Could Anaemia Be Contributing to Your Psoriatic Arthritis Fatigue?

From health.yahoo.com

By Carmen Chai-Oakley

Fatigue can be one of the most disruptive - yet common - symptoms of psoriatic arthritis (PsA). And it isn't just ordinary tiredness: PsA can cause a lingering physical and mental exhaustion that doesn't disappear after a good night's sleep and can make working, exercising, socializing, and even carrying out everyday tasks more difficult.

There are a few factors at play. Interrupted sleep, symptoms like anxiety, depression, and swollen joints, and certain medications may contribute to fatigue.

But another potential factor is anaemia, a condition in which your body doesn't have enough healthy red blood cells. It can cause symptoms such as tiredness, weakness, and shortness of breath.

Here's how to tell if your fatigue may be anaemia-related - along with how anaemia is diagnosed and treated alongside PsA.

Causes of Anaemia in Psoriatic Arthritis

Anaemia occurs when you don't have enough healthy red blood cells to adequately carry oxygen throughout your body. But there isn't one single reason someone with PsA may develop it, according to Alireza Meysami, MD, the head of rheumatology at Henry Ford Health in Detroit, where he specializes in diagnosing and treating inflammatory arthritis, including PsA.

"Persistent inflammation can increase hepcidin, a liver hormone that traps iron in storage and limits its availability for making red blood cells. This is called anaemia of inflammation," Dr. Meysami says.

This process is also known as anaemia of chronic disease because it can affect people with conditions that cause inflammation, including autoimmune diseases like PsA. With chronic inflammation, your body struggles to use stored iron for red blood cell production.

But PsA-related inflammation isn't the only possibility. Anaemia may be triggered by:

• Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain. "NSAIDs may cause gastritis, ulcers, or slow gastrointestinal bleeding," Meysami says. This may lead to iron deficiency anaemia.

• Iron deficiency from menstrual or gastrointestinal blood loss

• Iron deficiency from poor absorption or nutritional deficiencies

• Methotrexate. While methotrexate is commonly prescribed to treat PsA, anaemia is a potential side effect. "Methotrexate interferes with folate metabolism and, rarely, may suppress the bone marrow, which is why we prescribe folic acid and monitor blood counts," Meysami says.

Methotrexate itself can also cause fatigue in some people, even when it hasn't caused anaemia, says Neal Birnbaum, MD, a rheumatologist and past president of the American College of Rheumatology who's been practicing for 48 years in San Francisco.

Ultimately, anaemia can be "multifactorial," Dr. Birnbaum says. It shouldn't automatically be attributed to arthritis, he says. Comorbidities can contribute to anaemia, too, including kidney or thyroid disease.

Signs and Symptoms of Anaemia-Related Fatigue

It's not always straightforward to figure out whether fatigue is coming from PsA or anaemia, because there can be overlap.

"[PsA] patients often describe feeling completely drained, physically heavy, or mentally foggy, even after sleeping. Some have to choose between working, exercising, caring for their family, or participating in social activities because they do not have enough energy for everything," Meysami says.

Anaemia can cause fatigue and weakness, too. But some additional symptoms may make anaemia worth investigating, including:

• Shortness of breath

• Pallor (skin that's paler than usual)

• Dizziness, lightheadedness

• Headaches

• Heart palpitations

• Chest pain

• Cold hands and feet

Still, symptoms alone can't determine whether you're anaemic. Blood tests are needed for a diagnosis.

If your fatigue appears as your haemoglobin level falls and improves after the anaemia is corrected, that's a clue that anaemia was contributing to the exhaustion, Birnbaum says.

But even then, it may just be one factor among several. Sometimes, factors like chronic pain, poor sleep, anxiety and depression, thyroid disease, or fibromyalgia may be causing fatigue, Meysami says. "Steroids may cause insomnia while antihistamines and some pain or anxiety medications may cause daytime sleepiness," he says.

How Anaemia Is Diagnosed

Maria Kray/iStock

If persistent fatigue is interfering with your everyday life, talk to your rheumatologist or primary care doctor about whether testing for anaemia makes sense, Birnbaum says.

Your doctor may conduct a complete blood count test to start, which focuses on red blood cells, including their size and shape, Birnbaum says.

If anaemia is present, additional testing may include further blood testing for reactive proteins, ferritin, iron, transferrin saturation, reticulocyte count, vitamin B12, folate, and kidney and thyroid function, Meysami says.

"Depending on the patient, evaluation for menstrual or gastrointestinal blood loss may also be necessary," Meysami says.

Treating Anaemia When You Have Psoriatic Arthritis

Treatment depends on why you're anaemic.

If anaemia is related to inflammation from PsA, getting the disease under better control may help with both the anaemia and the fatigue. "If you have effective treatment, if the skin and joints are under control, then the anaemia is going to improve," Birnbaum says.

But controlling PsA won't resolve every form of anaemia. Blood loss, iron deficiency, vitamin deficiencies, kidney disease, or medication-related problems need their own treatment, Meysami says.

If testing confirms iron deficiency, treatment may include oral or intravenous iron, while folate or vitamin B12 can be replaced if a deficiency is found.

Your rheumatologist will also review your medical history, prescribed medications, and other factors, such as NSAID use, potential gastrointestinal bleeding, sleep problems, and chronic pain, Meysami says.

"Do not accept severe fatigue as something you simply have to live with because you have PsA. Fatigue is real, can be disabling, and deserves a proper evaluation," Meysami says.

The Takeaway

• Fatigue is a common symptom for people with psoriatic arthritis (PsA) and several potential factors can be at play, including inflammation, chronic pain, disrupted sleep, certain medications, or anaemia.

• Anaemia in PsA can stem from chronic inflammation, which causes the body to struggle to use stored iron for red blood cell production, or from factors like iron loss from bleeding, nutrient deficiencies, or medication side effects.

• Blood tests are needed to confirm whether anaemia is contributing to fatigue, and treatment ultimately depends on the cause, ranging from better management of PsA inflammation to iron and vitamin replacement.

https://health.yahoo.com/conditions/anemia/articles/could-anemia-contributing-psoriatic-arthritis-050000943.html 

Could Your Joint Pain Actually Be Psoriatic Arthritis?

From gq.com

By Caitlin Carlson

Experts share how to identify psoriatic arthritis, and how to stay active if you’re dealing with the condition 

It's easy to chalk up stiff fingers, sore knees, or an achy heel to aging (the joys!) or tough workouts. But for some active men with psoriasis, those symptoms may point to something else: psoriatic arthritis, a form of joint pain and stiffness that affects those with the skin condition psoriasis.

You might have psoriasis for a couple of years without joint involvement, but that doesn't mean you’re out of the woods, says Khattri Saakshi, MD, a board certified dermatologist, at Mount Sinai and one of only a handful of triple-board certified physicians across the United States. In fact, the typical delay between a psoriasis and psoriatic arthritis diagnosis is seven to 12 years, according to research published in the Journal of Clinical Medicine. If you don’t have diagnosed psoriasis or any of the accompanying skin symptoms, 10 to 15% of psoriatic arthritis patients develop joint symptoms before any skin issues from a psoriasis perspective show up, Dr. Saakshi says.

There is good news in all of this: Experts say there are now safe and effective medications to manage the condition, and people with psoriatic arthritis can—and should—keep exercising, which may even help alleviate symptoms.

While it’s always wise to see a doctor about your particular symptoms, here are some things to keep in mind if you’re wondering if your joint pain may actually be psoriatic arthritis—and how to keep moving if you do get a diagnosis.

Collage: Eva Baron; Getty Images

What is psoriatic arthritis?

Psoriatic arthritis is an inflammatory condition of the joints that can also impact where tendons and ligaments attach to bones.

Because early detection is key, Dr. Saakshi recommends discussing joint symptoms or morning stiffness with your dermatologist, who can refer you to a rheumatologist, (a doctor that specializes in conditions of the immune system), at every follow-up appointment. “Early diagnosis and treatment is super, super, super important because data says that even a six-month delay in diagnosis has irreversible changes,” Dr. Saakshi says. “We don't have any medications that reverse damage that has happened, it only prevents the progression of damage.”

It’s also important to point out that while many autoimmune conditions are more common in women, psoriatic arthritis is one of the exceptions, says Mayo Clinic Rheumatologist Nolan K. McBride, MD. “Men and women are equally likely to be affected overall,” he says, although women may have more severe symptoms compared to men.

How do I know if I have psoriatic arthritis?

When Dr. Saakshi sees patients, one of the first questions she asks is whether they have stiffness or joint pain that wakes them up at night, or first thing in the morning. Melanie H. Smith, MD, PhD, rheumatologist at Hospital for Special Surgery, agrees this is a “classic” differentiator between sports soreness/injuries and psoriatic arthritis: “With psoriatic arthritis, patients often tell me it feels like I'm moving through molasses,” when they first wake up, she says. “You can definitely feel sore in the morning after a hard workout, but usually you can still move pretty normally after two to 10 minutes as opposed to an hour,” Smith says. “When someone's telling me ‘I'm stiff in the morning’ or ‘I feel worse in the morning than I do in the afternoon,’ to me that is a flag that this is not mechanical issues or a gym injury,” she says. Men in particular have more spine involvement, called axial disease, than women, Smith says, which may cause low back pain that's worse in the morning.

Another “tell” of psoriatic arthritis, Saakshi says, is resting pain or stiffness that comes on after sitting much of the day as well as decreased range of motion.

Smith adds joint swelling to the list, which can be one of the first symptoms of the condition and doesn’t tend to accompany typical post-workout soreness. “In the hands, if there are defined joints, let's say one knuckle is painful, swollen, but the other ones aren't, that can also be a sign that something's up.” The technical term for this is dactylitis, but it’s sometimes referred to as “sausage digits,” Saakshi says. McBride agrees, adding “I always ask patients for changes they can see. Obvious swelling and discoloration of a joint or tendon warrants investigation.” With psoriatic arthritis, “some people also describe feeling flu-ish,” or achy all over, Smith says.

Perhaps the biggest difference between diagnosable psoriatic arthritis and soreness, McBride says, is how long the symptoms last. “Even some of the worst cases of post-workout soreness should start to improve after 48 hours,” he says. Joint pain, excessive stiffness, significant tenderness, or worsening of pain with touching or pushing on the area, especially lasting for days to weeks, should be discussed with your doctor, he adds.

For those with skin psoriasis and no joint concerns now, it’s important to recognize features that may suggest an increased risk for arthritis, McBride says, which may include scalp psoriasis, psoriasis affecting a large portion of the body, and changes to the nails called pits.

Smith points out that family history is a big part of this, too, so find out if anyone in your family has the condition. In patients that have psoriasis, another risk factor for developing psoriatic arthritis is obesity, Smith says. “I spend a lot of time talking to my patients about trying to get to a healthy weight or maintain a healthy weight, eat healthy, control your cholesterol, get exercise daily. All of those things are really important.”

How to exercise when dealing with a flare up

Saakshi says that the question of when and how to exercise comes up with many of her patients. “In the midst of a flare of your joints, it might be a little harder to exercise just because of the component of pain,” she says, but gentle low-impact movement could actually help. And while she can’t point to any hard data on whether exercise can prevent flares, “muscle strengthening around the joints is super beneficial,” she says. Smith agrees: “If you have a gym injury, oftentimes part of the answer is to rest,” Smith says. “With psoriatic arthritis, rest isn't necessarily going to make it better.”

Still, Saakshi cautions against pushing past pain and the range of motion your joints allow at any point in time. “The saying ‘no pain, no gain’ does not apply when you have an inflammatory condition like psoriatic arthritis,” she says.

She encourages patients to try lower-impact activities like swimming, cycling, walking, yoga, or Pilates, if higher-impact activities like running exacerbate symptoms. “It really comes down to how significant the flare is.” McBride adds that enthesitis, inflammation where the tendon attaches to bone, can up your risk for injury, so if this is the case, avoid explosive movements (think: box jumps) and use lighter weights for moves that impact affected areas. “Isometric exercises have been shown to be helpful for those with joint inflammation that is otherwise preventing full range of motion,” McBride says. “Stretching should be an integral part of every day, especially for those with inflammation in the back, to maintain mobility and function.” Smith says that working with a trainer or a physical therapist can also be helpful in these cases.

Once you get a diagnosis and start treatment, you may have more exercise options. “The goal is to have patients have no joint swelling or pain and to be able to do the activities they want to do,” Smith says.“ If that includes running marathons, that is definitely reasonable.”

When to see a rheumatologist

Unchecked or chronic joint inflammation can lead to permanent damage to the bones, Smith says. “Something we worry about, especially in patients who have long-standing, not completely treated disease, is cardiovascular risk, like risk of heart attack,” Dr. Smith says.

The experts agree that there should be a low bar as for when to see a rheumatologist about any of the aforementioned symptoms. At the end of the day, intervening sooner rather than later is the best choice for your health, McBride underscores. “I want to keep my patients healthy and moving for as long as possible, so they can enjoy doing the activities they love. We are lucky to have so many options now to help people meet that goal.”

https://www.gq.com/story/psoriatic-arthritis-joint-pain