your joint symptoms are due to PsA or could be something else.
Psoriatic arthritis can be challenging to diagnose for a number of reasons, including:
Whats The Treatment For It
There is the suggestion that it will go away on its own in a few weeks to a couple of months. But that can feel like a lifetime when youve got a flare-up. In a similar way to plaque psoriasis, you can also treat guttate psoriasis using medications or phototherapy. Talk to your doctor about the types of medication you could be able to use, such as steroids or hydrocortisone. Alternatively, you could also try several over-the-counter options like coal tar soaps and shampoos, vitamin A and plenty of moisturizing.
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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.
Tests For Psoriatic Arthritis
Psoriatic arthritis cant be diagnosed with any single test. Your doctor will probably order a number of tests and examine all of the evidence to make a diagnosis.
Your doctor will not only be looking for indications of PsA in your test results. They will also be looking for results that rule out other conditions as well as results that eliminate the possibility of PsA.
For example:
- Blood tests can help rule out gout and rheumatoid arthritis .
- A blood test that shows mild anemia points toward the possibility of PsA .
- Presence of RH factor in your blood means you dont have PsA.
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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.
How To Find A Dermatologist
People who think that they might have psoriasis may wish to schedule an appointment with their primary care doctor, who can likely refer them to a dermatologist. Alternatively, they can visit the NPFs Patient Navigation Center.
Once a person has obtained the names of some local dermatologists, the American Academy of Dermatology Association recommends visiting each of the doctors websites to check whether they are board certified.
In the United States, a qualified dermatologist will have certification from the American Board of Dermatology, the American Osteopathic Board of Dermatology, or the Royal College of Physicians and Surgeons of Canada. Some dermatologists with these credentials may have the initials FAAD after their name, which stands for Fellow of the American Academy of Dermatology.
The AAD provides this search tool to find dermatologists in a certain area.
Before making an appointment, a person may also wish to check with their insurance provider whether the dermatologist is in their network and whether their insurance plan covers the visit.
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Imaging Studies For Diagnosing Psoriatic Arthritis
In addition to laboratory tests, imaging studies can help your rheumatologist see whether the appearance of your bones and tissues suggests you could have PsA or another condition. Depending on your case and circumstances, your doctor may order one or more of the following tests:
X-ray: A radiograph image of your affected joints as well as your spine if that appears to be affected will help your doctor see marginal bone erosions, which means bone being eaten away where it meets a ligament or tendon. This would suggest PsA. Ankylosis may also be seen in very severe PsA. But a negative X-ray may simply mean the PsA is in an early stage, so additional imaging could be needed.
Ultrasound: A sonogram of the affected joints can help your doctor see disease activity and damage in tendons and ligaments. In cases of psoriatic arthritis, your doctor may see inflammation of tendons and joints or erosions where bone has been eaten away by immune cells.
MRI: Magnetic resonance imaging can be especially helpful in allowing your doctor to investigate back pain you might have associated with PsA.
Chances are, if youre seeing a rheumatologist because you have concerns about having psoriatic arthritis, youve already seen quite a few different doctors or health care providers by now. We know this process can be exhausting and exasperating. We are here for you to help make things easier.
Become part of the CreakyJoints community and follow us on and for ongoing support and education.
How Long Does It Last
Generally, guttate psoriasis will fade and go away on its own within a few weeks to a couple of months. A lot of the time people will only get it once and it wont come back. However, some people find that having guttate psoriasis led them to having life-long plaque psoriasis flare-ups. These can be managed using topical treatments or other prescriptions from your doctor.
Something else to consider about guttate psoriasis is that in summer it tends to recover quicker, while flare-ups may worsen during the colder winter months. This is similar to other types of psoriasis as well, due to sunshine being a great treatment for psoriasis.
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What Are The Symptoms Of Psoriatic Arthritis
If you are experiencing joint pain and have a history of psoriasis, it may be a good idea to visit a doctor to see if you have psoriatic arthritis. In addition to joint pain, some of the more common symptoms of psoriatic arthritis include:
- Swollen and red joints
- Joints that are warm to the touch
- Nail pitting and other changes such as nails lifting from the nail bed
- Stiff joints, especially when first waking up or after long periods of rest
- A general feeling of fatigue or malaise
- Sausage-like fingers and toes
- Plantar fasciitis, which refers to pain in ball of foot
- Conjunctivitis which may commonly be referred to as pink eye
There are many types of psoriatic arthritis. The sub-type of arthritis you are diagnosed with depends on where the symptoms occur and how many joints are affected. Currently, five types of psoriatic arthritis have been identified:
- Symmetrical polyarthritis psoriatic arthritis that affects multiple joints with comparable severity on both sides of the body
- Asymmetric oligoarticular psoriatic arthritis that affects few joints on one side of the body
- Spondylitis psoriatic arthritis affecting joints in the lower back and near the spine
- Distal interphalangeal psoriatic arthritis in the joints of the fingers and toes
- Arthritis mutilans a severe form of psoriatic arthritis that causes deformation of the joints, especially in the hands and feet
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:
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Who Will Be Responsible For My Healthcare
Youre likely to see a team of healthcare professionals.
Your doctor, usually a rheumatologist, will be responsible for your overall care. And a specialist nurse may help monitor your condition and treatments. A skin specialist called a dermatologist may be responsible for the treatment of your psoriasis.
You may also see:
- a physiotherapist, who can advise on exercises to help maintain your mobility
- an occupational therapist, who can help you protect your joints, for example, by using splints for the wrist or knee braces. You may be advised to change the way you do some tasks to reduce the strain on your joints.
- a podiatrist, who can assess your footcare needs and offer advice on special insoles and good supportive footwear.
Imaging Tests For Psoriatic Arthritis
Imaging tests can help your doctor closely examine your bones and joints. Some of the imaging tests your doctor may use include:
- X rays. X-rays arent always useful in diagnosing early stage psoriatic arthritis. As the disease progresses, your doctor may use imaging tests to see changes in the joints that are characteristic of this type of arthritis.
- MRI scans. An MRI alone cant diagnose psoriatic arthritis, but it may help detect problems with your tendons and ligaments, or sacroiliac joints.
- CT scans. These are used primarily to examine joints that are deep in the body and not easily seen on x-rays, such as in the spine and pelvis.
- Ultrasounds. These tests can help determine the progression of joint involvement and pinpoint the location.
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What Nail Psoriasis Looks Like
Nail psoriasis causes changes to your fingernails and toenails
This fingernail shows 3 signs of nail psoriasis: Crumbling, roughness, and blood under the nail .
Common signs of nail psoriasis
This nail also has 3 signs of nail psoriasis: Tiny dents in the nail , white discoloration, and lifting .
Most people who have plaque psoriasis develop nail psoriasis
Discoloration , nail lifting from the finger, and a thin line of blood are common signs of nail psoriasis.
Nail psoriasis usually begins years after psoriasis first appears on the skin
This patients nail has 3 common signs of nail psoriasis: Grooves, blood beneath the nail , and lifting of the nail from the finger.
Nail psoriasis can be mild
If you have psoriasis, ridges and a thin line of blood beneath the nail can be signs of nail psoriasis.
Improvement from treatment happens slowly
Nails grow slowly, so it will take 6 months or longer to clear debris, a common sign of nail psoriasis, beneath the nail.
Injections For Psoriasis Treatment
Injections are a common treatment option for people living with psoriatic arthritis or moderate to severe psoriasis. They are commonly prescribed to individuals who have not responded to other treatment options, like oral medications, topicals or phototherapy.
Some MyPsoriasisTeam members have expressed curiosity about the effectiveness of injectable medications for psoriasis and PsA. Has anyone been on psoriasis injections? one member asked. Is it for a lifetime? Does it clear the skin for good, or just manage it?
This article will explore the answers to these questions. It will also provide a summary of commonly injected medications and explore their benefits and drawbacks.
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How To Stay Safe
Having psoriasis and a compromised immune system is a good reason to want to stay healthy.
To minimize your risk for COVID-19, take the following CDC precautions:
- Stay home as much as you can.
- Avoid crowds, and limit close contact with others when out in public.
- Avoid touching your face, nose, and mouth when out.
- Avoid touching frequently touched surfacessuch as doorknobs and shopping cartswhen out in public. Carry disinfecting wipes for when you need to touch surfaces.
- Wear a mask when in a crowded place.
- Talk to your doctor about whether the COVID vaccine is an option for you, and if it is, get vaccinated as soon as you can.
- Wash your hands with soap and water for at least 20 seconds or use hand sanitizer after coming inside or after touching commonly touched surfaces.
Psa Treatment: How Do You Treat Psoriatic Arthritis
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Over 125 million people have psoriasis, a common skin condition that causes red, itchy skin with signature silvery scale patches. Afflicting 2-3% of the worlds population, psoriasis affects Caucasians more so than other races and it is the most common autoimmune disorder in the United States.
In addition to skin troubles, individuals with psoriasis are also more susceptible to joint troubles. Up to 30% of individuals who have psoriasis will also develop rheumatoid arthritis. Psoriasis precedes the onset of psoriatic arthritis in 85% of cases however, in rare instances individuals can develop psoriatic arthritis without having prior psoriasis symptoms. The onset of psoriatic arthritis typically occurs between the fourth and fifth decade.
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