Common Triggers for Psoriatic Arthritis

From healthcentral.com

From weather to medication interactions, learn all the ways this condition can be triggered 

Psoriatic arthritis (PsA), an autoimmune disease that leads to joint pain and skin rashes, can be unpredictable and change over time. If you have PsA, you know how hard it can be to pinpoint what’s causing your symptoms to worsen. There are multiple internal and external factors that impact the immune system, and figuring out which ones might set off a flare with psoriatic arthritis isn’t easy. What’s more, these factors, known as triggers, can vary from person to person. We asked the experts about some of the common psoriatic arthritis triggers and how to shield yourself from worsening symptoms.

                                                                                Getty Images/PeopleImages

Stress

“Stress is one of the biggest triggers for flares,” says Waseem Mir, M.D., a rheumatologist at Northwell Lenox Hill Hospital in New York City. Stress often occurs after an unpleasant life circumstance, new demands, an event like a death in the family. Stress could also result from an overall ongoing and challenging life experience such as poverty or marital dissatisfaction.

Short-term stress can help you respond to life’s challenges, but if the stress-inducing event goes on and on, your reaction can become more long-term, also known as chronic stress. According to an article in Frontiers in Human Neuroscience, large bodies of evidence show that chronic stress can activate inflammation in the brain and the body.

The relationship between stress and inflammation becomes clear with psoriatic disease. In one study, patients with psoriasis in 31% to 88% of cases reported stress as a trigger for their psoriasis and a higher incidence of psoriasis occurred in those with a stressful event in the previous 12 months.

Illness

A variety of infections have been reported as triggers of psoriatic disease. According to a 2024 review, both bacterial and viral infections have been responsible for the onset or recurrence of psoriatic disease. Bacterial infections include Streptococci pyogenes (strep throat), Staphylococcus aureus (staph infection), Porphyromonas gingivalis (periodontal disease). Viral infections related to psoriatic disease include human immunodeficiency virus (HIV), hepatitis C virus, and COVID-19.

Lack of Sleep

“Lack of sleep may contribute to psoriatic arthritis flares, but we need more research in this area,” says Melanie H. Smith, M.D., Ph.D., a rheumatologist at Hospital for Special Surgery in New York City, adding that the cause and effect may not be a straightforward relationship. “With sleep, maybe it’s not necessarily about being a trigger for psoriatic arthritis, but when we get less sleep, we feel more pain.” Given that people with psoriatic arthritis are more likely to have trouble sleeping, often from symptoms of the condition, exacerbation of pain is a real problem. According to the Arthritis Foundation, all the more reason to keep your psoriatic arthritis symptoms in check through proactive treatment.

Skin Trauma

If you have psoriasis along with your psoriatic arthritis, skin trauma or injury can be a flare of your symptoms, known as the Koebner phenomenon. According to the National Psoriasis Foundation, psoriasis can appear in the areas of the skin that have been harmed as a result of scratches, sunburns, bug bites, and vaccinations. The exact reason this occurs remains unclear without enough evidence to support any one theory.

Medication Disruptions

“Another trigger can be changing or discontinuing medication,” says Dr. Smith. That’s because a different mechanism of action might not work as well—or not work at all if you suddenly stop taking your medication. All of this can lead to worse symptoms, she explains. And in the world of psoriatic disease, medication changes happen quite frequently, according to the National Psoriasis Foundation.

Dr. Smith says that sometimes you will need to take the lead in shortening the time you are without treatment. “Sometimes it’s about making sure the doctor’s prior authorization is not running out anytime soon or if it is, letting the doctor know,” she explains. “I’m never upset about a patient advocating for themselves.”

Changing Physiology 

There are other times related to your medication where you could experience a psoriatic arthritis flare, but it may not be the fault of your medication. “Sometimes people will blame their medications for flares, reporting that their medications have stopped working,” Dr. Mir says. Usually, though, it is more complicated than that. “Sometimes it is about your body becoming weaker when you have a flare, not the medication stopping working,” he says. “Our physiology changes over time—especially as we grow older.”

“Maybe the medication was working for you five years ago, but now you are five years older and your body has changed,” Dr. Mir adds. These changes in your body as you age can sometimes trigger a PsA flare.

Alcohol and Cigarettes

A complex relationship has been discovered between psoriatic disease and alcohol. People living with psoriasis tend to consume more alcohol than the general population, according to the National Psoriasis Foundation. Whether that’s because the discomfort of the disease drives people to self-medicate, if the goal of drinking is to help treat the symptoms of the disease, the opposite is true. Drinking alcohol can cause dehydration and nutritional issues, and also create oxidative stress and inflammation.

Smoking should also be avoided if you have psoriatic arthritis. Smoking is an independent risk factor for psoriatic disease. Why? One of the reasons is that nicotine stimulates immune cells by releasing inflammatory cytokines, according to a 2024 article in Cell Communication and Signaling. And if you are already genetically predisposed to psoriatic disease, it seems that smoking can turn up the volume. Smoking upregulates the expression of psoriasis-associated genes.

Diet

Because everyone reacts differently to food, there is no one recommended diet for people with psoriatic arthritis, but Dr. Smith says that following a nutritious meal plan can help shield people from psoriatic arthritis symptom triggers.

In particular, foods with anti-inflammatory properties may help ease PsA symptoms: There is some evidence to support eating a Mediterranean diet if you have psoriatic disease. This diet emphasis is on plant-based foods, fruits, vegetables, whole grains, beans and legumes, fatty fish and olive oil.

A healthy diet is not just about what you eat, but also about what you leave off your plate, explains Dr. Smith. Because processed food may cause psoriatic arthritis symptoms to flare, limiting consumption of it can be helpful for keeping the disease in check.

Weight Gain

On average, people with PsA have a higher mean body mass index (BMI) than those with psoriasis, rheumatoid arthritis, or the general population, according to a study in Rheumatology; up to 45% of people with psoriatic arthritis are obese. Adipose (fat) tissue can act as an active organ in our bodies, secreting proinflammatory cytokines. As a result, obesity has the potential to activate many of the known immune-inflammatory pathways, causing a flare in symptoms to occur.

Additionally, carrying weight may also prevent your treatment from working as well as it should. According to the Arthritis Foundation, a number of studies have shown that for people with psoriatic arthritis, being obese raises the chances of not improving with certain types of medications.

Cold and Dry Weather

Dr. Mir said that weather changes can be a trigger for PsA symptoms. “I just spoke to a patient who was flaring with foot and hand pain and it seemed possible that it was from a weather change,” he says.

Dr. Smith agrees that weather changes seem to frequently be reported as a trigger of psoriatic arthritis symptoms. “Some patients say that their skin and joints get worse,” she says. The research supports the impact of weather exposure and variations. For example, a 2022 study reported that patients with psoriasis who had occupations with more sunlight exposure were less likely to report aggravation of psoriasis in autumn/winter. On the other hand, smoking and hyperlipidaemia (elevated lipids) were positively associated with the seasonal aggravation of symptoms.

Shielding Yourself From Potential Triggers

While you probably won’t be able to avoid all the potential psoriatic arthritis triggers, there are ways to reduce their impact. “Exercise does seem to help shield people from some of the triggers,” says Dr. Smith.

Keeping on top of your treatment can also impact the power of the triggers. “If your medication is barely covering your disease and you get an extra blow to the system, you are going to feel it,” says Dr. Mir. “On the other hand, if your treatment is covering your condition really well, then if you have a small hit from a trigger, the medication may cover it.”

https://www.healthcentral.com/condition/psoriatic-arthritis/psa-psoriatic-arthritis-triggers

Knee Trouble? Losing Weight May Help Slow Arthritis

From usnews.com

FRIDAY, Sept. 23, 2022 (HealthDay News) -- Losing excess weight may not only help prevent knee arthritis, but also slow its progression in people who already have the condition, a recent study suggests.

Researchers found that among over 9,000 middle-aged and older adults, those who managed to shed some extra weight benefited their knees in two ways: They were less likely to develop knee arthritis over the next several years; and if they already had knee arthritis, the joint damage progressed more slowly.

It has long been known that excess pounds are a risk factor for developing knee arthritis. And when people with the condition are overweight or obese, they are encouraged to lose weight to help ease their pain.

Experts said the new findings suggest that weight loss may not only curb pain, but also help protect the integrity of the knee joint itself.

"Even in overweight and obese patients who already have some structural knee osteoarthritis damage, there is still a role for weight loss in preventing further harm," said Dr. Emily Carroll, a rheumatologist with the Mount Sinai Health System in New York City.

Dr. Linda Russell, a rheumatologist at the Hospital for Special Surgery, also in New York City, agreed.

"There's no doubt that when you have knee osteoarthritis and you lose weight, you'll have less pain," Russell said. "This suggests that losing weight also slows the progression of the joint damage."

The findings — from a team at the University of New South Wales in Australia — are not particularly surprising, according to Russell. In basic terms, excess weight places more pressure on the knees, especially the medial (or inner) side of the joint. In this study, Russell noted, weight changes were specifically related to the odds of joint space narrowing on the inner side of the knee.

"So this is confirming what we've suspected," she said.

But that confirmation is important, Russell added, since it may give patients more motivation to shed extra pounds.

"If you have knee osteoarthritis and lose weight, you might be able to either avoid knee replacement surgery or delay it," Russell said.

One point, though, is that it did take substantial weight loss to make a major difference. On average, the study found, people had to drop a whole body mass index (BMI) category — going from obese to overweight, for example — to reduce the odds of arthritis progression by 22%.

That is challenging, according to Russell. "The hard part is, patients with knee osteoarthritis often find it difficult to exercise because of pain," she said.

Still, both doctors said, there are low-impact forms of exercise that get the heart pumping and burn calories — like swimming, walking, cycling and using elliptical machines.

"I do encourage patients to find activities they can do, and that they enjoy," Russell said.

The Australian study included nearly 5,800 adults who were free of knee osteoarthritis, and just over 6,000 who already had the disease. Osteoarthritis refers to the common, "wear-and-tear" form of arthritis that involves a breakdown in the cartilage that cushions joints.

Overall, the study found, about one-fifth of participants managed to lower their BMI over four to five years. (BMI is an estimate of body fat based on height and weight.)

For each "unit" decrease in BMI, the risk of developing knee arthritis dipped by 5%, and the risk of further joint damage declined by a similar amount. When people with knee arthritis had a BMI decline of 5 units — enough to drop down to a new BMI category — their risk of progression decreased by 22%, the investigators found.

But while lesser weight loss brought a smaller benefit, it still matters, according to Carroll. "Every bit does count," she said.

To both lose weight and keep it off, Carroll noted, exercise is only part of the equation: Healthy eating habits that can be kept up for the long haul are key.

Both doctors recommended that people with knee arthritis talk to their health care providers for help with weight loss: Some might benefit from physical therapy to help them get active. And some, depending on their BMI and other health conditions, might qualify for weight-loss treatments.

The findings were recently published online in the journal Arthritis & Rheumatology. Lead author Zübeyir Salis is a doctoral candidate at the University of New South Wales, in Australia.

More information

The Arthritis Foundation has more on knee osteoarthritis.

https://www.usnews.com/news/health-news/articles/2022-09-23/knee-trouble-losing-weight-may-help-slow-arthritis

Does BMI and Diet Affect the Severity of Psoriatic Arthritis?

From news-medical.net
By Ratan-NM, M. Pharm

Psoriatic arthritis is a painful, disabling disease which involves inflammation of the skin and joints.

Psoriatic arthritis is characterized by synovitis and enthesitis. Synovitis is inflammation of the membrane that covers synovial joints. Enthesitis is inflammation of the entheses, which are the regions where tendons or ligaments attach to the bone.

Swelling, pain and stiffness are the major symptoms associated with psoriatic arthritis. Psoriatic arthritis can affect any part of the body; however, the fingers and toes are most often affected.

Evidence suggests that both psoriasis and psoriatic arthritis are associated with obesity and the metabolic syndrome. These two conditions increase the risk of heart disease, type 2 diabetes and stroke.

Observational studies show that obesity is present in 45% of psoriatic arthritis patients. Obesity in psoriasis and psoriatic arthritis leads to higher disease activity, decreased responses to therapies, and lower probability of achieving minimal disease activity (MDA).

                                                  Image Credit: NAR studio/Shutterstock.com

The mechanisms linking psoriatic arthritis with obesity

Obesity may negatively impact the disease onset as well as the disease severity of psoriatic arthritis. Though the exact mechanisms linking psoriatic arthritis with obesity is not fully elucidated, the following are proposed as some possible ways.

1. Common immunologic pathways

Both psoriatic arthritis and obesity are characterized by chronic inflammation, which involves similar immunologic pathways. The key cytokines involved in the development of psoriatic arthritis are tumor necrosis factor α (TNFα) and interleukins (IL).

White adipose tissue, also termed white fat, is a type of adipose tissue found in human body which plays a key role in maintaining the energy homeostasis of the body. White fats produce the same cytokines (TNFα and IL) as those involved in the pathogenesis of psoriatic arthritis.

In addition to TNFα and IL, white fats also produce pro-inflammatory adipokines such as leptin, resistin, and anti-inflammatory adipokines such as adiponektin, omentin.

In people who are obese, white fats are infiltrated by macrophages, dendritic cells and lymphocytes.

Additionally, the pro-inflammatory cytokines and adipokines are overproduced in obesity, which propels the inflammatory processes in psoriatic arthritis.

Apart from systemic immune mediated inflammation, localized inflammation in fat cells inside joints and beneath the psoriatic skin lesions can also lead to progression of psoriatic arthritis.

2. Biomechanical stress

Biomechanical stress is another mechanism which links obesity with psoriatic arthritis. The extra weight around the joints can cause biomechanical stress and damage.

Psoriatic arthritis causes enthesitis or inflammation at site of tendons and ligaments where they attach to bones.

These sites of attachment are often subject to mechanical stress. In obese individuals, the weight load causes increased mechanical stress; it is also associated with increased possibility of local microdamage.

3. Behavioural factors

Another interesting mechanism linking psoriatic arthritis and obesity is behavioural factors.  The pain and skin lesions associated with psoriasis can lead to behavioural changes in the patient, which leads to lowered physical activity and over-eating.

This ultimately result leads to obesity, which may further reduce the patient’s mobility and physical activity. In such cases, it is suggested to seek physician advice and follow an efficient weight loss treatment.

Weight Loss Benefits

As per a recent study published in the journal Arthritis research & therapy, short-term weight loss treatment with VLED (very low energy diet), a diet that is low in energy/calories, can have significant positive effects on disease activity in joints, entheses and skin in patients with psoriatic arthritis and obesity.

Psoriatic arthritis patients who lose weight are found to have better treatment outcomes with disease-modifying anti-rheumatic drugs (DMARDs) and biological drugs.
As per a study published in 2016, in the journal Rheumatology (Oxford), obesity is associated with diminished treatment response and adherence to the biological drug, TNF-α inhibitor (TNFI), in psoriatic arthritis.

A combination of pharmacological drugs and weight loss treatment is recommended in patients presenting with psoriatic arthritis and obesity. Weight loss can lead to improvements in disease activity, treatment responses and also decrease the risk of cardiovascular diseases.

https://www.news-medical.net/health/Does-BMI-and-Diet-Affect-the-Severity-of-Psoriatic-Arthritis.aspx