Is There A Link Between Psoriasis And Rheumatoid Arthritis
Did you know that if you have psoriasis that you are more likely to have another kind of auto-immune disease such as rheumatoid arthritis? Those who are diagnosed with psoriasis are more than 50 percent more likely than patients without psoriasis to become diagnosed with at least one other autoimmune disease, and are almost twice as likely to have at least two if not more subsequent autoimmune diseases, according to research conducted Dr. Jashin J. Wu, Director of Dermatology Research and Associate Residency Program Director in the Department of Dermatology at Kaiser Permanente Los Angeles Medical Center, California.
In this post d like to talk about the connection between different kinds of auto-immune diseases, particularly the link between psoriasis and rheumatoid arthritis. But before we delve into the potential relationship between these two conditions, lets first explore what auto-immune disorders really are. An auto-immune disease is classified as a disease caused by the body attacking itself, i.e an inappropriate immune response is caused by the body and this response then goes about attacking specific tissues, whether they be skin cells, muscles, nerves, or other tissues specific to an auto-immune response. There are over one hundred different kinds of auto-immune disease diagnosed so far, including conditions such as ulcerative colitis, psoriasis, rheumatoid arthritis and multiple sclerosis.
Treatment For Psoriatic Arthritis
Treatment for psoriatic arthritis aims to:
- relieve symptoms
- slow the condition’s progression
- improve quality of life
This usually involves trying a number of different medicines, some of which can also treat the psoriasis. If possible, you should take 1 medicine to treat both your psoriasis and psoriatic arthritis.
The main medicines used to treat psoriatic arthritis are:
- non-steroidal anti-inflammatory drugs
- biological therapies
Biomarkers That Can Facilitate Differentiation Of Psa Ra And Oa
One challenge in the diagnosis of PsA is the lack of validated biomarkers detectable in the serum or synovial fluid that are unique to PsA however, there are serologic, genetic, and inflammatory markers that can be screened to substantiate clinical findings.
Serologic analyses for rheumatoid factor and cyclic citrullinated peptide can be used to facilitate the distinction between PsA and RA. Approximately 80% of patients with RA are RF positive and CCP positive, while nearly all patients with PsA are RF and/or CCP negative . However, it is important to not rule out PsA solely on the basis of CCP- and/or RF-negative status, as an estimated 13% of patients with PsA are RF positive . Additionally, C-reactive protein and erythrocyte sedimentation rate have been shown to be markers of inflammation in patients with RA and PsA. Both ESR and CRP were reported to significantly predict radiographic progression in RA . Patients with PsA, on average, have lower ESR and CRP levels than patients with RA, yet elevations of both have been significantly correlated with the number of swollen joints, structural damage, and abnormalities detected with US . Elevated ESR and CRP levels that are attributed to PsA are considered markers of severe PsA by the American College of Rheumatology /National Psoriasis Foundation, and tumor necrosis factor inhibitors and/or anti-interleukin-17 biologic disease-modifying antirheumatic drugs are recommended for earlier use in these patients .
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Skin Psoriasis Treatment Options And Medications
Every case of psoriasis is unique, and ultimately every treatment plan will be unique as well. While there is no known cure, the goal of psoriasis treatment is to reduce inflammation and control shedding of the skin to make flare-ups more manageable. It is important to contact your dermatologist right away if you develop joint pain, as psoriatic arthritis can cause severe joint damage if left untreated.
Dermatology Associates of Plymouth Meeting offers a variety of treatment options to manage psoriasis and treat psoriatic arthritis symptoms:
Diagnosed With Psoriasis First
The overwhelming majority of people who responded to this story shared that they have been diagnosed with both illnesses. It is most common to find out first that you have psoriasis, then to discover years later that you also have psoriatic arthritis.
- Yes, I had psoriasis for many years before any psoriatic arthritis.
- Yes, I was diagnosed with psoriasis 9 years before psoriatic arthritis.
- Yes. I had psoriasis first, then psoriatic arthritis several years later.
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Medical Writing And Editorial Assistance
The authors thank Linda Grinnell-Merrick, NP, of Novartis Pharmaceuticals Corporation, East Hanover, NJ for providing medical expertise and content development, and Charli Dominguez, PhD, of Health Interactions, Inc, Chicago, IL, for providing medical writing support/editorial support funding was provided by Novartis Pharmaceuticals Corporation, East Hanover, NJ, in accordance with Good Publication Practice guidelines . Authors had full control of the content and made the final decision on all aspects of this publication.
What Is The Difference Between Plaque Psoriasis And Psoriatic Arthritis
Psoriasis is an autoimmune disorder that manifests as a chronic skin condition. Psoriasis can lead to the development of plaques, which are patches of scaly, red or white skin. Many individuals with psoriasis are later diagnosed with psoriatic arthritis, which is a condition with similar causes that results in joint pain, stiffness and swelling..
Both plaque psoriasis and psoriatic arthritis develop as a result of an autoimmune disorder, which is when the immune system attacks the body, leading to inflammation and/or pain. While psoriasis and skin symptoms typically develop before psoriatic arthritis, there are some cases in which arthritis develops months or even years before skin symptoms appear. In addition to a link to the immune system, doctors believe there is a link between more severe cases of psoriasis and the development of psoriatic arthritis. Additionally, many people with psoriatic arthritis have a parent or sibling with the disease. It most commonly occurs in adults between the ages of 30 and 50.
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How Are Psoriasis And Psoriatic Arthritis Connected
You may have heard that psoriatic arthritis and psoriasis are connected, but might not understand how. Although the conditions share a similar name, they can have some very different symptoms and treatments. People with psoriasis are at a greater risk of developing psoriatic arthritis, and sometimes people with psoriatic arthritis develop psoriasis later on, meaning its helpful to have an understanding of both conditions if you are diagnosed with one, according to the Mayo Clinic.
Untangling the nuances between these two conditions can be a bit complicated. Thats why we spoke with experts about the important things you should know about psoriatic arthritis and psoriasis, including how the two are linked.
What Is The Link Between The Conditions
People with psoriatic arthritis often also have psoriasis, says Dr. Mhlaba. But just because you have psoriasis does not mean you have psoriatic arthritis.
Both psoriasis and psoriatic arthritis can lead to pain, discomfort and even embarrassment. You may have trouble doing daily tasks, especially those that involve fine motor skills.
In addition, the severity of the conditions is not always the same. Your psoriasis might be severe when your psoriatic arthritis is mild, and vice versa. The unpredictable natures of these conditions can be hard to manage on your own. Given this, Dr. Mhlaba recommends a group approach to treatment.
“Psoriasis and psoriatic arthritis are best managed by a team,” she says. “Most often, this would consist of a dermatologist, a rheumatologist and a primary care physician.”
If you have questions about your skin or think you have psoriasis or another skin issue, see your dermatologist or primary care physician. They can make a diagnosis and recommend the best treatment.
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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.
What Is The Link Between Psoriasis And Psoriatic Arthritis
Psoriasis skin symptoms usually appear first followed by psoriatic arthritic symptoms. However, in 15 percent of people, symptoms of psoriatic arthritis occur months, if not years, before identifying the presence of psoriasis and its associated skin issues. Psoriasis may go undetected in some people for over a long period because of the presence of skin changes in locations such as the buttocks or back of the scalp.
This makes it difficult to diagnose, and usually, psoriatic arthritis is misdiagnosed as other forms of arthritis such as rheumatoid arthritis. This results in improper treatment approaches. Just as psoriasis skin plaques worsen and then improve, symptoms of psoriatic arthritis may sometimes come and go.
If you are diagnosed with psoriasis, it is crucial to keep an eye out for any joint symptoms of psoriatic arthritis, such as swelling, discomfort, or stiffness. Psoriatic arthritis is a progressive condition, which means it will worsen with time. If you are identified with psoriatic arthritis early on, your doctor can prescribe various treatment options to reduce the course of the disease and help preserve your joints.
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Up To 30 Percent Of People With Psoriasis Will Go On To Develop Psa And 85 Percent Of People With Psa Also Have Skin Psoriasis
Psoriasis and psoriatic arthritis are distinct conditions, but they are connected. In fact, data show that up to 30 percent of people with psoriasis will go on to develop PsA and 85 percent of people with PsA also have skin psoriasis.
Although people can be diagnosed with PsA without having any skin involvement, most often they will have a family member with skin psoriasis, says Rebecca Haberman, MD, a rheumatologist at NYU Langone Health in New York City.
Psoriasis is an inflammatory condition of the skin, while psoriatic arthritis also includes inflammation of the joints and entheses , .
Read on to find out the different symptoms of psoriasis vs. PsA, how they are diagnosed and treated, and what you need know about the link between these health conditions.
How Do Psoriasis And Psa Overlap
For every 10 patients who walk in the door with psoriasis, about three or four of them will eventually get PsA, says Elaine Husni, MD, MPH, vice chair of the department of rheumatic & immunologic diseases at the Cleveland Clinic in Ohio. Most cases almost always start with the skin condition and then within seven to 10 years later, joint pain symptoms start to develop.
However, skin and joint symptoms can develop at the same time and, more rarely, joint symptoms can appear before skin involvement, says Dr. Haberman. While estimates vary, one study showed that up to 3 percent of patients developed joint disease before skin disease, she notes.
In some cases, there may have been skin involvement that went unnoticed or undiagnosed. For example, psoriasis can be sneaky and show up in hidden or private areas like the scalp, intergluteal cleft , belly button, and inside the ear, explains Dr. Husni. Since people dont really examine their scalp or buttocks very often, small psoriasis patches can get missed and delay diagnosis, she says.
Adds Dr. Haberman: You might have a small fleck in your scalp that you just think of as dandruff that is actually psoriasis.
Whats more, people with psoriasis in some of these hidden areas may actually be more prone to PsA. Studies have shown that you may be at higher risk of developing PsA if you have scalp, nail, or inverse psoriasis, says Dr. Haberman.
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How Is Psoriatic Arthritis Linked To Plaque Psoriasis
About 85% of people who develop psoriatic arthritis in their joints had psoriasis skin symptoms first. Most of those patients have mild psoriasis and have had skin symptoms for years before they develop joint symptoms1. Nail involvement is often one of the first signs that people with plaque psoriasis will also develop psoriatic arthritis5.
However, many patients with both conditions find that their joint symptoms and skin symptoms do not usually flare up at the same time2. Further, research has shown that there does not seem to be a direct link between the severity of the two conditions among people who have both of them3. For example, having severe skin symptoms does not necessarily mean that you will also have severe joint symptoms, and vice versa.
Psoriasis And Joint Pain
As a chronic autoimmune disorder, psoriasis can impact skin, joints and nails, and symptoms can vary from intermittent to chronic and from mild to debilitating. Symptoms develop as the immune system attacks the body, rather than protecting it from foreign intruders, which leads to inflammation. On the skin, this can manifest as sensitive, red patches and flaky skin.
Although both psoriasis and psoriatic arthritis can cause joint pain, stiffness and swelling, the signs of psoriatic arthritis often resemble those of rheumatoid arthritis. Common psoriatic arthritis symptoms include:
- Swollen fingers and toes which is often a precursor to significant joint symptoms
- Foot pain, particularly at the back of your heel or in the sole of your foot
- Lower back pain called spondylitis which causes inflammation of the joints between your spinal vertebrae and in the joints between your pelvis and spine.
There are several different types of psoriatic arthritis that are identified based on how symptoms are affecting your body. For example, symmetric psoriatic arthritis affects both sides of the body whereas asymmetric psoriatic arthritis only affects one side of the body. There are other types of psoriatic arthritis that are diagnosed based on the location of your inflammation.
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Multivariable Modeling Of Mental Health Outcomes
Combined results of the multivariate analyses for the above mental health outcomes are presented in . In the first model, patients with PsA had an average of 1.62 more days of poor mental health in the last month compared to normal controls . They were 1.6-times as likely to seek mental healthcare services , and had a 2.01-fold increased risk of depression compared to the normal controls . A similar trend, albeit to a lesser degree and not statistically significant, was observed in the intermediate control group when compared to normal controls.
Multivariable adjusted linear and logistic regressions between PsA and multiple mental health outcomes.
Genetic Markers Of Psoriatic Arthritis
In the last 3 years, significant progress has been made toward identifying genetic markers associated with psoriatic arthritis. However, most of these markers are also associated with psoriasis, and thus a major remaining challenge is to identify genetic risk factors that are specific to psoriatic arthritis.
HLA locus
The HLA locus contains many genes responsible for immunologic function in humans. Psoriasis and psoriatic arthritis demonstrate human leukocyte antigen associations, most frequently with HLA-Cw6., However, the HLA region may potentially harbor multiple genes that are associated with psoriasis and psoriatic arthritis. For psoriasis, Feng et al. recently identified three independent signals near the HLA locus that contribute to psoriasis risk: HLA-Cw6, c6orf10, and the region between HLA-B and MICA.
Although psoriatic arthritis is most strongly associated with HLA-Cw6, other HLA markers have also been associated with it. The frequency of HLA-B27 is reportedly higher among patients with psoriatic arthritis.,, Gladmann and Farewell performed a univariate analysis of psoriatic arthritis patients and showed that HLA-B27, HLA-B39, and HLA-DQw3 antigens were associated with psoriatic arthritis disease progression, whereas HLA-DR7 was protective. Additionally, the presence of HLA-B39 suggested early progression in psoriatic arthritis.
MICA locus
Other genetic loci
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How Is Psoriatic Arthritis Treated
If you are diagnosed with psoriatic arthritis, it is very important to start and maintain a treatment regimen in order to control your symptoms and prevent serious damage to your joints. You may be referred to a rheumatologist, which is a physician who specializes in diagnosing and treating arthritis. To diagnose psoriatic arthritis, the rheumatologist will need to rule out other conditions that have similar symptoms, such as rheumatoid arthritis2.
Treatment options for psoriatic arthritis depend upon how severe the symptoms are and where they are located. For mild psoriatic arthritis that affects 1-4 joints, treatment may include3:
- Pain relievers called nonsteroidal anti-inflammatory drugs
- Heat and ice therapy
- Physical therapy
- Injections of corticosteroid medicine directly into the affected joint
If symptoms are affecting multiple joints and the psoriatic arthritis is moderate or severe, patients may need stronger types of treatments. These may include medicines called disease-modifying antirheumatic drugs . Examples of DMARDs are methotrexate, sulfasalazine, leflunomide, and cyclosporine. DMARDs can help to improve both skin and joint symptoms, but they cannot prevent the longer-term joint damage that psoriatic arthritis can cause4.
How To Get The Right Arthritis Diagnosis
There is no single test for psoriatic arthritis, says Azar. Along with a physical exam, youll likely need a series of both imaging procedures and blood tests for a diagnosis, and to rule out other forms of arthritis, such as rheumatoid arthritis or gout.
Theres no one test to diagnose rheumatoid arthritis either, but, as with PsA, blood tests are part of the workup. The presence of autoantibodies in the bloodstream, either rheumatoid factor or cyclic citrullinated peptide antibodies, will suggest an RA diagnosis. These antibodies tend to be less typical in people with psoriatic arthritis, according to an article published in Rheumatic and Musculoskeletal Diseases in August 2018.
As part of the physical exam, the doctor will closely evaluate the affected joints. RA involves the joints in a symmetrical fashion, and often, when rheumatoid factor is very high, there may be nodules under the skin, Azar says. According to the National Rheumatoid Arthritis Society, 20 percent of patients with RA develop these firm lumps.
Psoriatic arthritis, on the other hand, can reveal itself in a variety of ways, affecting a large joint or a single small finger joint of the hand, says Azar.
Another notable difference between the two diseases is bone involvement. RA is characterized by bone loss or erosion near the joint, while PsA is marked by both bone erosion and new bone formation, Azar says. An X-ray or other imaging method can help reveal whats going on.
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