5 Psoriatic Arthritis Myths and Facts

From everydayhealth.com

Psoriatic arthritis (PsA) is often misunderstood, and those misconceptions can make it harder for people to recognize symptoms, seek care, or understand what living with the condition is really like. It can also be challenging to explain the effects of the condition to friends, family, and co-workers.

“Psoriatic arthritis can also be difficult to diagnose, which can add to the confusion,” says Christopher Richard Morris, MD, a board-certified rheumatologist in Kingsport, Tennessee.

From its demographics to its progression, misconceptions about this autoimmune disease can be surprisingly persistent. Here are five common myths — and the facts to help set the record straight.

                                                                                                                         Everyday Health

1. Myth: Everyone With Psoriatic Arthritis Has Psoriasis

Not everyone with one condition will automatically have the other. While there is a strong link between psoriasis and psoriatic arthritis, up to 17 percent of people with a PsA diagnosis don’t have any visible skin symptoms at the time of their joint diagnosis.

“Though most adult patients develop psoriasis concurrently or before the symptoms of arthritis, there is a small subset of patients where arthritis develops before the skin manifestations,” says Nayaab Bakshi, DO, a fellow at Stony Brook Medicine’s division of rheumatology in Stony Brook, New York.

That said, Dr. Morris points out that there are PsA patients who may not be aware they also have psoriasis, which manifests in different ways. There can be patches of thick, scaly skin that can appear on the scalp, elbows, knees, or lower back; yellow-brown spots on the nails; or pustules can develop on the hands or feet.

“Psoriasis is not recognized easily, and you may not know what to be looking for,” Morris says. If you do notice a skin eruption, he adds, make an appointment with a dermatologist for a thorough examination.

2. Myth: PsA Is Caused by ‘Wear and Tear,’ Like Osteoarthritis

While both conditions are defined by joint pain, they are driven by different biological processes. Osteoarthritis is a degenerative disease in which the cartilage in the joints breaks down over time due to age, injury, or repetitive use.

PsA is inflammatory, which means joint damage is caused by an overactive immune response.

“Inflammation in psoriatic arthritis triggers a cascade of immune responses that cause joint pain, swelling, and destruction through multiple mechanisms: synovial tissue invasion, cartilage breakdown, and bone erosion,” says Dr. Bakshi. The synovium is the lining in the joints that can become inflamed, causing pain, swelling, and stiffness.

In psoriatic arthritis, your immune system also mistakenly tells your body to strip away bone in some spots while simultaneously building extra bone in others. This uneven process can reshape the joint, whereas osteoarthritis involves the gradual breakdown of protective cartilage.

3. Myth: If Your Skin Is Clear, Your Joints Are Fine

While there is some correlation between the severity of skin symptoms and the severity of the joint pain, the two don’t always move in tandem. The skin and the joints are independent targets of the same overactive immune system.

“We have an immune system that can be directed in many different ways,” says Aly Cohen, MD, a rheumatologist and an integrative health specialist in Princeton, New Jersey, and the medical director of the online education platform the Smart Human. “Because of that variability, you can’t always predict what’s going to become inflamed.”

One study found that some immune cells can migrate from the skin into the joints, where they may continue to trigger inflammation. This could help explain why your joints are affected while your skin looks perfectly healthy.

But it is true that if your skin isn’t clear, your joints may also be affected. Bakshi says the severity of skin symptoms can mirror the severity of joint pain. On the other hand, patients can also have severe psoriasis with mild joint disease, or minimal skin issues with significant joint pain and damage.

4. Myth: Psoriatic Arthritis Primarily Affects Elderly People

Since PsA isn’t an aging-joint issue like osteoarthritis, it doesn’t take decades of living for it to emerge. PsA is triggered by a malfunctioning immune system, and that can activate at any age, including in childhood. Studies suggest that the disease is most common in people 40 to 59 years old.

“There is no great way to understand the demographics,” says Dr. Cohen. “It used to be considered male dominant, but I’ve seen it equalize over the years.” It was also long considered a Caucasian disease, but research now suggests Hispanic and non-white PsA patients may experience more pain and limitations in their daily activities.

More than 1.5 million people in the United States have PsA, and about one-third of people who have the skin condition will develop it. Most people develop psoriasis about 10 to 20 years before being diagnosed with PsA.

5. Myth: The Symptoms Are Limited to Joint Pain and Skin Rash

PsA is often thought of as a condition that is limited to two specific areas, but that view is incomplete. “Psoriatic arthritis (PsA) is a multisystem inflammatory disease that extends beyond joint and skin involvement,” says Bakshi.

In addition to achy joints and skin rashes, other symptoms of PsA include:

• Fatigue or a lack of energy
• Tenderness in the areas where tendons or ligaments attach to bones, such as the back of the heel or sole of the foot
• Painful, sausage-like swelling of a whole finger or toe
• Nail changes, such as pitting (tiny dents), crumbling, or separation from the nail bed.
• Eye inflammation, especially uveitis, which can cause eye pain, redness, and blurry vision, and must be treated promptly to avoid vision loss.
• Inflammatory bowel disease
• An increased risk of heart disease

The Takeaway

• Misconceptions about psoriatic arthritis (PsA) are common, largely because it can be difficult to recognize and diagnose; it can have both a joint and a skin component, and doesn’t always present in obvious or predictable ways.
• PsA is an inflammatory disease, not the result of cartilage deterioration. It’s caused by an overactive immune system that damages joints in complex ways, and skin symptoms don’t always reliably reflect what’s happening in the joints.
• PsA can affect the whole body, can develop at almost any age, and can impact more than joints and skin. It can also affect your eye, digestive, and cardiovascular health.
• Understanding the condition and the effects it may have can help you manage it better.

 https://www.everydayhealth.com/psoriatic-arthritis/myths-and-facts/