10 Questions Your Rheumatologist Wants You to Ask About Psoriatic Arthritis

The precise cause of PsA is not clear-cut. As an autoimmune disease, PsA can occur when your immune system attacks its own healthy cells and tissues. Autoimmune diseases are often hereditary, and not every family member has the same type. So, for example, if a family member develops rheumatoid arthritis, your chances for getting PsA are increased.

Psoriasis doesn’t necessarily cause PsA, though this puts you at a greater risk. People with psoriasis can develop other forms of arthritis, while others don’t develop arthritis at all.

Your rheumatologist first looks at your records to see what tests have been done. They also ask you about your family medical history, as well as whether you have psoriasis or not.

Next, your rheumatologist performs a physical exam. They look for any signs of plaque psoriasis and inflammation. They also examine your joints.

Finally, a PsA diagnosis depends heavily on testing to make sure that you’re not misdiagnosed with another form of arthritis or another type of condition altogether. A negative blood test for a rheumatoid factor is just one indicator of PsA.

There is no single test for PsA, so a proper diagnosis is often dependent on eliminating other possible conditions.

Persistent joint pain is often the first indicator of many types of arthritis, such as PsA. In addition, PsA can cause:

• swelling and tenderness of your joints
• reduced range of motion (especially in the
  morning)
• back pain
• changes in your fingers and toes (especially in
  the nails)
• conjunctivitis
• increased fatigue

PsA is just one form of arthritis. It also has several subtypes that are based on which joints are affected. You may have one of the following types of PsA:

• Arthritis
  mutilans is a rare form that primarily affects your hands and feet.
• Distal
  interphalangeal arthritis primarily affects toe and finger joints (called
  distal joints).
• Oligoarticular
  arthritis is a milder form that affects fewer joints in a more asymmetrical
  pattern (both sides of your body, but different joints).
• Spondylitis
  is a type of PsA that affects your spine, causing back and neck problems.
• Symmetric
  arthritis affects both sides of the body, and affects the same joints on
  each side.

PsA is typically treated with the following:

• Biologics
  are prescription medications such as adalimumab (Humira)
  and etanercept (Enbrel)
  that target your immune system to prevent it from attacking healthy tissues.
• Disease-modifying
  antirheumatic drugs (DMARDs) are used in severe cases of PsA. These work by
  slowing the progression of joint and tissue damage. (Many biologics are also
  DMARDs.)
• Nonsteroidal
  anti-inflammatory drugs (NSAIDs) work by reducing pain and inflammation.
  These are available in both over-the-counter and prescription forms.
• Small-molecule
  treatments are a new medication that can regulate inflammation associated
  with PsA.

The type of treatment selected is based on the severity of your condition. Your treatment plan may also be modified based on flare-ups and disease progression.

Your rheumatologist may also recommend physical therapy because PsA causes stiffening in your joints, which leads to discomfort and pain. There are exercises specifically designed for joints that help relieve your pain so that you can manage your PsA on an ongoing basis.

The only type of over-the-counter medications used for PsA are certain types of NSAIDs. These include ibuprofen (Advil) and aspirin. While over-the-counter NSAIDs may reduce pain and inflammation, they don’t solve the immune system issues that prescription medications can.

Ask your rheumatologist before taking over-the-counter drugs to make sure they won’t interact with any other medicines you take.

A nutritious diet can give you more energy while also naturally reducing inflammation from PsA. Though difficult at first, regular exercise can also help. Moderate, low-impact workouts, such as swimming and walking, can help condition and strengthen your joints.

Diet and exercise can also go a long way in helping you lose weight if you need to. Excess weight can heighten joint pain and damage.

If you experience depression, stress, and fatigue from your condition, consider alternative exercises like yoga. Going to bed at the same time each night can also make a difference in daytime tiredness.

Though paramount in the treatment of PsA, a rheumatologist shouldn’t be the only kind of doctor you see. A primary doctor is still necessary for annual checkups, as well as any other medical needs outside of PsA.

If you had psoriasis prior to receiving a diagnosis for PsA, you’ll also still need to see your dermatologist. While a rheumatologist treats the underlying inflammation of PsA, skin symptoms are best treated by a dermatologist. Both doctors can work with you to treat a variety of topical and internal symptoms — just be sure that you communicate with each one about the treatments you’re receiving.

Seeing a rheumatologist is the first step to preventing a PsA-related disability. Over time, joint wear and tear can cause permanent damage. Disability is a long-term concern with PsA because broken-down joints can significantly limit your range of motion.

PsA doesn’t necessarily lead to disability in all cases. Your chances are greatly reduced with ongoing treatment.

PsA is a lifelong or chronic condition, and it doesn’t have a cure. However, proper treatment can minimize the damaging effects that the underlying inflammation poses to various joints in your body. PsA can range in severity from mild to severe. The types of joints affected can also make a difference in terms of everyday movements and overall quality of life.