Psoriasis is a condition that causes the cells of the immune system to attack normal skin cells. As a result, it causes scaly red and white patches to form that can be itchy and uncomfortable.
Some people with psoriasis will also develop psoriatic arthritis (PsA), where the immune system also attacks the joints. Both conditions cause episodes where the symptoms worsen, also known as a flare. Most of the time the symptoms will lessen between flares.
This article will look at the outlook for people with PsA, examining how the disease progresses and how it may affect people's quality of life.
PsA symptoms may include painful, swollen joints and swollen fingers and toes.
In most cases, people are diagnosed with psoriasis before developing PsA. However, it is possible to develop joint inflammation and pain before being diagnosed with psoriasis.
Symptoms of PsA may include:
- painful and swollen joints that are warm to the touch
- swollen fingers and toes
- foot pain, especially at the heel or sole of the foot
- lower back pain
A person with these symptoms and who has a medical history of psoriasis should see their doctor promptly. Because the symptoms tend to worsen and get better, it can sometimes be difficult for the doctor to diagnose.
It is important for people to mention and discuss the diagnosis of psoriasis so that the doctor can evaluate the pain appropriately.
It can affect the joints on one or both sides of the body, and it can vary in severity from person to person. In some people, PsA is mild and causes little pain. In others, it can cause severe pain that makes it difficult to carry out normal activities.
PsA can affect different parts of the body in different ways, including the following:
- Arthritis, when PsA affects the joints.
- Dactylitis, when PsA affects the fingers and toes, causing them to look like swollen sausages.
- Spondylitis, when PsA affects the spine, causing stiffness and pain in the neck and back. It can also make it difficult to bend and move.
- Enthesitis, when PsA causes pain where the ligaments and tendons connect to the bones. This is most common at the back of the heel, sole of the foot, and around the elbow.
It is believed that inflammation associated with PsA can eventually cause joint damage later on. Early diagnosis and treatment is essential to reduce the risk as much as possible and improve comfort.
Doctors know that people with PsA may be at risk for other diseases that can lower their life expectancy. These diseases include diabetes and heart disease. Psoriasis is also linked to tiredness and mood changes, such as depression and anxiety.
Some research has suggested that people with psoriasis and PsA have a slightly increased risk of cancer. One study found that the increased cancer risk wasn't related to any of the medications used to treat the disease. This means that the cancer risk may be related to the disease itself, and not the treatment.
However, a more recent study suggests that experts are now unsure that life expectancy is affected. This study also does not suggest that the risk of cancer is increased.
It is important for people with psoriasis and PsA to maintain a healthy weight and be routinely screened for cancer and heart disease. Prompt treatment of high blood pressure and high cholesterol can help to minimize the risk of developing further complications.
Quality of life
Discussing pain levels with a healthcare professional is important for people with PsA to ensure they receive the correct pain treatment plan.
The biggest quality of life concern for people with PsA is pain and discomfort. The joint pain and stiffness from the arthritis can range from mild to quite severe.
In addition, the scaly patches of skin associated with psoriasis can be very itchy and uncomfortable, even painful. Without appropriate treatment of the arthritis the disease can be debilitating.
Having an honest conversation with the doctor about pain levels is an important measure for people with PsA. There are many different options for pain management, and sometimes people with PsA may have to try several different options before finding one that works.
Keeping a pain journal can be helpful to people with PsA. This includes keeping track of daily pain levels, activities that worsen pain, and measures that help to relieve it. Sharing this journal with the doctor can help them put together a personal pain treatment plan.
Staying active can help to relieve stiff joints and muscle weakness. Mild exercise, such as yoga, swimming, and gentle stretching can be especially beneficial for people with painful or swollen joints. Physical and occupational therapy can also sometimes be helpful.
In addition to pain management strategies and lifestyle changes, there are many different medication options available for people with PsA. Treatment selection depends on the level of pain, stiffness, and disability that the person is experiencing.
In some mild cases, simple non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are effective.
If NSAIDs are not effective for managing a patient's pain, there are other options, including:
- Disease-modifying anti-rheumatic drugs (DMARDs). These drugs help to slow joint damage associated with PsA. Common drugs include sulfasalazine, leflunomide, and methotrexate.
- Immunosuppressants. Medications in this class of drugs help to suppress the immune system to reduce joint pain. Common drugs include azathioprione and cyclosporine.
- TNF-alpha inhibitors. Tumor necrosis factor, or TNF, is a chemical that is produced in the immune system and is one of the causes of inflammation. Blocking TNF can reduce the inflammation and resulting pain, swelling, and stiffness that is common with PsA.
Other medications that block different parts of the immune system are also being used for PsA now as well.
Coping with psoriatic arthritis
Long-term pain can become very difficult for people to manage. In many cases, PsA is associated with depression, anxiety, insomnia, and difficulty coping.
Having family support can be very important when dealing with PsA. Attending support groups or seeing a counselor or therapist can also help people to learn additional coping skills.