Why Is It Important To Recognise Psa
Although PsA was thought initially to be a relatively benign disorder, registry data has shown the destructive and progressive nature of the disease it has a similar impact on quality of life and functional ability as in rheumatoid arthritis. In recent years, the additional burden of increased mortality and significant cardiovascular comorbidity has also been identified. Despite this, identification and treatment are still not optimal. There are significant delays in diagnosis for the majority of patients . Delay in diagnoses of 6 and 12 months have been shown to impact on long-term joint damage and functional disability.
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
Psoriasis And Psoriatic Arthritis Diagnosis
There are no tests yet for PsA. It is mainly your doctors observation and by ruling out other diseases. The symptoms are like those of rheumatoid arthritis, gout and reactive arthritis. Testing the fluid of the joint helps with ruling out gout or infectious arthritis.
Your doctor will review your medical history and may give a physical exam, looking for joint pain, tenderness, swelling, warmth or limited movement. Along with any skin or nail changes.
X-rays may be ordered to look for changes in bones and joints. Blood test help with diagnosing inflammation. This would be a C-reactive protein and rheumatoid factor . Those having PsA are almost always RF-negative if the blood test is positive for rheumatoid factor the doctor will suspect RA.
An increase with inflammation and or symptoms that become worse is called a flare. These can go on for days or months.
If PsA inflammation is not treated, this may lead to other health conditions. Those with PsA also may develop metabolic syndrome. These conditions include obesity, high blood pressure and poor cholesterol levels.
Recommended Reading: Is It Ok To Swim With Psoriasis
Treatments Designed With Hair In Mind
In recent years, pharmaceutical companies have worked not just on making scalp psoriasis treatments more effective, but on making them easier and more pleasant to apply.
This gives health care providers and patients options that now include shampoos, lotions, creams, sprays, gels, foams/mousses, and ointments. For more severe scalp psoriasis or when it also appears elsewhere on the body, there are also daily pills, occasional injections, and periodic infusions available that are effective on the scalp. UV light therapy is also appropriate in select cases .
A brief introduction to the many options follows, so you can make the most of your doctor visits and get on track to improve the condition of your scalp and give you a sense of peace that scalp psoriasis so often disrupts.
What Are The Odds
Despite the connection between conditions, most people with PsO wont develop PsA. The risk of psoriatic arthritis among patients with psoriasis is 10% overall, and up to 30% among patients with more severe psoriasis, says John Davis III, M.D., a rheumatologist at the Mayo Clinic in Rochester, MN. The longer someone has had skin psoriasis, the higher the risk of psoriatic arthritis. There often is a gap of 10 to 20 years between being diagnosed with PsO and seeing symptoms of arthritis. Also, though less common, you might develop symptoms of PsA first, followed by skin symptoms of PsO later.
When symptoms of PsA do appear, its easy to overlook them at first. But bouts of persistent aches and soreness brought on by nothing in particular , is a potential clue somethings up.
Couple that with swelling in your finger joints or ankles, or lower back pain that worsens with rest and improves with activity, and youve got the makings of a case for psoriatic arthritis. Psoriatic arthritis is a musculoskeletal diseaseit can affect everything from the small joints of your fingers to the larger joints in your knees, says Dr. Orbai.
Its more than joint pain, though: PsA also affects the spots where tendons and ligaments connect with bone or support the bone. A specific type of PsA-related inflammation called enthesitis can develop where tendons attach to your heelbone, leading to additional pain when you walk.
Recommended Reading: Can A Dermatologist Help With Psoriasis
The 5 Types Of Psoriatic Arthritis
Distal Interphalangeal predominant PsA involving the joint next to your nails. This type develops in about 10 percent of those having PsA.
Dactylitis is inflammation of a digit . The digit may swell resembling a sausage shape and this can be painful.
Treatment may include NSAIDs for easing pain and reducing inflammation. DMARDs help to relieve pain decrease inflammation and prevent joint damage.
Asymmetric Oligoarticular affecting the joint or joints, on one side of body. The joints can be sore and inflamed. Asymmetric PsA can be mild. Around 35 percent of people can be affected.
Symmetric polyarthritis affects both sides of body with same joints such as left and right knee. This is similar to Rheumatoid arthritis.
Symmetric PsA is usually milder and with less joint deformity compared to RA. Still it can be disabling. Around half of those with PsA will be diagnosed with symmetric PsA.
Spondylitis PsA The whole spine including your neck to your lower back may be affected, making movement painful. This may also include your limbs, hands, feet and hip. It usually occurs in early adulthood and more common among men.
Spondylitis PsA causes a reduction in movement eventually resulting in a hunched over position.
Treatment consist of medication, physical therapy and may include surgery in rare cases.
Psoriatic Arthritis Mutilans asevere and deforming type of PsA is rare, affecting around 5 percent.
Article Summary: Scalp Psoriasis Is Highly Bothersome And Hair Makes It Harder To Treat But There Are A Number Of Prescription Treatments In A Variety Of Formats Including Sprays Foams Gels And Shampoos To Help Treat The Scalp Effectively As Well As Treatments For The Whole Body That Have Demonstrated Strong Success In Treating Scalp Psoriasis
Psoriasis of the scalp is very common. Nearly 80% of psoriasis patients develop plaques on the scalp at some point in their life with psoriasis.
Scalp psoriasis is especially distressing to many patients. It can be extremely itchy, and when psoriasis extends beyond the hairline onto the face and around the ears or down the back of the neck, it is highly visible. In some cases, it can also cause temporary loss of hair in places where the psoriasis patches are thick on the scalp. Add to this the difficulty in applying medicine only to psoriasis patches, often covered by hair, without also treating the healthy skin and its not surprising that patients are eager for effective treatments.
Fortunately, there are a variety of medications that when applied directly to scalp psoriasis, are able to reduce or resolve it for a period of time and many of the newest psoriasis treatments, designed to treat psoriasis all over the body, have demonstrated excellent clearance of scalp psoriasis as well. Over-the-counter products can play an important supporting role.
Our message for those suffering with the frustration, itch, and pain of scalp psoriasis is: dont lose hope, as there are options available today that will likely provide you substantial relief from your scalp psoriasis.
Also Check: How To Stop Plaque Psoriasis
Causes Of Psoriatic Arthritis
Almost 1 in 3 people with psoriasis also have psoriatic arthritis.
It tends to develop 5 to 10 years after psoriasis is diagnosed, although some people may have problems with their joints before they notice any skin-related symptoms.
Like psoriasis, psoriatic arthritis is thought to happen as a result of the immune system mistakenly attacking healthy tissue.
But it’s not clear why some people with psoriasis develop psoriatic arthritis and others do not.
Early Signs Of Psoriatic Arthritis
Some of the symptoms of PsA are similar to those ofosteoarthritis and rheumatoid arthritis.
If you have psoriatic arthritis, you could experience:
- Joint swelling
- Stiffness, especially in the morning or afterlong periods of inactivity
- Swelling of an entire finger or toe in theabsence of trauma
- Lower back pain
Don’t Miss: What Does Psoriasis Scalp Look Like
Psoriasis And Psoriatic Arthritis Treatments Can Make It Easier To Live A Full Life With These Conditions
There are no cures for either disease, but an effective treatment plan can minimize symptoms for both psoriasis and psoriatic arthritis. With psoriasis, doctors generally prescribe treatments that prevent your skin cells from growing too quickly, according to the Mayo Clinic. There are many treatment options for this, including creams, light therapy, or oral or injected medications, the Mayo Clinic explains.
As for psoriatic arthritis, treatments generally focus on controlling inflammation to minimize your joint pain and damage. Your doctor might suggest pharmacological options that target your immune system to lower inflammation, along with exercise or other lifestyle modifications, according to the Mayo Clinic. With each condition, the best treatment depends on your particular situation.
Treatments For Scalp Psoriasis
There are many different treatments for scalp psoriasis, and the highly skilled specialists of the Mount Sinai Department of Dermatology are skilled in tailoring the right options to your specific needs.
Because treatments may work differently in different patients, therapies may be combined or alternated in order to minimize side effects and maximize efficacy. The treatment options for plaque psoriasis include the following:
- : Mount Sinai is home to a full Phototherapy Suite for the treatment of psoriasis and eczema. We also provide skilled excimer laser treatments.
- Steroids: These may be injected into the scalp.
- Biologic therapies: This safe treatment option has been dramatically effective for severe cases of scalp psoriasis. This targeted therapy blocks the activity of certain cells and proteins in the immune system that play a key role in causing psoriasis.
- Topicals: Topical treatments range from prescription therapies to medicated shampoos.
Don’t Miss: What Causes Psoriasis In Children
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.
Early Stages Of Psoriatic Arthritis
Recognizing the signs of psoriatic arthritis can be tricky since symptoms differ from patient to patient. For example, one person can experience psoriasis skin involvement and peripheral arthritis, another may experience axial disease , and someone else could have a combination of all three.
Whats more, especially during early disease, you may confuse your symptoms with other conditions. People can mistake enthesitis, inflammation of the entheses for tennis elbow or dactylitis for an infection, explains Dr. Mikulik.
If you have psoriasis and are having pain in your tendon and musculature and you think maybe Ive been too active lately, that may be the first sign of PsA, says Dr. Haberman. Doctors commonly hear people chalk up their symptoms to overuse, such as getting more exercise than usual or doing work around the house.
If you experience any of the following signs of early psoriatic arthritis its important to see your doctor as soon as possible:
- Back pain
- Changes in your fingernails or toenails, including holes, pitting, discoloration, or softness
- Eye inflammation
- Sausage-like swelling of an entire finger or toe
- Scalp psoriasis
- Skin rash
- Tendon or ligament pain at the Achilles tendon, bottom of the foot , or elbow
Don’t Miss: What Helps Psoriasis Flare Ups
The Majority Of People With Psoriasis Wont Develop Psoriatic Arthritis
About 7 million Americans have psoriasis, and only a fraction of them will ever develop psoriatic arthritis, according to the Cleveland Clinic. Estimates vary depending on the source, but the Centers for Disease Control and Prevention says that roughly 10% to 20% of people with psoriasis go on to develop psoriatic arthritis.
In contrast, the Cleveland Clinic estimates that up to 30% of people with psoriasis will develop psoriatic arthritis. That said, having psoriasis is the single most significant risk factor for developing psoriatic arthritis, Naomi Schlesinger, M.D., chief of the Division of Rheumatology at Rutgers Robert Wood Johnson Medical School, tells SELF.
If you have psoriasis, its extremely important to watch for any joint symptoms, such as swelling, pain, or stiffnessthe most common signs of psoriatic arthritisand report them to your physician, says David Giangreco, M.D., a rheumatologist at Northwestern Medicine Delnor Hospital. Psoriatic arthritis is a progressive disease, meaning it can get worse over time. And if you happen to get diagnosed with psoriatic arthritis in its early stages, then your doctor can prescribe treatments that slow the diseases progression and help preserve your joints.
Focusing On People With Psoriasis
Most people with psoriatic arthritis have psoriasis first. For a small percentage of patients, psoriatic arthritis occurs before psoriasis, although most often they will have a first-degree relative with skin psoriasis, notes Dr. Haberman. Still, others have no skin psoriasis or dont notice the psoriasis hidden in areas like the scalp, umbilicus, and gluteal fold.
Read more about the connection between psoriasis and PsA.
Up to 30 percent of patients with psoriasis will go on to develop psoriatic arthritis, says Dr. Haberman. The majority of cases begin with the skin condition and then progress to joint pain within seven to 10 years. Recent studies have found that patients with psoriasis who develop severe fatigue, heel pain, and joint pain without overt swelling are more likely to develop PsA.
While we dont yet know which individual patients with psoriasis will go onto develop PsA, researchers have identified a few potential risk factors for the progression of PsA, including:
- Family history of psoriatic arthritis
- Psoriasis that affects the scalp and groin
- Nail involvement in psoriasis, such as nail pitting
- Being overweight or obese. PsA is worse in patients who are overweight and often biologics may not work as effectively in people who are overweight, says Dr. Haberman.
- Smoking
- Age
- Exposure to certain infections
- Physical trauma
Also Check: Dr Blaine’s Revitaderm Psoriasis Treatment Reviews
Psoriatic Arthritis And Psoriasis Are Both Autoimmune Conditions
Both conditions happen when your autoimmune system mistakenly attacks healthy cells in your body, causing inflammation. With psoriasis, new skin cells grow too quickly and build up, resulting in thick, scaly rashes that can make it painful to move, according to the Cleveland Clinic. People with psoriatic arthritis also have inflammation, but their symptoms generally result in stiff, painful joints, and swollen skin surrounding the joints, according to the Mayo Clinic.
The exact causes of autoimmune diseases are not clear. Some experts theorize that injuries might trigger psoriatic arthritis and that infections could trigger psoriasis, according to John Hopkins University. Doctors commonly suspect that genetics may determine whether someone is susceptible to autoimmune disorders, but the specifics explaining how or why are up in the air.
Both conditions are lifelong diseases that can alternate between periods of remission where you have very few symptoms and flares in which your symptoms are worse.
Understanding Remission And Minimal Disease Activity
Psoriatic arthritis disease progression is not inevitable. When your PsA is treated with medications that reduce immune system overactivity, you can reduce your disease activity to a point that its no longer causing significant symptoms or increasing the risk of long-term health issues.
In general, going into remission means that you are no longer showing signs of active disease. Decades ago, remission wasnt conceivable for most people with psoriatic arthritis, but thanks to a proliferation in medication treatment options, getting to remission is a possibility for PsA patients today.
However, going into remission does not mean that you will stay there indefinitely. It is common for PsA symptoms to wax and wane. Even if youve been in remission for a long time and your pain starts coming back and you start flaring more, you may need to change your medication for better control, says Dr. Haberman.
You may also hear the phrase minimal disease activity in conjunction with psoriatic arthritis and remission.
Doctors dont have a clear definition of what it means to be in remission in PsA, but they have defined something called minimal disease activity as a treatment target. This is what your doctor may use to determine whether your PsA disease activity is low enough that you have few symptoms and a low risk of long-term damage.
People are considered to be in minimal disease activity when their scores on five out of these seven criteria are low enough.
Also Check: Can You Have Multiple Types Of Psoriasis
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