Psoriasis and psoriatic arthritis
Psoriasis is an autoimmune condition that speeds up the growth of skin cells. This can cause inflamed patches of skin that itch or are tender to the touch. There isn’t a cure for psoriasis, and the underlying cause is believed to be genetic. About 7.5 million Americans have some form of psoriasis.
Psoriatic arthritis (PsA) is a condition that often occurs alongside psoriasis. Like other types of arthritis, PsA causes pain, stiffness, and swelling in affected joints. It’s estimated that up to 30 percent of people with psoriasis will eventually develop PsA.
Psoriasis and PsA together are sometimes referred to as psoriatic disease. Psoriatic disease is chronic, meaning that there isn’t a way to completely stop symptoms from occurring. However, you can make certain lifestyle changes to help reduce your risk of flare-ups and improve your overall quality of life.
Keep reading to learn how these conditions are connected, how to manage your symptoms, and more.
Why some people with psoriasis develop PsA
Although psoriasis and PsA may appear unrelated, both conditions reflect underlying immune system dysfunction.
In psoriasis, your overactive immune system causes your body’s skin cells to develop too rapidly. This can be triggered by many environmental factors, such as stress or smoking.
But one thing these triggers have in common is that they stimulate your body’s inflammation response. This same inflammation response can happen in your joints. Inflamed joints are what cause PsA.
In PsA, white blood cells target your body’s tissues instead of protecting your body against foreign invaders. Though PsA is connected to psoriasis, it has very distinctive symptoms of its own. For this reason, some researchers have referred to PsA as “a disease within a disease.”
The Centers for Disease Control and Prevention calculates that 10 to 20 percent of people with psoriasis will go on to develop PsA. This is slightly lower than the figures provided by the National Psoriasis Foundation, which put the risk at about one in three.
Psoriasis is typically diagnosed by the onset of plaques. These are scaly patches of raised, silver-white or reddish skin. PsA affects your joints, typically those in your fingers, toes, and lower back. PsA can come in many forms, and it can trigger other side effects such as fatigue and decreased range of motion. Because psoriasis is more visibly apparent, it’s often easier to diagnosis than PsA.
The effects of psoriasis and PsA
The most common form of psoriasis is plaque psoriasis, also known as psoriasis vulgaris. It affects 80 to 90 percent of all people with psoriasis. It’s characterized by plaques. These may come and go, even though psoriasis is a chronic, or long-term, disease.
Like psoriasis, PsA is chronic. PsA is also a progressive condition. The inflammatory response that PsA triggers in joints can lead to the gradual destruction of joint cartilage and bone.
If left untreated, this process can result in twisted, painful, or swollen joints that no longer function. Joint pain may be widespread, or may only occur on one side of your body.
People with psoriatic disease are also at risk for other conditions. This includes:
Some people treat their occasional, mild symptoms of psoriasis with remedies applied directly to their skin. Similarly, mild PsA flares may occasionally be treated with over-the-counter pain relievers such as ibuprofen (Advil) and naproxen (Aleve). These remedies tend to provide symptomatic relief.
Additional treatments are available that target either psoriasis on its own or both psoriasis and PsA.
Treatment options for psoriasis only
The most common treatments for mild psoriasis are topical skin creams and ointments. These include vitamin D, salicylic acid, and a class of drugs called corticosteroids.
Vitamin D has been deemed an effective treatment for auto-immunity problems in the body, including psoriasis.
Corticosteroids have been found to be at least as effective as vitamin D. The drawback of corticosteroids is that over time, using them on your skin might make your skin weaker. Other side effects of corticosteroids include:
- broken blood vessels
- skin that bruises
Corticosteroids range from mild to extremely potent. The more potent the drugs, the more potential for side effects. Because psoriasis is a chronic disease, the best treatments are those that can be used long term without risk of injury to your body.
Certain home remedies may also help relieve psoriasis symptoms. Daily baths using Epsom salts can soothe scaly patches on your skin. Topical aloe vera and Oregon grape have been found to help reduce irritation and inflammation.
Treatment options for both psoriasis and PsA
Drugs to suppress immune system activity are among the most effective treatments for psoriasis and PsA. Systemic, immune-suppressing drugs often provide relief for both conditions. However, your risk of secondary infections and other side effects is greater when using these drugs.
If you have severe psoriasis and are diagnosed with PsA, your doctor may prescribe the anti-inflammatory and immune-suppressant drug methotrexate (Rheumatrex). This medication aims to slow down the cells in your body that are reproducing too quickly and causing psoriasis flares.
Common side effects of methotrexate include:
- upset stomach
A newer class of drugs called biologics, in particular TNF blockers, targets specific parts of the immune system more precisely. Because of this, they’re currently more likely to be recommended by your doctor over methotrexate.
Biologics reduce inflammation and psoriasis outbreaks in most people who give them a try. There are six brands of biologics approved for treatment of psoriasis in the United States, and none stand out as the most effective option.
Biologics need to be injected, and some need to be administered more often than others. Common side effects include:
- allergic reaction
- skin irritation at the injection site
- increase risk of infections
How to prevent psoriasis and PsA flare-ups
The symptoms of psoriatic disease can’t be completely avoided, but they can usually be controlled with treatment. Identifying what triggers your psoriasis and PsA flares is key to treating the condition. Because PsA is a result of psoriasis, both conditions may be triggered by the same environmental factors.
For some people, stress can be a major trigger for a psoriasis flare. Learning breathing exercises, practicing yoga, and using other coping mechanisms for stress may help stop stressful situations from making psoriasis symptoms worse.
The biggest lifestyle change that might ease the symptoms of psoriatic disease is diet. Looking at your diet to identify things that trigger your psoriasis symptoms could mean removing some foods as a form of treatment.
Obesity is known to contribute to psoriasis symptoms, and maintaining a healthy diet is essential to being in a healthy weight range. If you can avoid carrying extra pounds, studies indicate that your symptoms will be less severe.
Drinking alcohol and smoking can also trigger flares, so limiting or eliminating these entirely can be beneficial.
If you’ve been diagnosed with psoriasis, there’s a high probability that you may also develop PsA. Be on the lookout for the symptoms of joint pain or weakness. If you begin experiencing symptoms, see your doctor. They may refer you to a specialist, known as a rheumatologist, who should be able to determine whether the symptoms you have are caused by PsA.
It’s important to treat PsA as early as possible to minimize joint damage. Ignoring the symptoms can put you at risk for additional health concerns. Proper treatment is key to preserving your quality of life and reducing your risk of complications.