What doctors want patients to know about osteoarthritis

From ama-assn.org

Joint pain and stiffness may signal osteoarthritis. Learn more about the symptoms of osteoarthritis, risk factors and treatments that can help 

AT A GLANCE: Osteoarthritis is the most common form of arthritis, causing joint pain, stiffness and reduced mobility as cartilage gradually tears down over time. Here are four key things you will learn about osteoarthritis from Alexey Fomin, MD, PhD, a rheumatologist with Hattiesburg Clinic:

Osteoarthritis is the most common form of arthritis and is caused by the gradual breakdown of cartilage that cushions the joints. 

With osteoarthritis, knees, hips, hands and spine are most often affected and can lead to pain, stiffness, swelling and reduced range of motion. 

Age, prior joint injuries, repetitive stress, excess weight and genetics can all increase the risk of developing osteoarthritis. 

Treatment of osteoarthritis focuses on managing symptoms and preserving mobility, often through exercise, weight management, physical therapy and pain relief options.

Before joint pain and stiffness begin to interfere with daily activities, osteoarthritis often develops gradually over time. As the most common form of arthritis, osteoarthritis affects millions of people and occurs when the protective cartilage that cushions joints wears down, making movement more difficult and sometimes painful. While there is no cure, early diagnosis, lifestyle changes and treatment can help people manage symptoms, stay active and maintain their quality of life. 

Osteoarthritis is a common disease

“What I usually explain to my patients is that osteoarthritis is pretty common,” Dr. Fomin said, noting that “one in seven adults in the United States actually has osteoarthritis. It is a common disease and it’s one of the leading causes of disability.”

With osteoarthritis, “we are talking about the regular wear and tear changes in the joints. These changes most often affect weight-bearing joints such as the lower back, hips, knees and feet. The joints in the hands are also frequently affected because we rely on them for daily activities,” Dr. Fomin said.

“We predominantly see women rather than men with osteoarthritis, and it is one of the most common diseases after 45 years old,” he said.

Symptoms of osteoarthritis start with pain

With osteoarthritis, a main symptom is “pain at the beginning of the day. That’s what we call starting pain,” Dr. Fomin said. “When you wake up, you may notice pain and stiffness in the joint. As you begin moving and using the joint, it tends to loosen up and feel better.”

“In the morning and at the start of activity, there is pain,” he said. “But as the day goes on and you continue using the joint, the pain often returns. The more stress you put on the joint, the more discomfort you may experience.”

“Morning stiffness associated with osteoarthritis typically does not last long,” Dr. Fomin said. “It’s usually about 15 to 30 minutes, but it can still be quite painful.”

“Other symptoms may include a reduced range of motion, as well as grinding, clicking or popping sensations in the joint. Some people find that a hot shower or warm water helps loosen up stiff joints and improves movement,” he added.

Genetics can play a role in osteoarthritis

Osteoarthritis “is not just mechanical damage and degeneration. Sometimes osteoarthritis appears as early as age 40, while some women in their 70s or 80s have no issues and their joints still look great,” Dr. Fomin said. “So, it’s not simply a matter of age or getting older. Rather, it results from a combination of different factors.”

For example, “osteoarthritis is influenced in part by genetics,” he said. “If you have strong cartilage and a favourable genetic makeup, your joints are more likely to stay healthy. But if there is a family history of early osteoarthritis, your risk of developing the condition is higher.”

Your risk for osteoarthritis also depends on use of joints

“Osteoarthritis also depends on how much you use your joints. If your job is not physically demanding and you spend most of your time working in an office, you may be less likely to develop significant arthritis,” Dr. Fomin said. “But in physically demanding jobs, such as construction or factory work, we sometimes see younger people who use their hands extensively and experience joint degeneration.”

“So, osteoarthritis is influenced by how much you use your joints, as well as genetics and other factors,” he said. “Some people who eat a healthy diet and stay physically active have relatively few joint problems, while others who pay less attention to diet and exercise may experience more issues. 

“This is especially true for weight-bearing joints—the more weight those joints have to support, the greater the stress and wear on them,” Dr. Fomin added. 

Erosive osteoarthritis is bad joint destruction

“There is one type of osteoarthritis that behaves differently,” Dr. Fomin said. “It is called erosive osteoarthritis, and it primarily affects the hands, causing significant joint damage.”

“On X-rays, we often see severe cartilage loss and extensive bone erosion,” he explained. “It can resemble autoimmune arthritis, but it is actually a degenerative condition.” 

“Unlike standard wear-and-tear osteoarthritis, it features an inflammatory component that actively breaks down cartilage and leads to central bone erosion. It mainly affects the finger joints,” Dr. Fomin said.

Osteoarthritis requires a clinical diagnosis

“Osteoarthritis is often a clinical diagnosis, which means blood tests and X-rays are not always necessary,” Dr. Fomin said. “In many cases, the diagnosis can be made by listening to the patient’s symptoms and performing a physical examination. Bloodwork may then be used to help rule out other types of arthritis.”

“An X-ray mainly helps us assess the extent of joint damage,” he said. “Patients often report having joint pain for a long time that may have started intermittently, like at the beginning of the day, but gradually became more constant.”

“During the physical exam, the joint may appear enlarged because of bone spur growth, which can cause some deformity,” Dr. Fomin said. “You may also notice a decreased range of motion. By combining the patient’s history with the physical findings, you can often make the diagnosis.”

Treatment of osteoarthritis is mainly supportive

“Unfortunately, we do not currently have highly effective medications to treat osteoarthritis, so treatment is primarily supportive,” Dr. Fomin said. “By supportive, I mean that there is no medication available that can slow the progression of the disease or reverse the damage that has already occurred. Our focus is on managing symptoms.”

“For patients with osteoarthritis affecting weight-bearing joints, lifestyle changes are often an important part of treatment,” he said. “We encourage patients to lose weight through physical activity and healthy eating because the more weight a joint has to support, the more damage is likely to occur.”

As a first-line treatment, “we typically start with a pain medication such as acetaminophen,” Dr. Fomin said. “It is available over the counter and patients may use up to 4,000 milligrams per day.”

“If that doesn’t work, we can use nonsteroidal anti-inflammatory medications,” he said. “These medications can help reduce joint pain and stiffness. Unfortunately, they can also cause side effects, including stomach irritation, kidney problems and increased blood pressure.”

Dr. Fomin also noted that many supplements marketed for joint health such as glucosamine, chondroitin, turmeric and omega-3 fatty acids, remain popular among patients. 

“Some patients tell us these supplements help and make their joints feel much better,” he said. “But scientifically speaking, multiple studies have not shown strong evidence that they provide significant benefit.”

“Steroid injections into the joint can sometimes help relieve pain as well,” Dr. Fomin said. “We also strongly recommend physical therapy to strengthen the muscles surrounding the joint. Surgery is generally considered a last resort for treating osteoarthritis.”

You can live a normal life with osteoarthritis

“If you compare osteoarthritis with inflammatory arthritis, such as rheumatoid arthritis, which can cause severe joint deformities and significantly impair joint function, osteoarthritis is generally less severe,” Dr. Fomin said. “Although it can cause joint problems and discomfort, it tends to progress very slowly, making it easier for many people to live with.”

“Osteoarthritis usually does not cause the same degree of functional impairment seen with other forms of arthritis, so the overall prognosis is often better,” he said. “At the same time, because we do not have treatments that can stop or reverse the disease, it can sometimes lead to permanent disability.”

Prevent osteoarthritis with lifestyle changes

Preventing osteoarthritis “is all about your lifestyle,” Dr. Fomin said. That includes “eating a healthy diet and exercising regularly.”

“But if osteoarthritis runs in your family, it can be more difficult to prevent it from developing,” he said. Even so, it is important to “exercise regularly, eat healthy and maintain a healthy body weight.”

With osteoarthritis, listen to your body

“First of all, it’s important to understand what is causing your joint symptoms. If you don’t know what is behind the pain, it can create anxiety,” Dr. Fomin said. “Some patients come into our office worried that they are going to become completely disabled. We have to reassure them that osteoarthritis is a slow-moving process and, for most people, it is not going to have that level of impact.”

“The second thing is that it all comes down to lifestyle,” he said. “Try to stay active, but at the same time avoid overusing your joints. For example, if you have knee pain or hand pain, it may not be a good idea to move heavy furniture or take on physically demanding projects such as home renovations.”

“Sometimes patients tell us their joints are feeling better, so they start running or doing other high-impact activities,” Dr. Fomin said. “But that may not help in the long run. You have to listen to your body. If your pain is increasing, it is probably a sign that you need to rest the joint.”

Visit your doctor if osteoarthritis is interfering with your daily routine

“If osteoarthritis has started to interfere with your daily routine and you’re no longer able to do the things you normally do, it’s a good idea to see your doctor,” Dr. Fomin said. “If it affects your work or your ability to carry out activities at home, you should definitely talk to your doctor about it.”

“Joint swelling is not typically associated with osteoarthritis and may be a sign of inflammatory arthritis, so it should be evaluated by a doctor,” he said. “You should also seek medical attention if you begin experiencing joint pain at night.”

https://www.ama-assn.org/public-health/chronic-diseases/what-doctors-want-patients-know-about-osteoarthritis

Psoriatic Arthritis: Hand Strength, Dexterity, and Fine Motor Control

From everydayhealth.com

If you have psoriatic arthritis (PsA), you may be familiar with sore fingers, stiff wrists, and the frustration of struggling with formerly simple tasks like buttoning a shirt or chopping vegetables. Psoriatic arthritis is an inflammatory form of arthritis that causes painful, swollen joints. It frequently affects the hands.

When PsA impacts your hands, this can reduce strength, dexterity, and fine motor skills, all of which can interfere with your daily life.

“In severe cases, it may be almost impossible to open and close the hand or make a fist,” says Norman Gaylis, MD, a rheumatologist and board member of the American College of Rheumatology in Miami. “This drastically reduces the quality of life when people are unable to complete household chores, pursue hobbies they enjoy, or take care of their daily hygiene needs because they are unable to use their hands.”

How PsA Takes a Toll on Hand Function

In the most basic terms, psoriatic arthritis affects hand function through chronic inflammation. This can degrade cartilage and bone over time.

These are the ways that PsA can change your hands:

• Reduced Strength and Muscle Atrophy When your hands are painful, swollen, or stiff, you might use them less. This can lead to a loss of strength and muscle mass.
• Stiffness Inflammation from psoriatic arthritis can make your hands feel stiff. This is due to synovitis (inflammation of the joint capsule) and enthesitis (inflammation where your tendons and ligaments attach to your bones).
• Difficulty Gripping Grip strength decreases as the severity of psoriatic arthritis increases. This affects the ability to both grasp an object with your whole hand, like when you pick up a water bottle, and pick up small items with your thumb and index finger.
• Swelling Psoriatic arthritis can cause severe swelling in the fingers, called dactylitis. You might also hear this called “sausage fingers.”
• Nail Changes Up to 80 percent of people with PsA experience changes in their fingernails. “With some patients, nails start to look broken, become brittle, and even separate from the nail bed,” says Dr. Gaylis. Not only can this feel embarrassing but it can be painful and make it difficult to use the tips of your fingers (like you do when typing on a computer or phone).
• Deformities Actual deformities in the hands are rare these days, thanks to better treatment. However, they can still develop if psoriatic arthritis isn’t treated. “In the most severe cases, arthritis mutilans develops and dissolves tissue and bones in the fingers,” says Gaylis. This occurs in about 5 percent of psoriatic arthritis cases.
• Loss of Fine Motor Skills Hand swelling, pain, and stiffness can all make it challenging to perform tasks that require precision, dexterity, and coordination. You might find it increasingly difficult to manipulate small objects like zippers or buttons.

All these symptoms add up to real difficulty completing functional tasks in your everyday life.

Who Can Help Restore Hand Function

There are a few health professionals you can reach out to if psoriatic arthritis is affecting your hands. The primary ones are rheumatologists and certified hand therapists (CHTs).

Rheumatologists are doctors who specialize in autoimmune diseases and inflammatory diseases that affect the joints, bones, and muscles. If you’re diagnosed with PsA, you’ve most likely already seen a rheumatologist.

“Fortunately, rheumatologists can treat psoriatic arthritis with many new biologics and medicines that are very effective,” says Gaylis. These medications help manage inflammation and swelling from psoriatic arthritis, which can noticeably improve hand function.

CHTs are also an essential part of the team for anyone with psoriatic arthritis affecting their hands. These health professionals can either be occupational therapists or physical therapists who’ve gone through extra training to specialize in treating hand conditions like psoriatic arthritis.

A CHT will assess your mobility and function and give you tailored treatment that might include splints, exercises, and assistive devices. You can ask your doctor to refer you to a CHT, or depending on your health insurance, you may be able to make your own appointment.

Strategies to Improve Strength and Control

We use our hands constantly, from turning on the tap at a sink to sliding a credit card out of a wallet. Bringing back strength and control to your hands can improve your quality of life.

Therapeutic Exercises

Therapeutic exercises can reduce pain and improve coordination, strength, and function. Common exercises for PsA include the following:

• Isometric Exercises These are static exercises during which your muscles stay the same length. “Isometric exercises are safer for the arthritic hand to perform because the joints are not moving,” says Kristin Valdes, a certified hand therapist and professor at Touro University Nevada, in Henderson, Nevada. In this type of exercise, you squeeze an immovable object, and your joints are supported by the object you’re holding. Valdes suggests squeezing a firm racquetball or tennis ball to improve grip strength.
• Passive Range of Motion With psoriatic arthritis, the fingers can flex (or “claw” inward) over time as the skin contracts. Anyone experiencing this “should use the other hand or pull their fingertips over the edge of the table to try to straighten out the fingers daily,” says Valdes.
• Tendon Gliding This set of exercises encourages smooth movement of your finger tendons within their sheath.

Be cautious when starting hand exercises with psoriatic arthritis. “If treatment is too aggressive, it can increase hand pain and cause skin breakdown,” says Valdes.

Consider seeing a CHT for a personalized program of exercises, since everyone’s psoriatic arthritis is different.

Assistive Tools

When your wrist is sore, twisting open a jar can be very painful. And when your fingers are stiff, it can feel near impossible to pick up small items. Assistive devices can help you achieve these everyday tasks with less effort and therefore less pain.

Assistive devices for psoriatic arthritis include these examples:

• Wide-grip pens or utensils
• Electronic jar or can openers
• Ergonomic kitchen tools
• Button hooks
• Elastic shoelaces
• Electric toothbrushes
• Gripping materials (to hold a mixing bowl in place, for example, or grip a lid)
• Tap turners or lever handles (to avoid twisting)
• Tongs
• Adaptive cutting boards
• Motion sensor dish soap or shampoo dispensers

Orthoses

For those seeing a hand therapist for treatment, “The therapist can also fabricate a custom orthosis to rest the joints,” says Valdes. This might look like a ring to keep your finger joint straight or a brace that wraps around your thumb.

You can also get premade orthoses like wrist splints online or in pharmacies, but talk to your hand therapist or doctor first to ensure that you’re getting the right one.

Joint Protection and Skin Protection

Joint protection techniques, which are usually taught by a CHT, are ways to perform daily tasks so that less stress is applied to your joints. The following techniques are common:

• Practice the large joint rule. Use larger and stronger joints for tasks instead of smaller ones. Valdes gives the examples of pushing instead of pulling, carrying bags with your forearm instead of hands, and using a shoulder bag rather than a handbag.
• Limit repetitive hand movements. For example, use an electric can opener instead of a hand-operated one. You can still knit or do hobbies involving your hands, but Valdes recommends limiting these to no more than 30 minutes at a time.
• Use a light grip. “Try not to grip so forcefully that the hand fatigues easily,” says Valdes. One way to achieve this is to bulk up the handles of tools or utensils. For example, when cooking, wrap a potholder around a pot handle to make it larger; that reduces the pressure on your hand.
• Don’t forget skin protection. Applying cream to tight skin can help protect both the skin and joints.

Heat and Cold Therapy: Using Paraffin Baths for Stiffness vs. Ice for Acute Inflammation

If your fingers are swollen, try cold therapy with a cold cloth or ice pack. This can help reduce inflammation in the affected joints.

Heat therapy can’t bring down acute inflammation, but it can provide pain relief. If your hands are stiff or painful, consider applying a warm cloth or heating pad.

Warm paraffin, or wax, baths, which a CHT can perform, can also be soothing. A hand therapist might do this to loosen up your joints before exercising them. However, you’ll want to avoid paraffin baths if you have any open cuts or inflamed skin on your hands.

Lifestyle and Daily Habits

Breaking tasks into smaller, more manageable steps can help you conserve energy and manage pain. Be sure to take frequent breaks to rest your hands. “For example, when making a meal, break up cutting or chopping tasks throughout the day,” says Valdes.

You’ll also want to make a daily habit out of your therapeutic exercises, particularly stretching and range of motion exercises. However, avoid strengthening exercises when your hands are painful, says Valdes.

Overall, do your best to maintain an active lifestyle and keep up with the activities that bring you joy and meaning. You can also try new hobbies that don’t tax your hands as much, such as singing, line dancing, learning a language, or hiking.

If you’re struggling with hand pain or stiffness, talk to your rheumatologist or CHT. Your rheumatologist may adjust your medication, and your CHT can strategize personalized solutions, whether that’s a new hand splint or exercise program.

The Takeaway

• A rheumatologist can help you manage psoriatic arthritis hand symptoms with newer biologics and medications that control inflammation.
• Certified hand therapists can tailor exercises to your specific hand symptoms, recommend assistive tools, and educate you on joint protection to preserve and restore hand function.
• Therapeutic hand exercises can help enhance grip strength, dexterity, and control for performing daily tasks.

https://www.everydayhealth.com/rheumatic-conditions/psoriatic-arthritis-hand-strength-and-dexterity/

Beyond The Joints: How Arthritis Affects The Whole Body And How Modern Treatments Are Changing Lives

From news18.com/lifestyle

Arthritis affects far more than joints from heart health to emotional well-being but modern treatments and holistic care are helping patients regain active, fulfilling lives

When most people think of arthritis, they imagine stiff, painful joints, knees that ache or hands that no longer move as freely. Yet, as medical experts emphasize, arthritis extends far beyond the joints. It’s a complex, systemic condition that can affect nearly every aspect of a person’s physical and emotional well-being.

“When patients come to me with arthritis, they usually focus on their painful knees. But what they don’t realize is that arthritis affects their entire body and life," says Dr Deepak Saini, Senior Consultant and Joint Replacement Surgeon, Shalby Hospital, Jaipur. “The constant inflammation can increase their risk of heart problems, we’re seeing more arthritis patients developing cardiovascular issues."

This connection between chronic inflammation and heart health has gained increasing attention. Studies suggest that inflammatory chemicals involved in arthritis may contribute to the build-up of arterial plaque, heightening the risk of cardiovascular disease.

Beyond the physical, arthritis also exerts a heavy emotional and social toll. “Many of my patients experience exhaustion that never goes away, no matter how much they rest," adds Dr Saini. “Depression is another major issue because pain limits what they can do. They start avoiding social gatherings and family functions."

As mobility decreases, another vicious cycle begins: reduced movement leads to weight gain, which further increases pressure on already damaged joints. “It’s a domino effect," he explains. “But the important message is that arthritis is manageable if we treat it holistically. From medications to lifestyle changes, and in advanced cases, modern surgical interventions with state-of-the-art implant technology, we have effective ways to stop this progression and help patients reclaim their active lives."

                                                Arthritis can be managed with medications, physiotherapy, and lifestyle changes. (Image: AI)

Arthritis: More Than Pain, It’s a Life-Altering Condition

“People think arthritis is just about joint pain, but I see how it devastates every aspect of my patients’ lives," agrees Dr. Ashwani Maichand, Director, Orthopaedics, CK Birla Hospital, Punjabi Bagh, Delhi. “A 55-year-old who loved playing with his grandchildren suddenly can’t get on the floor. A working professional starts missing days at work because fatigue is overwhelming. And what’s worse is isolation. They stop going out, stop exercising, and their overall health declines."

Dr. Maichand emphasizes that the consequences of arthritis go well beyond mobility issues. “When movement becomes painful, people begin withdrawing not only from physical activity but also from social life," he says. “That isolation and inactivity worsen mental health and can accelerate other chronic conditions like diabetes, hypertension, and obesity."

Modern Medicine Offers Hope

Despite these challenges, both experts highlight a powerful message: the story doesn’t have to end in limitation.

“We’re in an era of remarkable medical advancement," says Dr. Maichand. “Whether it’s targeted therapies for early-stage arthritis or robotics-assisted joint replacement procedures, we can intervene effectively. I’ve seen countless patients return to activities they thought were gone forever."

Early diagnosis is critical, he adds, because intervention at the right stage can prevent cascading complications. “Early diagnosis and the right treatment plan make all the difference in preventing these effects," he stresses.

Dr. Saini echoes this sentiment. “We now approach arthritis not just as a joint problem but as a whole-body condition. By integrating lifestyle modifications, nutrition, medication, physiotherapy, and advanced surgical options, we can give patients both mobility and quality of life."

A Holistic Approach to Healing

Both doctors underscore that managing arthritis effectively requires a multidisciplinary approach addressing inflammation, mental health, physical function, and social well-being.

“Arthritis care has evolved from simply treating pain to restoring life," says Dr. Saini. “It’s about helping patients move without fear, sleep without pain, and live without constant fatigue."

As awareness grows and access to modern medical technologies expands, patients no longer have to accept a life of limitation. With early detection, expert care, and a holistic treatment plan, arthritis can be managed, mobility restored, and life reclaimed one step at a time.

https://www.news18.com/lifestyle/health-and-fitness/beyond-the-joints-how-arthritis-impacts-the-whole-body-and-the-promise-of-modern-treatment-9632403.html 

Empowering Patients and Raising Awareness: Interview With Experts for World Arthritis Day 2025

From rheumatologyadvisor.com

The theme for World Arthritis Day 2025 is “power of dreams,” which embodies the goals and hopes that drive individuals with arthritis to forge ahead

With its establishment in 1996, World Arthritis Day was intended to raise global awareness of arthritis as a public health issue. Organizations such as the Arthritis Foundation offer patient resources and information on the impact of arthritis while also celebrating the strength and resilience of affected families and individuals. International rheumatology organizations — including the European Alliance of Associations for Rheumatology (EULAR) — host campaigns to help achieve their goal of advocacy for rheumatic and musculoskeletal diseases. Their theme for World Arthritis Day 2025 is “power of dreams,” which embodies the goals, hopes, and visions of individuals with arthritis. World Arthritis Day is an integral part of furthering scientific research, medical education, and disease awareness.

To gain further insight on the role of providers in enhancing care, as well as promoting awareness and understanding of how patients can prioritize and be empowered to take charge of their bone and joint health, we spoke with experts Melanie Smith, MD, PhD, and Francis Keefe, PhD. Dr Smith is an attending physician in the Division of Rheumatology at the Hospital for Special Surgery (HSS) and an assistant professor of medicine at Weill Cornell Medicine, New York. Dr Keefe is a professor in psychiatry and behavioural sciences, psychology and neuroscience, medicine, and anesthesiology and a member of the Duke Cancer Institute at Duke University in Durham, North Carolina.

                                                                                                                                   Credit: Getty Images

How can clinical practices, by addressing barriers in rheumatology, play a role in guiding patients towards seeking early care for their symptoms, which has been associated with better outcomes, lower health care costs, and higher quality of life?

MS: One of the issues we have in rheumatology is overall awareness of rheumatologic conditions and the role of the rheumatologist, such as educating the general population, partnering with primary care providers (PCPs), and offering referrals to other specialties. Because autoimmunity may have a genetic component, families should be educated about symptoms that need evaluation in the future. In addition to these factors, misinformation leads to a delayed diagnosis. It is important for providers to dispel myths to encourage patients to seek early care and enhance their quality of life.

Providers should discuss important patient values and preferences and build achievable goals around them. This value-based approach can potentially encourage patients to engage in meaningful activities, which can improve the impact of the care they receive.

FK: Rheumatology is a tertiary care discipline. A significant time may have passed by the time a patient with arthritis visits a rheumatologist. Patients often work with their PCP and see a rheumatologist only for a consultation, once or twice a year. Rheumatology evaluations and assessments need to be focused on the disease process while simultaneously understanding how symptoms are affecting patients’ lives. Although pharmacotherapy has been the mainstay of arthritis treatment, the risk for medication side effects must be considered. Even with optimal medical management, patients still face challenges. In addition, management of pain — by both providers and patients — is important for achieving optimal quality of life.

What should clinicians consider in terms of screening practices to ensure timely diagnosis and appropriate management?

MS: We discuss with PCPs about their role in referring patients in a timely manner or encouraging patients to seek care and get a second opinion from a rheumatologist. For inflammatory arthritis (IA), it is important to refer a patient with joint swelling that lasts for more than 2 days and morning stiffness for at least 60 minutes. It has been observed that PCPs often emphasize laboratory values, but many of our patients have normal values for erythrocyte sedimentation rate and C-reactive protein, negative rheumatoid factor, and negative cyclic citrullinated peptide, and still have IA. This results in a delayed diagnosis. Clinical diagnoses for rheumatic conditions, such as rheumatoid arthritis and ankylosing spondylitis, are dependent on joint examinations and other factors, not only on blood tests.

FK: If we think about a patient population that often doesn’t get referred to a rheumatologist until later in their disease trajectory, it is those with social determinants of health (eg, low income or living in a rural areas) that increase the risk for delayed treatment. Because of costs, some individuals with osteoarthritis may wait until the pain is intolerable and only then seek referral to specialists.

Persistent pain and other arthritis symptoms also tend to affect psychologic well-being. Screening questionnaires can help [clinicians] identify problems and understand the impact of symptoms on quality of life. Many PCPs already use pain and depression screening tools not only to get a sense of disease severity, but also to understand the impact of a disease on quality of life. Rheumatologists also need to incorporate these tools in their practice to understand the disproportionate impact of pain on daily life to improve and encourage self-management.

While pharmacotherapy is the mainstay of arthritis treatment, the addition of lifestyle interventions is shown to be effective for patients with rheumatic disease. Are patients routinely counselled on incorporating lifestyle changes? Is there evidence for their effectiveness?

MS: Most patients with IA report benefit from being active; so, exercise is commonly recommended at my practice. To improve adherence to exercise regimens, providers and patients together can discuss the form of activity that patients enjoy and increase the frequency. If patients do not engage in regular physical activity but have their joint inflammation under control with medications, we refer them to physical therapists to start a weight training or cardiovascular fitness program to avoid risk for injury. Another consideration is the important role of a healthy diet and supplementation with calcium and vitamin D for optimal bone and joint health.

What steps can health care providers take to empower patients to be proactive in their joint health?

FK: Living with arthritis means accepting that pain and other symptoms will persist but realizing you can still have a meaningful life. Providers should discuss important patient values and preferences and build achievable goals around them. This value-based approach can potentially encourage patients to engage in meaningful activities, which can improve the impact of the care they receive.

MS: The most important way to empower patients in this regard is enabling them to stay active by recommending regular exercise and healthy sleep habits. Patients with IA should be counselled on a case-by-case basis regarding improving their joint health. Another important aspect is getting patients the help they need; for example, referrals to physical therapists for an exercise program or to address disease-related postural issues. I believe that helping patients with their psychologic health could make them empowered to take control of their arthritis symptoms as well.

Can you highlight the role of collaboration with different specialties (eg, psychiatry/psychology) and other stakeholders (eg, patient advocacy organizations) in enhancing care and achieving optimal patient outcomes?

FK: Arthritis self-management can be thought of as occurring along a spectrum. At one end is a self-directed approach in which, through experience, patients learn a variety of strategies they can use to manage their arthritis symptoms. At the other end of the continuum is formal self-management training programs, often led by professionals (eg, nurses and psychologists) that systematically teach patients coping strategies for managing arthritis symptoms, such as relaxation, goal setting, mindfulness-based meditation, and problem solving. Training in self-management is widely available through community groups, self-management classes, arthritis programs designed for patients and peers, books, handouts, and other community-based resources.

Apart from this, many rheumatologists provide education about self-management when they give interactive talks in the community about arthritis, such as at nursing homes and communities of older adults. Further, referral for formal training in self-management becomes critical when patients have severe depression or pain, which significantly affects their quality of life. Embedding psychologists into primary care settings where providers are being trained to identify symptoms and provide timely referrals for formal training in self-management is increasingly being seen as valuable to health care systems. Specialists in self-management have developed collaborations with organizations, like the Arthritis Foundation, and this collaboration has been instrumental in increasing access to accurate and timely self-management materials for patients. Educating patients about the importance of a comprehensive care model that combines specialist care with self-management is beneficial.

MS: Many of the conditions of IA co-occur with other systemic diseases. For example, some patients with IA have comorbid inflammatory bowel disease or psoriasis, with rheumatologists working closely with gastroenterologists or dermatologists. Some patients have other organ involvement and then we work closely with those specialists, like pulmonologists or nephrologists. We also work with mental health professionals, based on patients’ symptoms. Rheumatology is multidisciplinary, and as rheumatologists we must be team players to get the best care for our patients. Advocacy organizations play an important role in education. At HSS, we have social work departments with various support groups for patients with a new diagnosis or established RA. We encourage patients to connect with this network.

With women forming a major part of the rheumatic disease population, how can their care be more informed in terms of creating awareness and offering resources?

FK: Research shows pain severity differences between men and women. Our team has worked with women with arthritis and their pain, and related coping mechanisms. We found that women vs men are more active in their coping strategies, are more likely to prefer involving others in their coping efforts (ie, as “communal copers”), and adopt a greater variety of approaches. It may be important to explore the social context here, such as asking women about family responsibilities, self-care techniques, and social activities — all of which are very important and help to avoid setbacks.

MS: There are specific considerations for patients who are women. One is for patients with childbearing potential or who are interested in being pregnant — a situation which changes the way providers think about contraception, treatment, and disease management. We have discussions with patients about their preferences and care plans. In the disease diagnosis stage, some women with arthritis symptoms during postpartum or [when] entering menopause have misdiagnosis of their condition because of overlapping symptoms. Further, new mothers may not necessarily put their health first and ignore symptoms (it is a common time in a woman’s life to have an autoimmune disease). Another important aspect is that IA is a risk factor for osteoporosis, which especially affects postmenopausal women. Providers should advise patients to receive bone density scans for preventable fractures.

https://www.rheumatologyadvisor.com/features/world-arthritis-day-2025-interview-with-experts/ 

Ask the Expert: A Dermatologist's Approach to Managing Psoriatic Arthritis

From verywellhealth.com

By Brendan Camp MD

Psoriasis and psoriatic arthritis (PsA) are both autoimmune conditions.

Psoriasis occurs when skin cells turn over quickly—taking days to grow and fall off rather than the typical month-long cycle. As a result, skin cells build up, creating plaques that appear dry, inflamed, and flaky.

Psoriatic arthritis occurs when the immune system attacks your cells, leading to symptoms like joint stiffness, pain, and swelling.

Not everyone with psoriasis will develop PsA, and not everyone with PsA will have skin symptoms.

The Skin–Joint Connection: Can Treating One Help the Other?

Many traditional therapies for PsA broadly affect the immune system, impacting many body systems, but biologics, a newer class of drugs, offer more targeted treatment.

Biologics "turn down" the activity of various immune cells and are particularly effective in helping manage PsA and psoriasis symptoms.

As a dermatologist (a doctor specializing in treating skin, hair, and nail conditions), I usually see PsA patients with skin and joint symptoms. For many people, stress, illness, or even an injury can trigger an autoimmune response and result in psoriasis or PsA flare-ups.

Before prescribing a biologic, I typically ask my patients with PsA if they are experiencing symptoms of joint pain to ensure that the treatment covers both skin and joint inflammation.

Often, I coordinate with rheumatologists (doctors who specialize in autoimmune disease and other conditions affecting the musculoskeletal system) to ensure our patients receive comprehensive PsA care.

I usually recommend phototherapy or topical medications for those with psoriasis symptoms. While these treatments can effectively manage skin symptoms, they will not help joint pain.

Skincare Tips for PsA Skin Symptoms

There are many treatment options for people with psoriasis. Your dermatologist can help you find the best option for your needs. A good place to start, though, is to establish a skincare routine that focuses on the following:

• Reducing irritants: Opt for skincare products that contain the National Psoriasis Foundation Seal of Recognition.
• Exfoliating: Exfoliate dead skin with products containing chemical exfoliants like urea or salicylic acid.
• Showering smart: Take short showers with tepid water to avoid removing too much oil from your skin.
• Moisturizing: Apply moisturizer immediately after showering to provide a barrier layer to protect your skin.
  

These habits will help improve your skin's strength and overall health.

Lifestyle Factors That Influence PsA Skin Symptoms

Medications and skincare are critical to managing PsA. However, healthy lifestyle habits can help reduce symptoms and manage the condition long-term.

• Exercise can help keep joints loose, reducing pain and inflammation. To reduce joint strain, opt for low-impact exercises such as swimming, cycling, or yoga.
• Diet and lifestyle choices are essential to managing PsA. Emphasize whole foods. Limit foods, drinks, and substances that increase inflammation, such as processed foods, tobacco, and alcohol.
• Stress can be difficult to manage when you're dealing with the physical and emotional toll of PsA. Many of my patients rely on complementary treatments like acupuncture, massage therapy, and prioritizing sleep to improve their stress levels.
  

Living Well With PsA

The primary symptoms of PsA are physical: joint pain and stiffness. However, PsA can profoundly affect your psychosocial well-being. Early diagnosis and treatment are essential to mitigate the physical, mental, and social effects of PsA on your life.

One of the biggest challenges many people with PsA face is accepting that PsA medications are long-term treatments. Psoriatic arthritis is a chronic condition for which there is currently no cure. Joint damage from PsA can continue to worsen without treatment, necessitating the long-term use of medications.

It is important to remember that, while it sometimes may feel like it, you are not the only person living with PsA. There is a community of people experiencing similar physical, mental, and social challenges. Talking with others, including your healthcare provider, physical therapist, and members of support groups like the National Psoriasis Foundation and the Arthritis Foundation, can be a valuable source of information, education, and empowerment.

https://www.verywellhealth.com/ask-the-dermatologist-psoriatic-arthritis-11792302