Thursday, July 11, 2024

What Is Psoriasis Psoriatic Arthritis

Environmental Triggers And The Microbiome

What is Psoriatic Arthritis?

Environmental factors, such as stress, trauma, infection and/or microbiota/diet are possible triggers of chronic immune activation in genetically predisposed individuals. While some environmentally triggered changes to the epigenome have been mentioned above, the following section will discuss the involvement of gut microbiota in PsA and their contribution as pathogenetic factor in more detail.

Over the past years, increasing attention has been paid to the role of gut microbiota and their effects on immune homeostasis in health and disease. Unfortunately, individual microbiomes are variable and large datasets in various ethnic and cultural groups are necessary to understand what can be considered normal. Host-microbiota interactions are complex and very incompletely understood. Still, it is widely accepted that the gut microbiome is involved in the development and maturation of the hosts immune system . After birth, the expression and activation status of pattern recognition receptors in epithelial cells and other cells of mucosal immune system, such as macrophages, NK cells and DCs, keeps changing alongside microbial colonization. Pattern recognition receptors, including toll-like receptors, impact on epithelial cell proliferation and survival, and immune responses . Though the exact mechanisms involved are unknown, co-dependency and close interaction between host and gut microbiome are beyond doubt.

What Is Psoriatic Disease

Our immune system was designed to protect us from foreign bodies, much like an army would defend a fort.

When our immune system misidentifies a healthy cell as a foreign body, antibodies automatically defend the system by attacking what they perceive as a threat to our health and well-being.

A compromised or out-of-order immune system struggles to fight off infections, bacteria, and diseases.

It can even start to turn on ourselves. Our best defense becomes our worst enemy.

With autoimmunity on the rise in the U.S., the race to find possible cures or better treatment options for silent sufferers of an autoimmune disease is hampered by the race to find a Covid-19 cure first.

Recent research suggests that a number of underlying conditions noted in confirmed Covid-19 positive cases can be classified as autoimmune diseases.

Figure 1: Common autoimmune diseases.

Adapted from 

It is important to consult with your healthcare professional as soon as you feel or sense a change in your body and/or its way of working.

Many autoimmune diseases share common symptoms, and Dr. Google isnt always the expert we want it to be!

In most instances of autoimmunity diseases, the illnesses associated with autoimmunity are generally classified as chronic conditions and require ongoing, chronic medication to treat and manage.

Lifestyle changes are also needed in order to live better alongside your symptoms and flare-ups.

Does Diet Make A Difference

  • No particular diet is uniformly effective some people with psoriatic arthritis have found cutting down on saturated fats helps and may reduce the doses needed of other treatments, though research has not confirmed this.
  • Dietary supplements such as evening primrose oil and certain fish oils may have a variable effect. They are safe and have other health benefits, but effects specifically beneficial to psoriatic arthritis have not been proven in research.
  • Following guidelines about healthy lifestyle, keeping weight down and moderating alcohol intake are all generally accepted as beneficial regardless of having psoriasis or psoriatic arthritis. Keeping weight in the healthy range has been shown to improve the likelihood of responding to medication. See Psoriatic Lifestyle

Remember: many so-called cures for arthritis are not proven by clinical trials to be of use and may be driven by profit to those advocating them.

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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:

How Is Psoriatic Arthritis Diagnosed

New Research Into Psoriatic Arthritis

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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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 Symptoms Will I Experience With Psoriatic Arthritis

Psoriatic arthritis causes pain and stiffness in affected joints. Joint pain can be prolonged in the morning . It might feel worse when staying immobile and is alleviated with physical activity. Some people do not experience severe joint pain but will have joint deformity.

Your joints might not be affected the same way on both halves of your body. Some of the most common affected joint areas are the finger joints nearest the fingertip as well as the spine.

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There Are Various Forms Of Psoriasis And Psoriatic Arthritis

There are five types of psoriatic arthritis, and the disease can trigger symptoms in different areas of your body depending on the type you have, according to NYU Langone Health. They are:

  • Asymmetric oligoarthritis can cause pain and stiffness in up to five joints on either side of your body.
  • Symmetric arthritis is characterized by painful, swollen joints on just one side of your body.
  • Spondylitic arthritis When you experience arthritis symptoms in your spine, or you might have neck pain and difficulty moving your head.
  • Distal interphalangeal predominant psoriatic arthritis involves inflammation in your fingernails and toenails.
  • Arthritis mutilans is a rare but severe form of psoriatic arthritis that causes damage in the bones of your toes and fingers, according to NYU Langone.

The Mayo Clinic explains there are six types of psoriasis, and your symptoms may vary depending on the type you have.

Psoriasis and psoriatic arthritis do share one common symptom: fatigue, which is likely due to high levels of inflammation, according to NYU Langone Health.

Have Only Psoriatic Arthritis

Psoriatic Arthritis – What is it?

A handful of members in the community shared that they only have psoriatic arthritis and not psoriasis.

  • I have psoriatic arthritis but no psoriasis. My family has a strong history of psoriasis though on both sides. I guess I am kind of lucky!
  • No, just psoriatic arthritis.
  • No, just psoriasis arthritis and found out about it a month ago.

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What Causes Psoriatic Arthritis

The cause of psoriatic arthritis is unknown. Researchers suspect that it develops from a combination of genetic and environmental factors. They also think that immune system problems, infection, obesity, and physical trauma play a role in determining who will develop the disease. Psoriasis itself is neither infectious nor contagious.

Recent research has shown that people with psoriatic arthritis have an increased level of tumor necrosis factor in their joints and affected skin areas. These increased levels can overwhelm the immune system, making it unable to control the inflammation associated with psoriatic arthritis.

How Do I Know If I Have Psoriatic Arthritis

Your doctor will consider your medical history and examine your affected joints. They will also order blood tests to check for markers of inflammation and markers that might suggest other diseases. Your doctor may also choose to biopsy fluid from your joint capsule or obtain X-rays.

When examining your joints, your doctor will look for certain key features that are commonly found in psoriatic arthritis. These include tendon and ligament inflammation , inflammation of the fluid-filled sheath of a joint , and sausage-like swelling of an entire digit .

It is possible that your joint pain is caused by other joint disease, which include osteoarthritis, rheumatoid arthritis, gout, reactive arthritis, or arthritis related to inflammatory bowel disease. Your doctor will exclude these conditions before making a diagnosis.

Some doctors might use screening questionnaires to identify if you have psoriatic arthritis. In cases where they are not certain, you might be referred to a rheumatologist for further investigation.

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Occurrence In The United States

According to the National Psoriasis Foundation, psoriatic arthritis affects about 1 million people in the United States, or about 30% of all persons with psoriasis. However, prevalence rates vary widely among studies. In one population-based study, less than 10% of patients with psoriasis developed clinically recognized psoriatic arthritis during a 30-year period. A random telephone survey of 27,220 US residents found a 0.25% prevalence rate for psoriatic arthritis in the general population and an 11% prevalence rate in patients with psoriasis. However, the exact frequency of the disorder in patients with psoriasis remains uncertain, with the estimated rate ranging from 5-30%.

Moreover, since the late 20th century, the incidence of psoriatic arthritis appears to have been rising in both men and women. Reasons for the increase are unknown it may be related to a true change in incidence or to a greater overall awareness of the diagnosis by physicians.

Does The Severity Of Skin Or Nail Psoriasis Matter

Surgery Rate Doubles in Psoriatic Arthritis
  • Nail changes are found in 2 out of 5 individuals with psoriatic arthritis, compared with around half in those with psoriasis alone.
  • Nail changes include pitting and discolouration of the nail due to abnormalities in the growth of tissue in the nailbed.
  • The risk of developing psoriatic arthritis is greater in individuals with severe psoriasis, yet severe psoriatic arthritis may occur with minimal skin disease.

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What Is Cdc Doing About Psoriasis

In 2010, CDC worked with experts in psoriasis, psoriatic arthritis, and public health to develop a public health perspective that considers how these conditions affect the entire population. The resulting report is Developing and Addressing the Public Health Agenda for Psoriasis and Psoriatic Arthritis pdf icon. You can read a short article about the agendaexternal icon in The American Journal of Preventive Medicine.

CDCs National Health and Nutrition Examination Survey , an intermittent source of national psoriasis data, has included questions about psoriasis as late as the 2013-2014 cycle. A recent analysis of NHANES data estimates that 7.4 million adults had psoriasis in 2013external icon.

  • Psoriasis causes patches of thick red skin and silvery scales. Patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places . The most common type of psoriasis is called plaque psoriasis.
  • Psoriatic arthritis is an inflammatory type of arthritis that eventually occurs in 10% to 20% of people with psoriasis. It is different from more common types of arthritis and is thought to be related to the underlying problem of psoriasis.
  • Psoriasis and psoriatic arthritis are sometimes considered together as psoriatic disease.

Who is at risk for psoriasis?

Anyone can get psoriasis. It occurs mostly in adults, but children can also get it. Men and women seem to have equal risk.

Can I get psoriasis from someone who has it?

What Are The Treatment Options For Psoriatic Arthritis

The aim of treatment for psoriatic arthritis is to control the disease and relieve symptoms. Treatment may include any combination of the following:

Choice of medications depends on disease severity, number of joints involved, and associated skin symptoms. During the early stages of the disease, mild inflammation may respond to nonsteroidal anti-inflammatory drugs . Cortisone injections may be used to treat ongoing inflammation in a single joint. Oral steroids, if used to treat a psoriatic arthritis flare, can temporarily worsen psoriasis. Long-term use of oral steroids should be avoided when possible due to the negative effects on the body over time.

DMARDs are used when NSAIDs fail to work and for patients with persistent and/or erosive disease. DMARDs that are effective in treating psoriatic arthritis include: methotrexate, sulfasalazine, and cyclosporine.

Biologic agents are an important consideration when disease control is not being achieved with NSAIDS or DMARDs. Biologics have been utilized for the treatment of psoriatic arthritis since 2005 and are highly effective at slowing and preventing progression of joint damage. Your healthcare provider will complete additional laboratory tests and review safety considerations before initiating a medication regimen. Gaining good control of psoriatic arthritis and psoriasis is important to avoid increased systemic risks, particularly heart disease.


Heat and cold therapy



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Psa Affects People Differently

No people with PsA are affected the same. Some people with the condition might only have peripheral joint disease where only their hands, wrists, knees, and other large joints are affected. The research shows that peripheral joint disease in PsA is quite common and often symmetrical and polyarticular .

Others with PsA might have only spine involvement. Still others will be affected by joint and spine inflammation.

Many people with PsA have skin involvement while others dont have any skin symptoms or psoriasis. It is more common to have skin symptoms with PsA, but there are people with PsA who dont have skin symptoms. In up to 80% of people with PsA, skin disease usually precedes joint disease.

Other effects of PsA include:

  • Axial disease: Also called psoriatic spondylitis, a subtype of PsA that affects the spine and joints of the pelvis
  • Enthesitis: Inflammation of the entheses, the sites where tendons or ligaments insert into the bone
  • Dactylitis: Diffuse swelling of a finger or toe, described as “sausage-like”
  • Nail psoriasis: Changes to nails, including thickened nails, nail pitting , discoloration, nailbed separation, and nail shape changes

Not everyone with PsA will experience all the possible effects of the condition. Each person will experience a different combination of symptoms and severity.

Key Points About Psoriatic Arthritis

What Is – Psoriatic Arthritis
  • Psoriatic arthritis is a form of arthritis with a skin rash.
  • Psoriasis is a chronic skin and nail disease. It causes red, scaly rashes and thick, pitted fingernails. The rash may come before or after the arthritis symptoms.
  • Psoriatic arthritis causes inflamed, swollen, and painful joints. It happens most often in the fingers and toes. It can lead to deformed joints.
  • Treatment may include medicines, heat and cold, splints, exercise, physical therapy, and surgery.

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Dna Methylation Patterns In Psa

DNA methylation is mediated by the covalent ligation of a methyl group to the 5carbon position of cytosine in cytosine-phosphate-guanosine dinucleotides . The addition of methyl groups to CpG dinucleotides confers genomic stability and adds another level of tissue-specific transcriptional regulation through the prevention of transcription factor recruitment and the assembly of the transcriptional complex .

In line with findings in psoriatic disease, abnormal DNA methylation also characterizes other auto-immune/inflammatory disorders, such as systemic lupus erythematosus , where global DNA hypomethylation of CD4+ T cells has been associated with T cell autoreactivity in active lupus patients . Also, in SLE patients, DNA hypomethylation CD4+ T cell is associated with reduced expression of DNMT1, which correlates with disease activity . Although data on DNA methylation signatures in PsA are limited, aforementioned preliminary observations are promising and, also in the context of findings from other autoimmune/inflammatory conditions, will trigger further investigation.

You Can Develop Psoriatic Arthritisanytimebefore Or After Your Psoriasis Diagnosis

Medical experts used to believe that people with psoriasis could only develop psoriatic arthritis within 10 years of their initial psoriasis diagnosis, according to the Cleveland Clinic. However, studies have shown that this isnt true. In fact, up to 15% of people with both diseases actually experienced their psoriatic arthritis symptoms first, according to the Cleveland Clinic. Some people may develop psoriatic arthritis before psoriasis, and others may have had psoriasis for years without realizing it, according to Dr. Giangreco. Psoriasis can remain hidden from patients on the back of the scalp or buttock area and go unnoticed for long periods of time, Dr. Giangreco tells SELF. If you have psoriatic arthritis and suddenly notice changes in your skin and nails, then you dont want to rule out the possibility of psoriasis. Rarely do people have psoriatic arthritis without getting psoriasis, too, according to the U.S. National Library of Medicine.

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