From aarp.org/health
How to get relief for this difficult to diagnose condition
About six years ago, Mike Braucher, 58, had to stop playing basketball with his sons because of joint pain. After a few pain medications didn’t work, he was eventually referred to a rheumatologist who provided a more accurate diagnosis: Psoriatic arthritis, a chronic condition marked by joint pain and skin symptoms.
Braucher, like many with psoriatic arthritis, experienced an inability to do what he loved because of his symptoms. Fortunately, his rheumatologist provided the right diagnosis and psoriatic arthritis treatment plan, allowing Braucher to return to his regular routine. “We're in an amazing era of treatment with options that were not available 10 years ago,” says Julius Birnbaum, M.D., a professor of medicine at the University of Pittsburgh and author of Living Well with Autoimmune Diseases. The pathway to that initial psoriatic arthritis diagnosis and finding the right treatment can be difficult, but not impossible, to navigate.
What is psoriatic arthritis?
Psoriatic arthritis occurs when someone has both inflammatory arthritis and psoriasis, says Lawrence Brent, M.D., associate director of rheumatology at Temple University. Inflammatory arthritis is a group of conditions that occur when the immune system is overactive. Psoriasis is an inflammatory skin condition which often manifests as erythematous plaques, a type of red or flat red skin lesions.
Researchers are unsure what causes psoriatic arthritis, though there seems to be a genetic component. Other risk factors include obesity and severe psoriasis. Trauma to the joint or bones often triggers this condition.
Psoriatic arthritis symptoms
Symptoms can vary greatly, but common ones include:
- Joint swelling and inflammation: This occurs in the spine, neck, lower back or hips. Pain is usually worse in the morning or after rest.
- Back pain: Birnhaum notes that back pain occurs more often in younger patients. Older patients’ back pain is more likely related to degenerative changes in the spine than psoriatic arthritis.
- Rash: A rash or skin inflammation, particularly in the elbows, knees or scalp.
- Sausage fingers and toes: Psoriatic arthritis may cause sausage-like swelling of toes or fingers that’s often painful.
- Tenderness: Many patients experience tenderness in areas where ligaments or tendons attach to bones.
- Psoriatic arthritis nails: A tell-tale sign of psoriatic arthritis is when there’s nail pitting, dips or depressions in the nail plates.
- Mental health symptoms: A lack of energy as well as anxiety or depression often accompanies psoriatic arthritis.
- Uveitis: As the disease progresses, some patients will also develop uveitis, inflammation of the eye which can cause light sensitivity and decreased vision.
Psoriatic arthritis is also associated with a higher prevalence for other conditions, such as diabetes, hypertension, heart disease and obesity.
Difficulty in diagnosing
“Patients with psoriatic arthritis could have psoriasis first and then go on to develop the musculoskeletal complications afterwards,” explains Birnbaum, who notes other patients experience the opposite: They develop arthritis before skin symptoms develop. He adds, “Then, there are patients who develop psoriasis skin disease at the same time that they develop arthritis.”
These three different presentations make it difficult to diagnose psoriatic arthritis, an experience familiar to Tim Clepper, 68. Clepper was an avid cyclist until about five years ago, when he began experiencing fatigue and joint pain. He went to every doctor he could think of, but none could diagnose his symptoms. About two years ago, he finally was referred to a rheumatologist who diagnosed him with psoriatic arthritis.
“One of the issues with psoriatic arthritis is that diagnosis can be very difficult and very time consuming,” says Klepper, “I've been volunteering with the Arthritis Foundation for 25 years, yet the last thought in my mind was that I had some sort of arthritis.”
Clepper isn’t alone in a long path to diagnosis. Braucher mentioned a similar journey, and nationwide, about 15 percent of psoriatic arthritis cases are currently undiagnosed.
What are the early warning signs of psoriatic arthritis?
Once a patient is referred to a rheumatologist, they can often spot warning signs of psoriatic arthritis by examining the skin of patients with joint pain. “When someone presents with inflammatory arthritis, I make sure I look at the skin,” says Brent, noting the scalp and other areas prone to skin symptoms are the most important to check.
He also asks patients if they’ve had a skin rash before. For some patients, like Braucher, the answer is no. Braucher’s first warning sign was joint pain and he didn’t present with a rash, though he did experience irritation in his scalp. Other patients may have an active case of psoriasis or have been diagnosed in the past but not had a flare in years.
Psoriatic arthritis treatment options
There have been significant advancements in arthritis medication and complementary treatments in the last ten years. Despite this progress, it takes time to discover the right treatment plan, though it’s often a mix of medication, support from healthcare professionals and lifestyle changes.
Medication for psoriatic arthritis
Usually, treatment starts with non-steroidal anti-inflammatory drugs (NSAIDs) to help manage symptoms. If someone has heart disease or another condition that interacts negatively with NSAIDs, a different pain medication may be prescribed.
If this initial class of medication fails, doctors often prescribe disease-modifying anti-rheumatic drugs (DMARDs) that suppress immune system activity, with the most common being methotrexate. Biologic therapies and oral "targeted" therapies which stop inflammation by interrupting immune system messaging may also be considered.
Dermatology and physical therapy
While a rheumatologist is often the primary doctor, many with psoriatic arthritis also benefit from seeing a dermatologist and physical therapist. Typically, biologics help with skin-related symptoms but a dermatologist may recommend complementary treatments. Braucher says that his dermatologist recommended a special shampoo to help with scalp irritation. When patients experience joint stiffness or pain, physical therapy may help relieve symptoms when used in tandem with medication.
Lifestyle changes to help psoriatic arthritis
“We understand now that it's important to live a healthy lifestyle,” says Birnbaum, who points out that maintaining a healthy weight or losing weight is one of the most effective ways of managing psoriatic arthritis. Birnbaum often recommends a well-balanced diet and regular exercise. He notes that exercise doesn’t have to be intense in order to be effective; a gentle walk or aqua aerobics class works well (and is less likely to trigger joint pain).
For Clepper, that form of exercise is biking. Each year, he signs up for the Arthritis Foundation's California Coast Cycling Tour because it gives him a goal to work toward, creating more consistency in his cycling. “Movement gives me the most relief and makes me feel the best,” says Clepper, “and so that would be my recommendation for anybody who's able — do whatever exercise they can to keep those joints moving.”
Psoriatic arthritis can also disrupt sleep, an essential element for overall health. Medication to manage arthritis pain should improve sleep length and quality, but following good sleep practices, like sleeping in a dark, quiet environment and not using your phone before bed, can help too.
The best diet for psoriatic arthritis
Any well-balanced diet may work for psoriatic arthritis, though the Mediterranean diet is one of the most evidence-backed. This diet includes:
- Plenty of vegetables, particularly leafy greens and fruit
- Legumes, such as lentils and chickpeas
- Olive oil for healthy fat
- Small daily servings of cheese and yogurt
- Fish or poultry a few times a week
- Minimal or no red meat
For psoriatic arthritis, avoid smoking or alcohol, especially if it interferes with any prescribed medications.
Self care with psoriatic arthritis
Psoriatic arthritis can take a toll on mental health, often due to worries about physical symptoms, healthcare access and future disease development. To combat these impacts, many people find it valuable to practice self care.
A 2022 study found mindfulness and self-compassion practices, like guided meditation or self-compassion journaling, help decrease negative feelings stemming from psoriatic arthritis and improve overall quality of life. A mental healthcare provider can also help someone navigate self care options.
Psoriatic arthritis outlook
With the right diagnosis and appropriate treatment plan and lifestyle, those with psoriatic arthritis usually experience fewer symptoms, though it’s rare for the disease to be inactive or enter remission. Both Braucher and Clepper report that after finding the right treatments, they have been able to return to activities they loved.
No comments:
Post a Comment