What to Expect From a Psoriatic Arthritis Diagnosis

From self.com

By Sara Gaynes Levy; Medically reviewed by Olga Petryna, M.D., FACR

Psoriatic arthritis is a lifelong inflammatory condition that can be challenging to manage, especially if you also have to manage psoriasis symptoms (another chronic condition that people with psoriatic arthritis commonly develop). In some cases, psoriatic arthritis can be debilitating and damage joints when it is left untreated. That’s why a prompt psoriatic arthritis diagnosis is important so you can get proper care and minimize the likelihood of this happening. Understanding more about the condition, including risk factors for psoriatic arthritis and psoriatic arthritis symptoms, can help you determine if you want to talk to your doctor about pursuing a psoriatic arthritis diagnosis and workup. Beyond that, the following information can help you better anticipate the process involved with a psoriatic arthritis diagnosis.

There are several tests involved for a psoriatic arthritis diagnosis. kuniharu wakabayashi / Getty

What is psoriatic arthritis?

Psoriatic arthritis is an autoimmune disorder, meaning the immune system misreads healthy joint, tendon, pelvic joints, or spine as a potential threat that needs to be attacked. This process can cause inflammation, pain, swelling, and/or stiffness, most commonly in the hands, feet, ankles, wrists, or knees. One of the major risk factors of developing psoriatic arthritis is having psoriasis, a skin condition most commonly characterized by patches of scaly skin that has dead skin cells on top. Of the approximately 7.5 million people in the U.S. who have psoriasis, between 20 and 30 percent will go on to develop psoriatic arthritis. That said, psoriasis does not cause psoriatic arthritis, and having the skin condition doesn’t mean you’ll automatically develop psoriatic arthritis.

Psoriatic arthritis usually shows up after about 7 to 10 years of living with psoriasis, although a small minority of patients will develop psoriatic arthritis before ever seeing any skin evidence of psoriasis. And the severity of someone’s psoriasis doesn’t determine whether they will develop psoriatic arthritis. “Someone can have a horrible skin disease, but no joint problems, and vice versa,” Samar Gupta, M.D., an associate professor at the University of Michigan Medical School and the chief of VA clinical rheumatology and medical education, tells SELF.

We don’t know why the two conditions are connected, but there are certain types of psoriasis more closely linked to psoriatic arthritis, Dr. Gupta explains. “If someone has, for example, scalp psoriasis, we find that it is more associated with psoriatic arthritis,” he says.

Other psoriatic arthritis risk factors include:

• Tissue damage related to injuries
• Severe infections
• Family history of psoriasis or psoriatic arthritis

Is psoriatic arthritis genetic?

There is no single gene that causes psoriatic arthritis to develop, but experts believe there is probably a genetic component, as nearly half of those who develop the condition have a family history of either psoriasis or psoriatic arthritis. A family of genes known as the human leukocyte antigen (HLA) complex may be involved. HLA genes help the immune system know which proteins to attack, and variations in this group of genes may alter your risk of getting psoriatic arthritis. However, there is still a lot of research to be done. Some people with psoriatic arthritis test positive for the HLA antigen, but a positive test is not a requirement for a psoriatic arthritis diagnosis.

Psoriatic arthritis symptoms

Psoriatic arthritis can be mild, moderate, or severe, depending on how intense the experiences of pain, swelling, tenderness, or stiffness are. Hallmark psoriatic arthritis symptoms commonly include:

Joint pain, aching, or tenderness (often in the feet, ankles, knees, wrists, or hands)

Back pain

Joint stiffness that is typically worst in the morning

Fatigue

Heel pain

Enthesitis or inflammation in the area where your tendons insert into the bone

Swollen fingers

Nail changes, such as nail ridges, grooves or pitting on your finger or toenails

Patches of psoriasis

Depending on the location and the severity of the inflammation, these symptoms can change from person to person, and not everyone will experience all symptoms. (Symptoms can also flare up and go into remission intermittently. Trauma to the joints, such as from an injury, may cause flares.)

Psoriatic arthritis diagnosis

You’ll most likely be referred to a rheumatologist for an official psoriatic arthritis diagnosis, explains Dr. Gupta. (Although dermatologists sometimes diagnose psoriatic arthritis when they’ve already been treating someone for psoriasis.) “Most patients get referred to [rheumatology] when they start having joint pain, after having had psoriasis for years,” Dr. Gupta says.

Tests for psoriatic arthritis

Unfortunately, no single test exists for diagnosing psoriatic arthritis. Physicians may use a combination of tests, in conjunction with a person’s medical history and a physical exam, to assess whether someone has psoriatic arthritis.

Physical exam

During the exam, your doctor will examine your joints and tendons for tenderness and swelling, check your fingernails for pulling and pitting, and look for other uncomfortable areas. If you’ve never been diagnosed with psoriasis, your physician may also check your scalp as psoriasis can hide there without being terribly bothersome (not to mention this type of psoriasis is also commonly associated with psoriatic arthritis).

Medical history

Your rheumatologist will want to know if you have previously been diagnosed with psoriasis, as this can help distinguish psoriatic arthritis from other conditions. Your doctor will also ask about a family history of both psoriatic arthritis and psoriasis. This is helpful in the event that you don’t also have psoriasis since a family history of either condition makes it more likely that your symptoms are caused by psoriatic arthritis. About 40 percent of people who have psoriatic arthritis have at least one first-degree relative who also has it, so make sure you are aware whether any of your siblings or parents have been diagnosed with psoriasis or psoriatic arthritis.

Imaging tests for psoriatic arthritis

To further evaluate your condition, including learning how far along your psoriatic arthritis may be, your doctor needs to look for signs of inflammation or joint damage inside your body, which is done via imaging tests. X-rays are the most common initial imaging tests used to diagnose psoriatic arthritis. Magnetic resonance imaging (MRI) is sometimes used to assess your tendons and ligaments in the feet and is frequently used to assess for inflammation in the lower back where x-ray can be less informative.

X-rays

After your physical exam and medical history discussion, your doctor may order X-rays. “The [psoriatic arthritis] diagnosis basically comes from a good physical exam and X-rays,” Dr. Gupta says. The more advanced the psoriatic arthritis is, the more helpful an X-ray can be (there is not much to see early on in psoriatic arthritis.) On X-rays, doctors are looking for changes in the joints specific to psoriatic arthritis. One is described as “pencil-in-cup.” In pencil-in-cup, the end of a bone is reduced to a sharp point. “If psoriatic arthritis has advanced enough, we can see the bone damage in the joints which makes it look like a pencil in a cup,” says Dr. Gupta.

If there are no psoriatic arthritis findings present on the X-rays, your doctor can order additional tests to rule out other conditions, like rheumatoid arthritis and gout since both can cause joint pain and inflammation similarly to psoriatic arthritis. This is helpful in situations where people have less severe forms of psoriatic arthritis that aren’t easily detected on X-rays.

Lab tests

To rule out gout, your doctor can perform a joint fluid test. By using a needle to extract a small amount of fluid from a swollen, tender, or stiff joint, your doctor can look for the presence of uric acid crystals, which indicates that you may have gout.

Blood tests

Blood tests cannot positively identify psoriatic arthritis, but they can still be helpful for ruling out other types of inflammatory arthritis. Some blood tests can identify inflammation in the body, for example, one test looks for C-reactive protein, a blood marker of inflammation. The presence of C-reactive protein may help support a psoriatic arthritis diagnosis.

Rheumatoid factor

Nearly everyone who is evaluated for psoriatic arthritis will have their blood tested for rheumatoid factor (RF), a protein produced by the immune system that attacks healthy joints. People with rheumatoid arthritis will often test positive for the RF antibody. People with psoriatic arthritis generally test negative for the RF antibody. (It’s not a guarantee, though: about 20 percent of people who do have rheumatoid arthritis test negative for RF.) To test for RF, a health care worker will take a vial of blood using a small needle—you don’t have to do anything to prepare, and it usually only takes a few minutes.

Screening tests

Sometimes, physicians ask people to complete screening tests to assess the patient’s risk for developing psoriatic arthritis. For example, people with psoriasis may be asked to complete these tests, which are self-reported questionnaires covering topics like joint pain and morning stiffness. These can help physicians refer people to a rheumatologist for further psoriatic arthritis testing and possible diagnosis. Screening tests aren’t perfect— they’re most likely only moderately accurate—but they may help doctors identify early-stage disease, which is easier to treat.

Psoriatic arthritis diagnostic criteria

Finally, in order to confirm a psoriatic arthritis diagnosis, your doctor can use a criteria checklist. Since 2006, doctors have used a test designed by a group of rheumatologists known as the CASPAR—classification criteria of psoriatic arthritis— for this purpose. The CASPAR test assigns point values to different symptoms and signs, as follows:

• The presence of skin psoriasis (2 points, 1 point for having it previously or having a family history but not having it yourself)
• Nail lesions, pitting, or pulling away from the nail bed (1 point)
• Swollen toe or nail (1 point)
• RF negative (1 point)
• Juxta-articular bone formation (in other words, a bone formation near a joint) (1 point)

People who score at least three points are considered to have psoriatic arthritis.

Psoriatic arthritis treatment

Psoriatic arthritis treatment is highly variable, depending on the severity of your case, how many joints are affected by the condition, whether you have psoriasis, and your personal preferences. “The treatment is very individualized,” Dr. Gupta says. Treatment can both help ease the severity of symptoms and prevent the disease from getting worse. Usually, doctors will recommend medication combined with lifestyle treatment for the best symptom management.

Psoriatic arthritis medication

Psoriatic arthritis medication functions like a ladder: If the first treatment doesn’t combat your symptoms, you stop taking it and climb up to the next rung. People with mild cases of psoriatic arthritis might just treat symptoms as they occur. Then, if those don’t work, you may be prescribed a more powerful drug. Here are the commonly used psoriatic arthritis medications:

Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs treat symptoms by reducing inflammation and pain when it occurs. “If the disease is mild, we can sometimes get away with symptomatic treatment, like a prescription-strength Motrin,” Dr. Gupta says. NSAIDs can be both over-the-counter (aspirin, ibuprofen, naproxen) or prescription (celecoxib or prescription-strength Motrin). Side effects are generally mild and may include gas and an upset stomach.

Corticosteroids: For more inflamed and bothersome joints, steroids like cortisone can be injected directly into the affected spot for quicker relief. This is most often used when arthritis pain is not widespread. Side effects include pain at the injection site and skin discoloration.

Disease-modifying anti-rheumatic drugs (DMARDs): These reduce pain and inflammation by suppressing the immune system so it doesn’t attack your healthy cells. In addition to treating symptoms, these drugs are designed to prevent arthritis from getting worse. Common DMARDs for psoriatic arthritis are methotrexate, leflunomide, apremilast, and sulfasalazine. Side effects can be more severe since your immune system is suppressed, and may include infections.

Biologics: If both NSAIDs and traditional DMARDs don’t help, biologics may be prescribed for moderate to severe psoriatic arthritis. These work by preventing a specific protein that causes joint inflammation from being produced. People with very severe psoriatic arthritis may need to take biologics alongside another DMARD, like methotrexate, to fully treat their symptoms. There are numerous biologics used to treat psoriatic arthritis, and they are divided into groups. They are generally administered by injection or intravenously, anywhere from once a week to a few times a year. Biologics also suppress your immune system and can make you more susceptible to infections. Other side effects include headache, nausea, increased risk of malignancy, redness or itchiness.

Just because your doctor suggests a particular treatment doesn’t mean it’s the only one that will work for you. “Even if biologics are indicated, some patients do not want to use needles. So then we sit down with the patient and present them with the options,” Dr. Gupta says. “The patient's preference takes precedent— which medication are they comfortable with?” Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.

Lifestyle therapy

Managing psoriatic arthritis often includes more than just taking medications. Your doctor may also recommend the following:

Exercise/physical therapy: This can help reduce stiffness and joint pain (and a lack of exercise can make joint instability worse). Range-of-motion exercises, strength training, and low-impact activities can help you better support and stabilize your joints. A physical therapist can help recommend specific exercises that work best for you and your abilities. They can also teach you proper body mechanics for everyday tasks like sitting, standing, and bending, in order to protect your joints. If possible, ask your physician for a referral to a PT.

Splinting: If one joint is particularly unstable or misaligned, your doctor may splint it in order to allow it an opportunity to heal. However, it is still important to remove the splint occasionally to work on range of motion and maintain muscle strength.

Heat and cold therapy: Using damp heat (for instance, a compress) and cool temperatures (such as an ice pack) on your affected joints can reduce inflammation. The heat relaxes muscles, while the cold reduces swelling and numbs pain. You can also take a warm bath or shower and apply a bag of ice to the affected area afterward.

Surgery: In very rare cases, severely damaged joints may need to be repaired or replaced with surgery.

Psoriatic arthritis is a lifelong condition, but getting an early psoriatic arthritis diagnosis can really help you avoid potential joint damage and pain. “We are lucky in this era,” Dr. Gupta says. “We have so many options that we can pick and choose the most appropriate treatment. And there are very, very effective therapies available.”

https://www.self.com/story/psoriatic-arthritis-diagnosis

What Can Bring on Sudden Ankle Pain When You Didn’t Injure It?

From healthline.com

You’re strolling along when suddenly a pain shoots through your ankle for no obvious reason. Or perhaps you wake up one morning and your ankle is aching. Without an obvious injury, you might be wondering where the pain came from.

Ankle pain can be — but doesn’t have to be — the result of an injury. While fractures and sprains cause ankle pain, others are coping with an ache of a different origin. It could be the result of arthritis or an autoimmune condition.

Jan-Otto/Getty Images

The best treatment may depend on the root cause, so don’t hesitate to get it checked out by a doctor.

Why does my ankle suddenly hurt for no reason?

If you know you haven’t been injured, and you don’t have pre-existing health conditions that you’re aware of, the pain may feel random. But there may be an underlying cause that you don’t know about — or that you didn’t connect with your ankle pain.

Osteoarthritis

With osteoarthritis, the cartilage cushion between two bones gradually wears away, causing the bones to rub up against each other. And it’s painful. You may also have some stiffness and tenderness. You might realize that it’s worse when you wake up in the morning. This condition sometimes causes pain that comes on suddenly.

Rheumatoid arthritis

When you have this chronic autoimmune disease, your body’s immune system begins attacking healthy tissue, including the lining of joints like your ankle joints.

As many as 90 percent of people with rheumatoid arthritis develop symptoms in their feet or ankles. The symptoms, which include pain but may also include swelling and stiffness, usually start in the toes and move toward the ankles.

Reactive arthritis

A bacterial infection in another part of your body, like your genitals or bowels, can trigger arthritis symptoms in other parts of your body. And your ankles are one of the most common areas affected by reactive arthritis, which is also known as spondyloarthropathy. Your knees, heels, and toes may also develop severe swelling and pain.

Lupus

Lupus is another autoimmune disease that causes inflammation. It tends to cause swelling, muscle pain, and joint pain in various parts of the body, including the feet and ankles. In fact, as many as two-thirds of people with lupus wind up with arthritis in their feet.

Gout

Gout is a type of inflammatory arthritis that’s very painful. It occurs because uric acid crystals build up in the joints. It most commonly affects the big toe, but it can and often does affect other joints, including the ankle. An attack of gout can come on suddenly.

Bursitis

When the small fluid-filled sacs (bursae) that act as cushions between the bones that make up your ankle joint become inflamed, you have developed bursitis of the ankle. It can develop as a result of injury, but overuse and stress on the ankle are also possible causes.

Arthritis and gout may be responsible in some cases. Even a poorly fitting pair of shoes might cause those sacs to get inflamed and cause pain. This is a condition that can develop slowly in some cases, and you might first begin to notice swelling or pain when you stand a certain way, like on your toes or leaning back on your heels.

Scleroderma

Also known as progressive systemic sclerosis, scleroderma is a rare autoimmune disease. Although it’s not well understood, it seems to occur when your immune system provokes the overproduction of a fibrous protein called collagen that results in thickened, hardened skin.

Inflammation caused by scleroderma can also result in swelling and damage to various organ systems, tissues, and joints. You may develop some ankle stiffness and pain, as well as pain and stiffness in other joints.

Fallen arches

When the tendons supporting the arches of your feet get damaged, the arches lose support, resulting in a condition known as fallen arches. It’s very similar to having flat feet, or pes planus, a condition that occurs when the entire sole of your foot touches the ground instead of leaving a little bit of daylight under the middle part of your foot.

This affects at least 8 million adults in the U.S.

Achilles tendonitis

Your Achilles tendon connects your heel to your calf muscle. An injury can rupture or tear it, of course, but consider other reasons that you might wind up with a sore ankle. If you do a lot of walking or repetitive movements, the wear and tear can result in Achilles tendonitis.  

Aging makes the tendon get weaker, too. As a result, the back of your heel may feel swollen or painful. You may have trouble moving or flexing your foot.

Osteochondral lesion of the talus (OLT)

This occurs when a previous injury accumulates damage to the cartilage and bone on top of the lower bone of your ankle joint. It may worsen during jumping or running, and you might even hear a clicking or popping sound from any loose cartilage.

Infections

An infection can work its way into your ankle and cause pain. This could be the result of bacteria such as:

• Staphylococcus aureus
• Streptococcus
• Enterobacter

All three are known to cause bone and joint infections.

Diagnosing the cause

A doctor will likely perform a physical examination of your ankle and foot to check your range of motion, as well as to look for swelling and possible signs of infection.

In some cases, other diagnostic tests may be necessary to rule out fractures or structural injuries. For example, an ultrasound might show damage to a tendon. Joint or bone damage might be detected via a CT scan. Bone spurs and cartilage loss can also be seen on X-ray. 

If you already have a diagnosis like rheumatoid arthritis or lupus, especially if you have a history of previous episodes of ankle pain or pain in other joints, it can help your doctor get a handle on the cause.

Treatment for sudden ankle pain without an injury

The cause of the pain will direct the treatment.

Osteoarthritis

Depending on how severe your ankle pain is, your doctor may suggest nonsteroidal anti-inflammatory drugs (NSAIDs) or applying a topical cream to your ankle. Wearing a brace or shoe inserts might also help.

In much more severe cases, joint fusion surgery or ankle replacement surgery might become options.

Rheumatoid arthritis

Your doctor may recommend a combination of exercise and medication to address this cause.

An over-the-counter pain reliever may help dull the pain, but a steroid injection in the joint may help more.

You may also need a medication like a disease-modifying antirheumatic drug (DMARD) to decrease inflammation and slow the progression of the disease.

Sometimes when the back of the foot and the ankle are affected, it can make your arches fall. In this case a doctor might suggest you wear orthopaedic shoes to give you some support.

Reactive arthritis

For new or early-stage pain, you can take NSAIDs. If it sticks around and becomes chronic, though, your doctor may prescribe disease-modifying antirheumatice drugs (DMARDs). 

Severe joint pain may necessitate biologic drugs or even corticosteroid injections into the joint, according to the American College of Rheumatology.

Lupus

Your doctor might suggest rest and NSAIDs, but your treatment might also depend on whether your disease is active.

Gout

If you have gout, you may be taking a medication, such as xanthine oxidase inhibitors or probenecid, to prevent painful flare-ups or attacks. But if you have an attack, your doctor may suggest an NSAID, a corticosteroid, or colchicine, which is an anti-gout medicine that should alleviate the pain. It may also help prevent it.

Diet and exercise can also help you manage gout.

Bursitis

You’ll likely be sent home with a prescription for rest and anti-inflammatory meds. Applying compression or wearing a splint or brace can also help with the pain. If your doctor decides to drain any fluid from your bursae and finds an infection is causing the inflammation, you may be prescribed antibiotics.

Scleroderma

There’s not a cure for scleroderma, and there’s really not one single effective treatment regimen, either.

Your doctor may aim to try to slow the progression of the disease, which may entail the use of immunosuppressants. They may also recommend NSAIDs and corticosteroids for pain, and possibly other treatments depending on how widespread the disease becomes in your body.

Fallen arches

Orthotic shoes or inserts are the most common treatment. The pain can be addressed with an OTC pain-reliever, too. Certain exercises, known as short foot exercises, have been shown to ease symptoms more than insoles. In rare cases, surgery may be necessary to address the fallen arches.

Achilles tendonitis

Rest and stretching exercises are usually part of the treatment, as well as wearing shoe inserts or a brace (or both). Your doctor may suggest you cut down on your physical activity for a while. Anti-inflammatory meds or corticosteroids may also help with the pain. In severe cases, tendon repair surgery may become an option.

Osteochondral lesion of the talus (OLT)

Research suggests that cartilage repair or replacement may help with OLT, but it should be undertaken thoughtfully and with regard to your specific condition.

Infections

A blood test or tissue culture should be able to reveal the type of bacteria causing the infection in your ankle. Then your doctor can start you on oral or IV antibiotics to knock out the infection and alleviate pain in your ankle.

When to see a doctor

If you don’t know what’s causing your ankle pain, it’s a good idea to see a doctor. It might be a strain that will go away on its own. But it could be a sign of a progressive disease that, if left untreated, could get worse over time and cause permanent damage.

https://www.healthline.com/health/sudden-ankle-pain-without-injury

The 6 Best Exercises for Arthritis, According to Experts

From health.com

Plus, how to exercise safely to avoid worsening any pain

If you have arthritis pain, exercising might be the last thing on your mind—but regular exercise can not only improve your symptoms, it can also help prevent future pain from occurring. That's because pain and lack of movement work in a cycle—one can cause the other.

"Pain inhibits movement, and then the muscles around the joint become tight, limiting normal function of the joint and decreasing the range of motion," John Gallucci Jr., DPT, a Doctor of Physical Therapy and CEO of JAG-ONE Physical Therapy tells Health. "When you have a stiff joint [and then] go outside that range of motion, it causes pain."

Low-impact exercise is one of the best and easiest ways to break this cycle, but not all kinds of exercise are good for people with arthritis pain. Here's what you can do, along with why and how you should incorporate exercise into your daily routine if you're struggling with arthritis.

What are the benefits of exercising with arthritis?

Just like for people without arthritis, exercise is good for your body and mind: it boosts your mood and energy levels, acting as a natural source of endorphins, and often improves daytime alertness and night-time sleep.

For people with arthritis, exercise can also reduce your joint pain, increase your range of motion, and help you feel stronger and more flexible. These results may be seen with even mild exercise, as long as you're doing something to regularly move your body.

"Patients hurt and they don't want to move, but then they gain weight, have a higher risk for fractures and falls, and lose their range of motion," Jonathan Greer, MD, rheumatologist with Arthritis & Rheumatology Associates of Palm Beach and medical advisor to CreakyJoints, tells Health. Dr. Greer advises people with arthritis to exercise early on in their diagnosis to stay as healthy as possible.

Which exercises are the best for arthritis pain?

Swimming

For the gold standard in low-impact exercise, both Dr. Greer and Dr. Gallucci suggest swimming or water aerobics. It's joint- and cardio-friendly at the same time, plus has some other arthritis benefits. "In a pool that's between 70 to 85 degrees, swimming is a non-weight bearing exercise [that also gives you] aerobic activity, plus the warmth of water helps with circulation as well," explains Dr. Gallucci. Improving circulation can also improve joint health, carrying important oxygen and nutrients to joint tissue, according to the Arthritis Foundation.

Light aerobic exercise

Any kind of exercise that gets your heart pumping is good for your cardiovascular system, which has the added benefit of helping you manage your weight. That's not all, though: Dr. Gallucci says aerobic exercise also lubricates your joints, emphasizing that our bodies are "locomotive tools" that are meant to be used (the phrase "use it or lose it" applies here).

Still, you want to be mindful of the type of aerobic exercise you choose. A Zumba class or outdoor run may be too high-impact for you, but taking a daily walk around your neighbourhood, riding your bike or taking a spinning class, or speed-walking on a treadmill are great ways to engage your cardio health without damaging your joints.

Yoga and Pilates

Whether at-home or in-person, a yoga or Pilates class can go a long way toward increasing your balance, range of motion, and flexibility. These activities are low impact but utilize many parts of your body and can give you a moderate cardio workout, as well, in some cases.

Plus, yoga and Pilates often have benefits for your mental health as well: you may notice you are more relaxed, less anxious, sleep better, and have overall better mood and energy levels when you incorporate these exercises into your routine. (Less stress and more rest means less overall tension and strain on your muscles and joints, FYI.)

Stretching

It might seem basic, but sometimes simple is best. Especially if you're new to working out, stretching is a great way to utilize your joints and muscles without injuring yourself. You can do full body stretches or isolate individual body parts if you have pain specific to your hands, fingers, knees, or neck. Either way, static stretching (where you hold a stretch for 30 to 60 seconds at a time before releasing) can prevent and manage arthritis pain.

Strength training

According to the Arthritis Foundation, strong muscles can support and protect affected joints, so strength training is a smart addition to your exercise routine.

One 2001 study published in the journal Arthritis and Rheumatism looked at the effects of strength training on people with RA over two years, and found that patients who performed strength training as little as once or twice per week experienced an improvement in physical strength, joint function, and disease activity.

Dr. Gallucci suggests using a variety of equipment to do strength training, including resistance bands, hand weights, and dumbbells, and emphasizing lightweight high-repetition movements (versus fewer repetitions with heavier weights) so as to avoid putting stress on joints.

Range of motion exercises

Range of motion refers to how fully a joint can move within its parameters. For example, your knee is designed to flex up to 135 degrees at its healthiest range of motion; once you fall below about 105 degrees, your ability to perform basic tasks will suffer. "Most arthritic knee patients can't get past 90 degrees range of motion," says Dr. Gallucci, "which inhibits their daily life, like their ability to sit comfortably on the couch or even use the toilet without pain."

Consistently using arthritis-affected joints for range of motion exercises (such as bending and flexing, stretching your limbs out to their full length, rotating your head, and rolling your shoulders) will, over time, increase your joints' range of motion. Unlike some other exercises that should be done in moderation, these movements can usually be done every day.

How to exercise safely with arthritis

Although exercise is important to maintaining your physical and mental health when you have arthritis, it's also important to know how to exercise correctly to avoid overuse, inflammation, and injury. Keep the following seven tips in mind before you start or change your exercise plan (and, of course, it's smart to always consult with your physician before trying anything new).

1. Stretch before and after. Warm-up and cool-down with a few stretches to keep your joints and muscles limber, prevent injury, and ease into your exercise routine.
2. Avoid high-impact exercise. Too much jostling and strain on your joints can not only worsen arthritis pain, but it can cause further inflammation of your affected joints. You may want to stay away from activities like running, cross-training, contact sports, and intense cardiovascular aerobic exercise.
3. Use the right "tools." Everything from the weight of your kettlebells to the style of your sneakers can impact how well—and how safely—you exercise with arthritis. If you're not sure what to use or wear while working out, ask your doctor or a physical therapist for tips.
4. Apply heat and ice. Generally, using heat before a workout and applying ice, if needed, after exercise works well together. Heat will relax muscles and make it easier to perform physical activities, while ice can reduce any swelling or inflammation from your workout.
5. Start small and slow. If you've never had much of an exercise routine before, it's important to build up your body's tolerance. Do what you comfortably can until it becomes a little easier, and then slowly start to add on from there. Make sure you also allow yourself plenty of time to rest after exercising; the Arthritis Foundation has a list of gentle movements you can do on "rest days" to keep your joints loose.
6. Don't ignore pain. Some people might be able to "push through the pain" without any side effects, but this isn't good advice for people with arthritis. Some mild discomfort may be normal if this is a new-to-you activity, but you shouldn't power through moderate pain. Instead, take a break or modify your activity until it's more comfortable to you.
7. Ask a physical therapist for help. If you're struggling with where to start or how to maintain a safe exercise routine, Dr. Greer suggests talking to a physical therapist: "We refer to PTs all the time [because it's a great idea to] work hand-in-hand with a PT for joint protection needs and help with range of motion."
8. Try not to be deterred. Like anything else, exercise takes some practice. You may also have good days and bad days, but a bad day doesn't mean you have to stop exercising altogether; do what you can, as often as you can.

https://www.health.com/condition/rheumatic-conditions/exercise-for-arthritis

Psoriatic Arthritis Vs. Rheumatoid Arthritis: How the 2 Conditions Differ, According to Experts

From msn.com

People often use an arthritis diagnosis as an umbrella term to mean any kind of painful joint condition, but there are actually several different kinds of arthritis across a few different "families," so to speak.

While some forms of arthritis, like osteoarthritis, are degenerative, occurring with age, wear and tear, or injury, there are two types that are autoimmune (i.e. a condition where your immune system mistakenly attacks your own healthy cells): rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

But even though RA and PsA are both autoimmune diseases, they are still two different conditions with their own causes, symptoms, and treatments. Here's what you need to know about the similarities and differences between these two rheumatic conditions.

What's the difference between psoriatic arthritis and rheumatoid arthritis?

RA and PsA are both inflammatory conditions that affect people in the same age group (between 30 and 60 years old) and are often symmetrical, which means symptoms affect the joints on both sides of the body, rheumatologist Vinicius Domingues, MD, medical advisor to CreakyJoints, tells Health. Both conditions are also the result of an overactive immune system—one where your body attacks the joints and causes pain, stiffness, and swelling.

Many symptoms are the same between the two diseases—and treatments often overlap as well—but the main difference is where those symptoms are located. People with PsA, for example, often have symptoms in the distal joints of their fingers and toes, whereas people with RA suffer in their middle joints. PsA also affects more than just your joints, often attacking your eyes, skin, nails, and tendons.

What are the causes of psoriatic arthritis and rheumatoid arthritis?

We don't have an understanding of what causes many autoimmune conditions, including RA and PsA, but there are common links among people who develop these diseases.

"We don't know exactly what causes RA or PSA, but we do know there are genetic components and stress components to both," Magdalena Perez-Rivera, MD, rheumatology specialist with Conviva Care Centres tells Health.

Here are some of the primary risk factors for RA and PsA—you'll see there is a good amount of overlap.

Risk factors for psoriatic arthritis

• Psoriasis (about 30 percent of people with this inflammatory skin condition go on to develop PsA)
• Genetics
• Stress
• Smoking
• Infections (bacterial or viral)
• Obesity

Risk factors for rheumatoid arthritis

• Genetics
• Stress
• Gender (RA is more common in females)
• Smoking
• Poor dental health
• Hormones changes or abnormalities
• Obesity

How do the symptoms of psoriatic arthritis and rheumatoid arthritis compare?

The symptom profile for these two arthritic conditions is actually where they differ the most. Although joint pain, stiffness, and swelling are the most typical symptoms for both RA and PsA, that's where their similarities end—and even with that, the way joint symptoms are experienced can be pretty different.

How are psoriatic arthritis and rheumatoid arthritis diagnosed?

Unfortunately, there's enough overlap between these two conditions that diagnosis can be a little difficult, though a doctor may be able to know right away which kind of arthritis is affecting their patient.

For example, Dr. Domingues notes that the distal joints (i.e., the ones closest to the tips of your fingers and toes) aren't affected in RA, so asking a patient about where they experience pain can be a useful tool. Likewise, if a patient has diagnosed psoriasis or crumbling, pitting nails and visits their doctor complaining of new joint pain, they probably have PsA, not RA.

Just as often, however, further testing is needed to truly determine whether the cause of symptoms is RA or PsA.

"The good thing about RA is there are blood tests that can help us diagnose, but they aren't terribly helpful with psoriatic arthritis," says Dr. Domingues. "There's no gene or blood test for PsA, but inflammatory markers can be elevated in both conditions."

Radiology can also be helpful for diagnosing both conditions, Dr. Domingues explains: "Both x-rays and MRIs can allow us to see inflammation and bone issues [for RA and PsA]."

What does treatment look like for psoriatic arthritis and rheumatoid arthritis?

The main treatments for autoimmune arthritis conditions generally work for both RA and PsA; Dr. Domingues says most of the medications are used interchangeably and that non-pharmaceutical treatments, like physical therapy, also work well for both types.

Pharmaceutical treatments for RA and PsA:

• Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
• Corticosteroids like prednisone
• Disease-modifying anti-rheumatic agents (DMARDs) like methotrexate and hydroxychloroquine
• Biologics, a more advanced type of DMARD that can stop or slow inflammation; these include Tumour Necrosis Factor-α (TNF) inhibitors and interleukin inhibitors (this is also where treatments for PsA and RA diverge a bit, with a few specific inhibitors working well for PsA but not RA and vice versa)

Non-pharmaceutical treatments for RA and PsA:

• Physical therapy
• Low-impact exercise
• Smoking cessation
• Topical analgesics
• Ice and heat
• Surgery

https://www.msn.com/en-us/health/medical/psoriatic-arthritis-vs-rheumatoid-arthritis-how-the-2-conditions-differ-according-to-experts/ar-AAMD7DL?li=BBnba9O

6 Psoriatic Arthritis Management Tips That Can Help

From self.com

It’s about more than just your joints

Living with psoriatic arthritis can be draining, both physically and mentally. That’s why caring for your overall well-being is an extremely important part of psoriatic arthritis management. 

Psoriatic arthritis is a type of inflammatory arthritis that causes joint pain, stiffness, swelling, tendonitis, and fatigue. The condition can affect any joint but is common in the small joints in the hands, tendons, and spine—which can make it really difficult to perform daily activities, like brushing your teeth or walking. Because of this, people with psoriatic arthritis sometimes stop doing things they love or otherwise change their lives to accommodate the disease. For example, maintaining relationships when you have to cancel plans unexpectedly because you can’t get out of bed can be stressful. Understandably, navigating all of this can affect your quality of life.

We asked people with psoriatic arthritis what they do to manage both the physical and mental aspects of the disease and ultimately, feel better day to day. Here’s what they recommend doing for psoriatic arthritis management.

1. Spend time being active outdoors.

Davinia A., 36, who was diagnosed with psoriatic arthritis in 2012, says that she goes for a walk outside whenever she’s stressed about her joint pain and feels up to moving. “I’m very lucky because I have a lot of green spaces around, and it’s very easy for me to just go for a walk and disconnect, so that really helps,” Davinia tells SELF. She says she notices her mood improves after getting fresh air and movement. “It’s amazing how simple things can improve mental health and the way we feel,” she says. And exercise in whatever form you prefer can help relieve joint pain and stiffness.

For Whitney M., 38, who was diagnosed with psoriatic arthritis in 2013, doing yard work is her favourite way to stay active. “Gardening is a huge factor in managing my psoriatic arthritis. It not only helps with keeping my body in motion but also reduces stress,” she tells SELF.

2. Try deep breathing exercises.

Speaking of stress, there’s no doubt that dealing with chronic pain can be a lot. And feeling stressed may lower your threshold for pain, meaning that your physical symptoms could be easier to manage when you’re more relaxed, according to the Cleveland Clinic. Deep breathing is one way to help counteract the stress response and allow your body and mind to feel more relaxed. Davinia says that focusing on diaphragmatic breathing for even 10 minutes is especially helpful when she feels like a joint flare is on its way. “It’s almost like creating the space for you to relax,” Davinia says. She has a lot of neck pain from psoriatic arthritis and says that taking deep breaths releases some of the physical tension and helps ease her pain. To breathe through your diaphragm, you can place one hand on your chest and the other on your stomach while slowly breathing in and out through your nose. You’ll know you’re doing it right if only the hand on your stomach moves.

3. Change your routine to better suit your abilities whenever you can.

It’s easy to get down on yourself when you have a chronic illness. You might think that you’re doing something wrong if you can’t get your pain levels to zero, or maybe you wish you could finish more activities throughout the day. Jennifer C., 42, who was diagnosed with psoriatic arthritis in 2010, says that adjusting her expectations and redefining what pain-free means to her has been instrumental in feeling better day to day. “I’m never pain-free, but that’s okay. I’m just kinder to myself and have accepted that as my new normal,” she tells SELF. After realizing that she needs to move slower on some days, Jennifer decided to make adjustments to her routine. “I get up 30 minutes earlier in the morning so that I can go slowly to manage my foot and ankle pain before having to run out the door,” she says. “I buy new running shoes as soon as I feel the cushion wearing down, which ends up being every five or six months, versus the year that I used to wait,” Jennifer explains.

4. Share your experience with loved ones.

Cancelling plans over and over again can make you feel guilty. Katie R., 44, who was diagnosed with psoriatic arthritis in 1994, says that being honest with her loved ones about why she has to cancel has eased that feeling.

“Every now and then, I will experience a flare that takes me out of the game for a few days. While I try not to let psoriatic arthritis dictate my life, including my social activities, there are times when the disease affects my day-to-day activities,” Katie tells SELF. “Telling the people around me that I am experiencing a flare is important for me, and for them. They don't have to wonder why I'm not my usual chipper self, and I feel more comfortable asking for help from them or asking to change our plans,” Katie says. Many times, her friends will offer to come over, bring a bowl of soup, or help her complete household tasks. “I find that being honest about my disease with friends and family allows them to be part of my pain management too,” Katie says.

5. Don’t be afraid of asking for assistance when you need it.

“As an independent person, I find it difficult to ask for help,” Jaime Lyn M., 44, who was diagnosed with psoriatic arthritis when she was 28, tells SELF. “But over the years, I’ve learned that asking my family to assist me in running errands and chores helps our family’s overall mood and my pain level. Now, I take a deep breath and swallow my pride and know that being reliant on others is usually only temporary.”

Allowing yourself to ask for help can be easier when you accept that you can’t do it all. Know that you’re not a failure for admitting that you’re human and have limits.

6. Find a community that gets it.

Many people with psoriatic arthritis—and any chronic health condition—say they sometimes feel isolated in their experience. Talking to others who understand what it’s like to cancel plans when you’re in pain, for example, can be a total game changer.

Jennifer found an online community of people with chronic health conditions through her job managing social media strategy for an app called Chronically Simple. “I’m now submerged in a community of amazing people trying to keep their health in check, trying to get through their new diagnoses, and mourning their pre-illness life while accepting their new life,” she says. On particularly hard days, Jennifer says she finds comfort in talking to other individuals managing psoriatic arthritis. “There are online communities of people who, despite never meeting you, know what you are going through—even more than your family does sometimes.”

You can also find an immense amount of support on social media, says Meaghan Q., 28, who was diagnosed with psoriatic arthritis in 2019. Meaghan created an Instagram about her journey soon after she received the news and gets many encouraging comments on her posts. “I discovered an unbelievable support system of others [on Instagram] who can really relate to the day-to-day struggles of living with this disease. It’s so helpful,” she says. You can look for communities on Facebook by searching for “psoriatic arthritis” in groups or find individuals with psoriatic arthritis on Instagram by using the #psoriaticarthritis hashtag. Additionally, you can find groups and virtual events through the National Psoriasis Foundation and the Arthritis Foundation.  

Finding what makes you feel better may require some experimentation. Ultimately, you’ll probably need to work with a doctor for psoriatic arthritis management strategies that include medication caring for your overall health.

https://www.self.com/story/psoriatic-arthritis-management-advice

I just had hip surgery but now I have pain in my back. Why and what should I do?

From miamiherald.com

By Harlan Selesnick, M.D. Special to the Miami Herald                 

Q. I had progressive left hip pain for two years that reached a point that I could no longer tolerate it. Two months ago, I had a left hip replacement and my hip pain is now virtually gone.

I am very happy with my result but over the last few weeks, I have developed moderate mid-line lower back pain. I can’t recall an injury and I have no pain going down my legs. Advil has helped mildly. Do you think my back pain has any association with my hip surgery? What can I do to get better?

Advances in hip implants have made hip-replacement surgery much easier, with patients walking with a walker the day after surgery. From top are implants using ceramics, plastic and metal

Read more here: https://www.miamiherald.com/living/health-fitness/article252986743.html#storylink=cpy

A. Hip replacement surgery is indicated for patients with arthritis that reaches a point that the patient can no longer deal with the pain.

Technology has improved considerably and many patients have a minimally invasive anterior approach for hip replacement surgery. Most patients are up walking with a walker the day of surgery and have great pain relief and improved ambulation within a few weeks.

It is likely you had an abnormal gait and limb length difference prior to surgery that you had gotten used to. The surgeon probably corrected any significant limb length difference and allowed you to walk more normally.

Your lower back and other lower extremity joints may have some trouble adjusting to these changes. Your lower back pain could also be caused by arthritis or a lumbar disc problem.

I suggest you get checked by your hip surgeon or a spine specialist to determine the cause of your lower back pain. Hopefully, a return to physical therapy and a core strengthening program may be all you need to get better.

Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital.

https://www.miamiherald.com/living/health-fitness/article252986743.html

Read more here: https://www.miamiherald.com/living/health-fitness/article252986743.html#storylink=cpy

Read more here: https://www.miamiherald.com/living/health-fitness/article252986743.html#storylink=cpy

Why are arthritis symptoms worse at night?

From medicalnewstoday.com

Many people notice that their arthritis symptoms get worse at night. When this occurs, it can be hard for people to sleep, leaving them exhausted in the morning and potentially contributing to daytime pain or fatigue

It is common for pain to get worse at night. A 2020 study found that online searches for information about pain management peaked between 11:00 p.m. and 4:00 a.m.

Doctors do not fully understand why arthritis pain often worsens at night, but possible causes involve changes in the levels of hormones and cytokines, which are cell-signalling proteins, in the body. Daytime arthritis medication, which some people take during the morning, may also wear off by the evening.

In this article, we examine why arthritis pain gets worse at night and how it disrupts sleep. We also provide tips on ways to improve sleep.

Why arthritis symptoms get worse at night

delihayat/Getty Images

Researchers have several theories to explain why many people with arthritis experience worse pain at night.

One theory is that the body’s circadian rhythm may play a role. In people with rheumatoid arthritis (RA), the body releases less of the anti-inflammatory chemical cortisol at night, increasing inflammation-related pain.

Other processes may also intensify RA pain, including the night-time release of pro-inflammatory cytokines, an increased number of cells traveling to inflamed tissue, and changes in the body’s immune response.

Additionally, the body releases higher levels of melatonin and prolactin at night, both of which can cause an increase in inflammatory cytokines.

A person’s arthritis inflammation and pain may worsen if:

• they are already in pain when they go to bed
• their mattress or pillow puts pressure on their joints and irritates their arthritis
• they have other risk factors for insomnia, such as high stress levels or drinking caffeine before bed

How arthritis disrupts sleep

Many studies show a link between arthritis and sleep deprivation. People with arthritis may have trouble falling asleep and staying asleep. They may also report lower quality sleep due to the pain that the condition causes.

A 2021 study involving 133 people with arthritis and 76 matched controls found that 54.1% of people with arthritis reported poor sleep quality. The issues included:

• greater difficulty falling asleep
• shorter periods of sleep
• poor sleep quality
• more daytime problems related to poor quality sleep

A 2018 study reached a similar conclusion. The researchers compared 178 people with arthritis — 120 with RA and 58 with osteoarthritis (OA) — with 51 people with no arthritis. The rate of insomnia was comparable between the OA and control groups, at 32% and 33%, respectively. However, insomnia was significantly more prevalent among the RA group, affecting 71% of these participants.

Both studies also found a link between arthritis and mental health. People with arthritis were more likely to report marital problems and experience depression, suggesting that insomnia may be a reaction not only to arthritis but also to stress.

The link between arthritis pain and sleep goes in both directions. For example, arthritis can make it difficult to sleep, but sleep deprivation can also worsen arthritis pain. A 2018 study found that pain intensified as sleep worsened. In addition, a 2017 study found that people with knee OA who had poor quality sleep were more likely to ruminate on their pain.

Tips to get better sleep with arthritis

As insomnia can make pain worse, it is important that people with arthritis take steps to improve their sleep, as well as treating their pain.

Practice better sleep hygiene

Tossing and turning at night when unable to sleep may cause a person to notice and fixate on their pain. Good sleep hygiene may help a person fall asleep faster and remain asleep longer. People can try the following:

• going to bed at the same time each night and establishing a bedtime ritual, such as taking a bath, meditating, or doing another calming activity
• avoiding daytime naps
• exercising during the day to ease arthritis symptoms and support better health, but avoiding exercise for 4 hours before bed
• avoiding stimulants such as caffeine and nicotine, especially in the afternoon and evening
• refraining from drinking alcohol or only drinking it in moderation
• developing strategies for managing daytime stress to prevent negative thoughts from keeping a person awake or triggering joint pain
• eating a balanced meal a few hours before bed and trying a light snack just before bed if night-time hunger is a problem
• using the bed only for sleeping and sex and not for watching television or doing work
• keeping the bedroom cool and dark, potentially by using blackout curtains
• investing in a comfortable, supportive mattress and quality pillows
• trying different pillow positioning, such as putting a pillow between the knees or under the hips, to ease joint pain

While they are working on improving their sleep hygiene, a person may find it helpful to get back up if they cannot fall asleep. Doing this helps the association between bed and sleep remain strong.

Develop an arthritis pain management strategy

A person can work with a doctor to develop a plan for managing arthritis pain.

Where possible, it is important to avoid going to bed in pain. A doctor can recommend an appropriate pain relief medication to prevent pain before bedtime. They might suggest:

• night-time release arthritis drugs
• drugs that work for 24 hours
• an evening dose of pain medication

Identifying and managing arthritis triggers can also be helpful. A person can try keeping a pain and sleep log to determine and address any patterns that seem to worsen sleep or pain.

Consider psychotherapy

Being in pain night after night can affect a person’s emotional well-being and cause them to experience more pain. A 2017 study of people with knee OA found that people with sleep issues tend to catastrophize and focus on their pain, intensifying both pain and insomnia.

Therapy can help a person better cope with their pain and deal with daytime stressors that undermine sleep. Cognitive behavioural therapy for insomnia (CBT-I) is an evidence-based intervention that assists a person with learning new skills for sleeping better.

Summary

Night-time arthritis pain is common. However, having arthritis does not mean that a person has to live with chronic sleep deprivation. The right combination of medications, sleep hygiene practices, and lifestyle adjustments may help a person sleep better and for longer.

People with arthritis should be aware that while pain can make sleep worse, low quality sleep can also intensify pain and increase stress. This can create a vicious cycle that arthritis medication alone may not be sufficient to break.

The best path to complete relief is to treat both insomnia and arthritis. A person can work with their doctor to create a treatment plan that addresses the two conditions.

https://www.medicalnewstoday.com/articles/arthritis-symptoms-worse-at-night

6 Tips That Help Me Cope with Sun and Heat Sensitivity and Rheumatoid Arthritis

From healthline.com

By Cheryl Crow

Medically reviewed by Nancy Carteron, M.D., FACR

Growing up, I always looked forward to the long, warm, sunny days of summer. But ever since my diagnosis with RA, the summer months have become more complicated

You may have heard that cold winter months can trigger rheumatoid arthritis (RA) flare-ups, but what about the summer? I hate to be the bearer of bad news, but warm sunny weather can also pose unique challenges to people living with RA.

Some medications commonly used to treat RA can cause photosensitivity, also known as sun sensitivity. These medications include methotrexate (Trexall), azathioprine (Imuran, Azasan), leflunomide (Arava), and hydroxychloroquine (Plaquenil).

People on these medications are instructed to avoid excess sun exposure, which can be a huge lifestyle change for people who enjoy lounging around the pool in the summer.

Another reason people with RA may have sun sensitivity is if they have Sjogren’s. This condition is also associated with photosensitive skin rashes.

Like some others with RA, I find hot weather can lead to discomfort and fatigue even if I’m not in direct sunlight.

Researchers are still not sure exactly how or why temperature changes affect RA, but many folks find that extremes in weather or weather changes can trigger flare-ups.

After analysing my own patterns, I’ve found that heat and sunlight each independently trigger fatigue, but when both are present, the effects are more severe. I also find that my joints swell painfully in excessively hot weather.

While taking methotrexate for the last 18 years, I have learned to modify my summer schedule to avoid excessive sun and heat exposure.

These are my six best tips for coping with sun and heat sensitivity.

Plan ahead to minimize exposure to sunlight or heat

I’m able to prevent a flare-up from sun or heat by avoiding sunlight and heat altogether. However, that’s not always feasible or desired if I want to actually live my life and participate in meaningful summer activities, like going to outdoor events with friends and family.

So, I have to find a happy medium. Whenever possible, I avoid direct sunlight during peak hours (between about 10 a.m. and 3 p.m.). For example, I try to schedule social gatherings for dinner or sunset rather than lunchtime.

In the middle of a heat wave, I try to arrange for air-conditioned activities or plan outdoor activities for the coolest time of day. Additionally, I always bring a small portable fan with me, or a dual fan and spray bottle to provide extra cooling.

Cover up adequately

If I need to be outdoors during peak heat or sunlight hours, I protect my skin by:

• bringing an umbrella to provide shade
• covering my skin with sun protective clothing
• wearing ample sunscreen

Hydrate

Adequate water intake during the summer months helps to prevent dehydration, but did you know it can be even more important if you have RA?

The disease process for RA involves inflammation of the synovial fluid and synovial lining of your joints. Staying hydrated can help maintain the lubrication of your joints, which helps them move smoothly.

Track your unique patterns of sun and heat sensitivity

Learning to correlate my daily activities to my symptoms has been very empowering for me. This involves symptom tracking, a skill you can apply not only to heat and sun exposure, but also to things like food choices, exercise, sleep, meditation, and of course, medications.

I started by tracking the days and times I was exposed to heat and sunlight and noting the amount of fatigue and pain I felt on those days.

I discovered that both heat and sunlight could cause fatigue and pain for me. Some people might find that they are only sensitive to one and not the other, which can be very helpful when deciding how much energy to put into avoiding sun or heat.

Knowing your triggers can give you a sense of control over your condition. It’s also satisfying to feel like you can make informed decisions about when — and how much — to push yourself.

Communicate your sun and heat sensitivity to loved ones

It’s one thing to know what your triggers are and how to avoid them. But what do you do when your health needs conflict with your social needs?

Unfortunately, sometimes others don’t understand how serious RA is because they don’t see anything “wrong” on the outside.

Our friends and family might also not understand that RA can make someone more sensitive to sun or heat. You may have to explain to friends and family that your need for shade is medical and not a simple preference.

I’ve had to learn to stand my ground and advocate for my medical needs, which sometimes sadly does mean missing out on social activities when there are no shaded or cooling options (like air conditioning) available.

Find a balance

While growing up in infamously cold and grey Seattle, I eagerly looked forward to the summer months when I’d finally get some vitamin D and soak up the sun’s rays!

However, ever since getting diagnosed with RA, the summer months have become more complicated. I’ve had to learn to balance my social needs with my medical ones, and I’ve had to learn to cope with FOMO (fear of missing out).

Sometimes, it’s worth it to push myself to spend more time in the sun or heat than is ideal. For example, I will accept the fatigue hangover that comes with sun and heat exposure in exchange for attending a dear friend’s outdoor wedding.

Other times, I have to simply accept my limitations and accept that my medical needs require me to spend less time in the sun and heat than others. It’s hard to miss out on outdoor activities and can trigger people to grieve what their illness has taken from them.

Receiving therapy from a licensed health professional has greatly helped me accept the many ways RA has affected my life.

Cheryl Crow is an occupational therapist who’s lived with rheumatoid arthritis for 18 years. In 2019, Cheryl started Arthritis Life to help others thrive despite arthritis. She facilitates online courses and support groups to help people adjust to their conditions and live full and meaningful lives. Most days you can find Cheryl creating life hack videos, sharing patient stories on the Arthritis Life Podcast, or spreading the word about Acceptance and Commitment Therapy (ACT).

https://www.healthline.com/health/rheumatoid-arthritis/tips-for-coping-with-sun-and-heat-sensitivity-with-ra

What Are the 5 Types of Psoriatic Arthritis?

From healthline.com

Psoriatic arthritis (PsA) is a kind of arthritis that impacts individuals with the skin condition psoriasis. It’s estimated that PsA affects about 20 to 30 percent of people with psoriasis. 

PsA can cause the affected joints to become painful, stiff, and swollen. The condition is different for everyone. Symptoms can range from mild to severe and can impact only a few or several joints.

There are 5 different subtypes of PsA. These are based off of the areas of the body that are affected as well as the severity of symptoms. A person with PsA can also have symptoms consistent with multiple subtypes of PsA.

In this article, we’ll outline the different subtypes of PsA, their symptoms, and how common they are. Then, we’ll cover how PsA is diagnosed and treated. Continue reading to discover more.

1. Asymmetric psoriatic arthritis

Asymmetric PsA impacts a joint or joints on one side of your body. Typically, less than 5 joints are impacted by this type of PsA. Asymmetric PsA is more common in people assigned male at birth.

The Arthritis Foundation notes that most of the time, PsA is asymmetric. It’s estimated that about 60 percent of individuals with PsA initially present with asymmetric PsA. But over time, this can progress to symmetric PsA.

Any joint in the body can be affected by asymmetric PsA. Some areas that are more commonly impacted are the:

• knee
• feet
• ends of the fingers and toes
• large joints

Symptoms

Symptoms of asymmetric PsA can be mild to severe and can include:

• joints that are:
  • tender or painful
  • swollen
  • warm to the touch
• reduced range of motion in the affected joints
• morning joint stiffness
• swelling and redness of the fingers or toes (dactylitis)
• swelling and pain where tendons and ligaments connect to bone (enthesitis)
• nail changes, like pitting, cracking, or separation from the nail bed
• itchy, scaly skin patches
• fatigue
• eye problems like redness and uveitis

The fact the asymmetric PsA only affects one side of the body can help to distinguish it from other types of arthritis, liker rheumatoid arthritis (RA).

2. Symmetric psoriatic arthritis

Symmetric PsA impacts five or more of the same joints on both sides of the body. While this type of PsA can occur in any joint, the small joints in the hands and feet are most commonly affected. Symmetric PsA is less common in larger joints.

The incidence of symmetric PsA is estimated to range from 15 to 61 percent. Symmetric PsA is more common in people assigned female at birth.

Symptoms

The symptoms of symmetric PsA are generally the same as those observed in asymmetric PsA. They can also range from mild to severe.

Because this type of PsA is symmetrical and mainly impacts small joints, it can often be mistaken for RA. But it’s generally milder than RA and blood tests for rheumatoid factor (RF) are almost always negative.

3. Distal interphalangeal predominant psoriatic arthritis

Distal interphalangeal (DIP) predominant PsA mainly affects the distal interphalangeal joint. This is the joint that’s closest to the ends of the fingers and toes.

In someone with DIP predominant PsA, it’s estimated that over 50 percent of all impacted joints are DIP joints. This type of PsA can be either symmetrical or asymmetrical and impacts about 10 percent of people with PsA.

Symptoms

In addition to other general symptoms of PsA, nail changes are very common in people with DIP predominant PsA. These can include nail pitting, nail cracking, and separation of the nail from the nail bed (onycholysis).

4. Spondylitis psoriatic arthritis

Spondylitis PsA mainly affects the joints between your spinal vertebrae. You may also see this type of PsA referred to as axial arthritis. It’s thought that spondylitis PsA is present in 7 to 32 percent of people with PsA.

Symptoms

In addition to other general symptoms of PsA, those with spondylitis PsA also experience pain, swelling, and stiffness in the neck and back, which can make movement very difficult.

Even though spondylitis PsA primarily impacts the spine, people with this type of PsA can also experience symptoms in other joints. These can include the:

• hips
• arms
• legs
• hands
• feet

5. Psoriatic arthritis mutilans

PsA mutilans is the most severe type of PsA. It’s rare and is estimated to impact about 5 percent of all people with PsA. The small joints of the hands, feet, and wrist are most often affected.

Symptoms

In PsA mutilans, inflammation is very severe, leading to significant damage to the affected joints. This can lead to symptoms like:

• deformities of the affected joint, which can be serious
• problems with movement and range of motion
• bone loss in the affected joint, which can lead to shortening of the fingers or toes

PsA mutilans can also impact other areas as well. People with this type of PsA may also experience pain in their neck and back.

How is psoriatic arthritis diagnosed?

Early diagnosis of PsA is vital. This is because starting treatment as early as possible can help to prevent further joint damage.

A doctor will typically use the following steps to diagnose PsA:

• Medical history: To get an idea of your medical history, a doctor will ask you a variety of questions, which can include:
  • When did you first notice your symptoms?
  • How would you describe the severity of your symptoms?
  • Is there anything that makes your symptoms better or worse?
  • Do you have a family history of psoriasis or PsA?
  • What medications or supplements are you currently taking?
• Physical examination: Next, your doctor will perform a physical examination. During this time, they’ll examine your joints for any signs of tenderness and swelling. They’ll also check for movement difficulties or nail changes.
• Blood tests: Blood tests for PsA look for signs of inflammation and can include tests like those for C-reactive protein (CRP) and rheumatoid factor (RF). A negative test for RF can help to rule out RA.
• Imaging: Imaging technology can help your doctor to evaluate your joints for signs of inflammation and damage. Examples of imaging techniques that may be used include X-ray and MRI.

How is psoriatic arthritis treated?

There are several potential treatment options for PsA. What’s involved in your specific treatment plan can depend on a variety of factors, including:

• the severity of your symptoms
• how many joints are impacted
• which joints are affected
• the extent of the damage in the affected joints
• your responses to previous treatments for PsA
• your overall health
• your personal preference

Medications

A variety of medications can be used in the treatment of PsA. Some examples include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are medications that can work to ease inflammation and pain in mild PsA. They’re available either over-the-counter or by prescription.
• Disease-modifying antirheumatic drugs (DMARDs): DMARDs are drugs that help to prevent mild to moderate PsA from getting worse. Examples of DMARDs include methotrexate, sulfasalazine, and apremilast (Otezla).
• Biologics: Biologics are a newer type of DMARD. They’re proteins that target specific parts of the inflammatory process. They may be used for more severe PsA or spondylitis PsA. Examples of biologics are adalimumab (Humira) and secukinumab (Cosentyx).
• Immunosuppressants: Immunosuppressants are drugs that dampen the activity of your immune system. Due to the availability of biologics, they’re not used as often. Examples include cyclosporine and azathioprine.
• Corticosteroids: Corticosteroids work to reduce inflammation. They can be given as a pill or an injection. Due to side effects, oral corticosteroids are taken at the lowest dose for the shortest amount of time possible.

Surgery

Surgery can sometimes be used for PsA. But this type of treatment is typically only recommended when PsA has caused joints to become severely damaged.

Exercise

Engaging in regular, low-impact exercises like walking and swimming can also help to keep joints healthy. Physical therapy may also be recommended to improve or maintain strength, flexibility, and range of motion.

What causes psoriatic arthritis?

PsA is an autoimmune disease. This is where the immune system mistakenly attacks healthy tissues, leading to inflammation and damage.

What exactly causes the immune system to behave this way in people with PsA isn’t clear. It’s believed that a complex combination of genetic and environmental influences may play a role.

About 33 to 50 percent of people with PsA have at least one close relative that has either psoriasis or PsA. Additionally, several genes associated with PsA have been identified.

Environmental factors that may contribute to the development of PsA include things like infections or physical trauma.

Takeaway

PsA is a condition that can affect some individuals with psoriasis. It can cause joint inflammation and pain ranging from mild to severe. The symptoms of PsA can also impact movement and quality of life.

There are 5 different subtypes of PsA. These are divided up based on factors like the affected area and symptom severity. It’s possible for an individual with PsA to experience symptoms that align with multiple subtypes of PsA.

A variety of treatments can help to ease PsA symptoms and slow the progression of the condition. An early diagnosis is important in preventing further joint damage. See a doctor as soon as possible if you’re experiencing symptoms of PsA.

https://www.healthline.com/health/psoriatic-arthritis/5-types-of-psoriatic-arthritis

Can You Live a Long Life With Rheumatoid Arthritis?

From medicinenet.com

Rheumatoid arthritis (RA) is a type of chronic inflammatory autoimmune disease. It is caused when the immune system erroneously attacks its own body tissues. Like several other autoimmune diseases, RA is more common in women than men. Women are two to three times more likely to have RA than men. In this condition, the immune system attacks the joints. However, it can also affect other body tissues and cause problems in organs, such as the heart, lungs and eyes. The disease can affect many joints in the body at the same time. RA commonly affects joints in the hands, wrists and knees. In a joint affected by RA, the lining of the joint becomes inflamed, which damages the joint tissue.

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis (RA) particularly affects the small joints in the hands, wrist and feet. RA may also involve the elbows, knees, ankles and other body parts. The joint involvement in RA is symmetric, which means that if the joints in the fingers of your left hand pain, you will experience pain in the fingers of the right hand, too. The common symptoms of RA are:

• Warm, swollen and painful joints
• Morning stiffness in joints or stiffness after inactivity
• Joint deformity
• Fever
• Fatigue
• Loss of appetite
• Loss of weight
• Dryness in eyes
• Dry mouth
• Numbness and tingling in hands and feet 
• Difficulty breathing
• Pale skin
• Depression
• Chest pain or pressure

Rheumatoid arthritis (RA) is a type of chronic inflammatory autoimmune disease

The symptoms of RA do not remain the same all the time. There may be exacerbation (flare-ups) and resolution (remissions) from time to time.

Can you live a long life with rheumatoid arthritis?

Yes, you can live a long life with rheumatoid arthritis (RA), although on average the disease has been found to shorten lifespan by a few years. RA does not kill people, but its complications can be fatal. RA raises your risk of having cardiovascular disease (the leading cause of death in people with RA). It can also affect your lungs and blood vessels and increase your risk of infections. Although the disease cannot be cured, effective treatment can control the symptoms, reduce the risk of complications and improve quality of life and lifespan. The medications for RA aim at reducing inflammation in the body and achieving remission (low disease activity). Various drugs used for RA aim to reduce symptoms and improve quality of life. These drugs are collectively called disease-modifying anti-rheumatic drugs or DMARDs. To achieve a longer and better quality of life

• Take your medications as advised by your doctor.
• Eat a balanced and nutritious diet. 
• Include lots of fibre in the form of vegetables, whole grains and fruits in your diet. 
• Limit the intake of processed, fatty and sugary foods.
• Limit alcohol intake.
• Avoid smoking. 
• Perform enough physical activity as advised by your doctor. Generally, it is advised to perform at least 30 minutes of low- or no-impact aerobic exercises, such as cycling and walking, five days a week. Also, including strengthening exercises (weights, resistance bands, squats, climbing stairs, etc.) in the routine helps strengthen and support the joints. Adding stretching and flexibility exercises helps boost the range of motion and limits stiffness.
• Get enough sleep and rest.
• Maintain personal hygiene.

https://www.medicinenet.com/can_you_live_a_long_life_with_rheumatoid_arthritis/article.htm