Dealing with children's psoriasis

From gulfnews.com/uae/health

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Like adults, children too get red scaly patches and plaques on elbows, knees and scalp; but unlike grown-ups, children’s face and even eyelids can get affected 

With ground-breaking treatment options being discovered at a rapid pace, life for psoriasis patients has taken a turn for the better over the past decade and a half.

We now know that psoriasis is not just a skin disease. Chemicals and cells involved in the inflammation have been found to be not only responsible for red scaly patches and plaques on the skin but also joint swellings, pain and many other problems.

An inflammatory systemic disease, psoriasis is often associated with diabetes, heart disease, joint swellings, inflammatory bowel disease, depression and even cancer. It affects about 2.5-3 per cent of the world population; that is about 125 million people regardless of age, gender, ethnicity and socio-economic status. About one third of adult patients develop the disease in their childhood.

Like adults, children too get red scaly patches and plaques on elbows, knees and scalp; but unlike grown-ups, children’s face and even eyelids can get affected, says Dr Srikumar Goturu, Specialist Dermatologist and Medical Director at Dr Joseph’s Polyclinic in Karama.

Paediatric psoriasis can be difficult to diagnose. Irritations that look like a diaper rash but doesn’t respond to treatment may be psoriasis. Teardrop-like scaly patches that appear on the body after a throat infection can be psoriasis too.

“The management of paediatric psoriasis is more important as it is well established that children with psoriasis commonly become obese, develop blood pressure, diabetes and high cholesterol, and are also more likely to have ischemic heart disease, arthritis and even inflammatory bowel disease, not to mention the psychosocial impact,” explains Dr Goturu.

About 19 per cent of the affected children get psoriatic arthritis — pain in their joints — compared to 30 per cent of the adults with psoriasis.

“Good treatment is a combined effort of a dermatologist, paediatrician, rheumatologist, nutritionist, psychologist, counsellor, the parents and the child,” he adds.

Various studies have discovered that the cost of caring for psoriasis patients can be more than the cost of treating heart attacks, cancers, or even serious road traffic accidents.

“Recent advances in our understanding of psoriasis and the many new medications that are available have revolutionised the management of the disease,” he says. The US National Psoriasis Foundation has declared complete cure of psoriasis as a goal. Although that seems difficult at the moment, it is possible to control psoriatic disease to almost 100 per cent nowadays, explains Dr Goturu.

Creams, lotions and shampoos are the first line of treatment. If the condition is severe, phototherapy is used.

Amber Clinics provides all the treatments licensed in Dubai. The most modern — the biologic treatment — has been in use for four years. “When pioneering biologic treatments for paediatric psoriasis are used judiciously, they can vastly improve the quality of life of the child as well as the family.

“We have an excellent protocol for the treatment of the disease and have been using all the recent medications with good outcomes as borne out by our patients.”

Effects of paediatric psoriasis

1. Low quality of life; 2. Disruption in family and social relationships; 3. Interferes with play and sport; 4. Affects normal development

How it affects adults

1. Embarrassment and isolation; 2. Low quality of life; 3. Anxiety and depression; 4. Associated problems such as hypertension, obesity, diabetes and metabolic syndrome; 5. Joint swelling and pains; 6. Absenteeism and job loss; 7. Sexual issues and marital problems; 8. Diet and lifestyle; 9. Networking

Lending a helping hand

Launched six months ago at Dr Joseph’s Clinic Karama, the Psoriasis Support Group provides patients a platform to understand the disease better. “Our main aim is to empower psoriasis patients through education and support,” says Dr Srikumar Goturu. “The interactive group offers an effective platform for patients to enhance their quality of life.” The unsightly appearance of the plaques, irritation and pain as well as the long-standing nature of the disease usually isolate patients. Discussions with their doctor about shared problems and concerns enhance understanding of the disease, which relieves emotional burden and anxiety. The patients recognise that they are not alone. To enrol in the Psoriasis Support Group, call 04 337 8828 or email docsrikumar@gmail.com

PATIENTS REVEAL THEIR PSORIASIS JOURNEY

“Diagnosed with psoriasis 12 years ago, I’d learned to accept the plaques on my body and adopted a dress code that concealed them. Over the years I’ve tried to understand the triggers and changed my lifestyle for better. I’ve been managing the condition on my own. However, things changed drastically two years ago, when a pain in the knuckle started to increase gradually, making it almost impossible to carry out simple daily tasks. I was then diagnosed with psoriatic arthritis. Although I learnt a lot about my condition and how to deal with it on the net, denying medication due to the high cost associated with the biologics vaccination worsened my condition. A year later when I couldn’t manage the pain anymore, my doctor, Srikumar Goturu, suggested trying a cheaper alternative oral drug. It turned out to be a lifesaver. Today I’m a happier person and try to give back by working closely with the doctor on the Psoriasis Support Group, helping people with similar issues.”

Deepa C.

“I was diagnosed with psoriasis eight years ago. I found it difficult to deal with the disease in the initial days. I met a lot of doctors and was advised different medications. I met Dr Srikumar Goturu about 18 months back. Things have improved drastically since. As the treatment was very expensive, he guided me to different charitable institutions for my medication. Being part of the Psoriasis Support Group has also helped me immensely. Sharing our experiences with each other gives us the feeling that we are not in this alone.”

Rakesh Singh

https://gulfnews.com/uae/health/dealing-with-psoriasis-1.1554023364709

What to know about psoriatic arthritis jaw pain

From medicalnewstoday.com

Psoriatic arthritis can affect any joint in the body, including the jaw. The condition can cause jaw pain, teeth grinding, and other dental issues such as tooth loss.

Psoriatic arthritis (PsA) is an autoimmune condition. It causes joint pain, swelling, and stiffness.
PsA causes inflammation that attacks healthy joints and tissue, leading to painful symptoms.
In this article, we look at how PsA can affect the jaw. This includes jaw-related symptoms, complications, treatments, and how to relieve jaw pain.

PsA and jaw pain

PsA can affect the temporomandibular joint (TMJ), or jaw joint, in the same way as other joints in the body.
Recent research suggests that jaw pain may affect up to 35 percent of people who have PsA.
One study states that psoriasis and PsA play a significant role in TMJ disorders. These TMJ problems can include:

• clicking or making other sounds when using the jaw
• pain when moving the jaw
• misalignment of the jaw
• teeth grinding, or bruxism

People who have jaw pain from PsA may experience symptoms that make it difficult to chew, eat, drink, speak, and sleep.
Many current treatments can help control inflammation and the immune system's involvement, allowing many people with PsA to lead active lives and stay healthy.

Can PsA cause dental problems?

PsA mainly affects the joints, but it appears to have a link to gum disease and dental problems, too.
One 2013 study found that people with PsA had more severe gum problems than those who did not have the condition. Gum disease can lead to chronic bad breath, changes in bite, and, in severe cases, tooth loss.
A more recent study suggests that the inflammation in PsA could lead to gum inflammation. However, researchers need to explore this further to fully understand the link.
People with PsA have a higher rate of TMJ problems, which can lead to tooth damage from grinding and clenching. A dentist may prescribe a bite splint that a person can wear over the teeth to protect them from damage.

Home remedies for PsA and jaw pain

There are some home remedies that can help relieve jaw pain, clicking, grinding, and any other symptoms that affect the jaw.
Medical treatments can tackle the underlying causes of PsA symptoms to prevent joint damage and stop the condition from progressing.
People should not rely on home remedies alone to treat PsA, however. This is because even if symptoms are mild, the condition can still cause permanent damage to the joints.
To relieve PsA-related jaw pain at home:

Apply ice or heat

Many people find that applying a moist heat pack is effective for relieving jaw pain and stiffness. Ice packs can also soothe pain and reduce swelling and inflammation. However, avoid leaving an ice pack on for more than 10 minutes at a time.

Adopt a jaw-friendly diet

People with PsA that affects the jaw may wish to temporarily switch to a jaw-friendly diet when their symptoms flare up.
A jaw-friendly diet includes foods that are soft or liquefied to give the jaw a chance to rest and heal.
Tips for adopting a jaw-friendly diet include:

• avoiding chewy and crunchy foods, such as crusty breads, chips, and chewy meats
• opting for cooked instead of raw vegetables and fruits
• making smoothies with fresh vegetables and fruits
• eating soups

Rest the jaw

A jaw that is inflamed from PsA may be less painful when a person gives it time to rest. Some ways to rest the jaw include:

• avoiding chewing gum
• being mindful of chewing habits, such as biting the nails or chewing on pens, that can stress the jaw
• taking time away from activities that require extensive talking, such as lectures and meetings
• avoiding cradling a phone between the face and shoulder, as this can stress the neck and jaw muscles

Reduce stress

High stress levels can cause a person to grind their teeth and clench their jaw more often. Using relaxation techniques such as meditation, yoga, and deep breathing can help reduce tension in the jaw.
Reducing stress can also help with other PsA symptoms, as stress can cause psoriasis and PsA flares.

Seek physical therapy

Practicing specific exercises, with the guidance of a physical therapist, can help relieve PsA symptoms in the jaw and other joints.
Research has found that physical therapy can help with TMJ symptoms and jaw joint pain.
Physical therapy for the jaw may involve jaw movements, stretches, and correcting the positions of the body and head.

Exercise

Physical activity can help reduce stress and improve sleep. The National Psoriasis Foundation recommend exercise as a way to relieve PsA symptoms. Regular exercise keeps the joints and tendons loose and reduces inflammation.

Treatments

Inflammation and an overactive immune response cause most PsA symptoms, including those in the jaw.
Because of this, doctors will usually treat PsA-related jaw pain by reducing one or both of these.
Below are some treatment options for PsA, including jaw-related symptoms:

• Take nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, aspirin, and naproxen, for temporary pain and inflammation relief. Ask a doctor before taking NSAIDs for prolonged periods of time.
• Ask a doctor about corticosteroid injections, which can quickly reduce swelling and pain. A clinician will usually administer these in-office.
• Take prescription inflammation medicine. Some newer oral medicines, such as tofacitinib and apremilast, can help control inflammation that causes PsA.
• Take disease-modifying anti-rheumatic drugs, which prevent inflammation-causing chemicals that result in the clinical findings seen in PsA.
• Ask a doctor about biologics. Scientists make these agents from living cells in a laboratory. A person takes biologics by injection or infusion. These drugs target certain cells or proteins in the immune system that cause PsA.

Diagnosis

There is no single test for PsA or TMJ problems. However, a clinician will use a combination of medical tests, a person's medical history, and a physical exam to determine whether a person has PsA and which joints may be affected.
Diagnostic tests for PsA and jaw involvement may include:

• blood tests, which can help rule out other types of arthritis, such as rheumatoid arthritis
• X-rays of the jaw and other joints, though these do not usually detect early-stage PsA
• MRI scans
• a skin exam to look for rash or silvery scales, which are signs of psoriasis
• a physical exam of the jaw
• medical history and family history, because PsA can be genetic

Other symptoms of PsA

PsA is related to psoriasis, a skin condition that causes a scaly rash. About 30 percent of people who have psoriasis also develop PsA. As a result, many clinicians will check for PsA when a person experiences psoriasis and joint pain together.

However, doctors cannot always diagnose PsA based on skin symptoms alone. Some people develop PsA without having psoriasis. In 85 percent of people with PsA, the skin symptoms come before the joint symptoms.
PsA is different from other forms of arthritis. Many types of arthritis can cause joint pain and stiffness, but PsA has its own unique symptoms.
Studies show that two particular symptoms can be tell-tale signs of PsA: enthesitis and dactylitis.

Enthesitis

Enthesitis is inflammation in areas where tendons or ligaments attach to bones. This can cause new bone to form, similar to a bone spur.
It can also cause pain, stiffness, and swelling. Enthesitis often affects the heels, bottoms of the feet, fingertips, elbows, knees, hips, and the spine.
The pain from enthesitis may be focused on an area next to the joint rather than the joint itself.

Dactylitis

Dactylitis causes swelling, inflammation, and pain in an entire digit (finger or toe). This symptom can cause severe pain and may make it difficult or impossible to move the affected digits.
Dactylitis normally affects one or a few digits, but not in a symmetrical pattern. This means that it can affect one side of the body and not the other.

Other signs

Other signs of PsA include:

• spondylitis, wherein PsA affects the joints in the spine, pelvis, or neck
• fatigue
• joint stiffness, especially in the morning
• pain, throbbing, and stiffness in one or more joints
• nail changes, such as crumbling, pitting, or a nail fungal infection
• uveitis, which is inflammation within the eye that causes redness and pain, affects about 7 percent of people with PsA

Outlook

PsA symptoms, including those that affect the jaw, can be painful and disruptive to a person's daily life. However, following an effective treatment plan for PsA can help a person get relief and, in many cases, achieve remission.
The Arthritis Foundation say that up to 60 percent of people with PsA can achieve remission with proper treatment. Remission means that there is very little disease activity in the body. However, it does not mean that a condition is cured, or that a person can stop taking their medications.
People with PsA must take their medications indefinitely, as their doctor prescribes, to keep their condition under control and achieve the best possible quality of life.

https://www.medicalnewstoday.com/articles/324751.php

How to Reduce Your Risk of a Stroke With Psoriasis

From healthcentral.com

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Skin and stroke: not typically relatives. But increasing evidence shows a connection between psoriasis – a chronic skin condition that causes dry and itchy patches of skin – and a higher risk of stroke and other cardiovascular disorders, according to an article published in Cureus. The researchers suggest that the chronic inflammation associated with psoriasis is also central to strokes and other cardiovascular diseases. However, even with an increased stroke risk there are still things you can do to stay as healthy as possible.

Why stroke and psoriasis might be related

After an extensive review of the evidence, the authors of this latest study believe that those of us with psoriasis are more likely to have increased cardiovascular risk factors such as hypertension, diabetes, and obesity compared to the general population. The risks are even higher if we have severe psoriasis and psoriatic arthritis. In two different studies of psoriatic arthritis that were included in the review, death was more likely than in the control groups, and cardiovascular disease was the leading cause of death.The authors of the review believe there may be a variety of reasons psoriasis and stroke are related. One reason is that severe psoriasis is associated with an increased prevalence of metabolic syndrome, a chronic inflammatory state. The inflammation that is present with psoriasis is also linked to elevated levels of C-reactive protein, which is an independent risk factor of cardiovascular disease. Psoriasis is also associated with other health risks such as obesity and an increase in cholesterol levels that could lower the quality of life.

How to lower your risk

The good news is that stroke is largely preventable by lowering your risks. This can be done by what is referred to as Life’s Simple 7. These anti-stroke behaviours include not smoking, being physically active, maintaining a healthy body weight, eating a healthy diet, controlling blood pressure, cholesterol, and blood sugar.
If you are living with psoriasis, you should also go a step further by making sure that your psoriatic disease is being treated as well as possible. The inflammation that you see on your skin begins below the skin, so you want to make sure that you are treating the inflammation throughout your body. These latest findings led the study investigators to suggest that psoriasis should be treated systemically with methotrexate or biological drugs to reduce stroke risk.

You may also want to talk to your doctor about measuring and determining your overall stroke risk. Your doctor can determine if you are at low, moderate, or high risk of stroke. If you are at a high risk of stroke due to a variety of risk factors, you may want to discuss therapeutic interventions directly related to stroke prevention with your doctor.

https://www.healthcentral.com/article/how-to-reduce-your-risk-of-a-stroke-with-psoriasis