When to Worry About Joint Pain With Psoriasis

From healthcentral.com

For some people, this condition can progress to joint disease. Here are the signs to look for 

IF YOU HAVE psoriasis (PsO), you’re likely aware that it puts you at risk for another condition as well: psoriatic arthritis (PsA). A skin condition that evolves into a joint condition? Is that fair? Of course not! It can be nerve-wracking, then, every time you’ve got a new ache or pain. Because let’s be honest, who doesn’t have knee or back pain sometimes? We asked the experts to help us differentiate between run-of-the mill body pain and PsA-specific symptoms. The information they provide will help guide you through the ways you can potentially spot early signs of psoriatic arthritis when you have psoriasis—so you can be treated for both.

The Psoriasis-Psoriatic Arthritis Connection

No matter how many times you hear about the relationship between PsO and PsA, it can still be tricky to completely comprehend the connection. After all, one is a disorder of the skin and the other impacts the joints. What marries them together is inflammation brought on by an overactive immune system. And the relationship goes deeper: According to a 2022 analysis published in the Journal of the American Academy of Dermatology, approximately 20% to 30% of individuals with PsO also have a diagnosis of PsA.

Psoriatic Arthritis Symptoms to Look for With Psoriasis

Understanding when you should worry about potential PsA is key with psoriasis, since early treatment makes for the best outcomes. Unfortunately, that can be easier said than done. “It’s hard to separate ‘normal’ wear and tear on the joints from progressive, destructive psoriatic arthritis,” says George Han, M.D., a dermatologist at Lenox Hill Hospital in New York City. “It’s sometimes even hard to tell on an X-ray early on.” Instead, says Dr. Han, your doctor should advise you on specific clues in how your pain presents itself that help point to a psoriatic arthritis diagnosis.

Location of Joint Pain

Clue #1? Dr. Han believes it is important to consider where the joint pain is. Questions to ask yourself that may provide insight into whether PsA is involved: “Is the pain in a single or a few fingers only?” “Do you have joints that swell for no apparent reason?” “Is there tenderness along the Achilles tendon?”

Certain screening questions about the location of your pain can help identify the likelihood of PsA, agrees Zhanna Mikulik, M.D., a rheumatologist at The Ohio State University Wexner Medical Center in Columbus, OH. One area in particular to consider? The presence of low back pain, Dr. Mikulik says. While PsA can impact any joint, up to 50% of people with PsA will experience inflammatory back pain and stiffness. Psoriasis patients with psoriatic arthritis who experience inflammatory back pain are usually worse in the morning and better with activity, according to Dr. Mikulik.

Joint Stiffness

If you have psoriasis, be on the lookout for joint stiffness, especially when you wake up, which could indicate early PsA, Dr. Mikulik says. “Morning stiffness in joints, for greater than 30-45 minutes and which requires movement to improve,” could point to psoriatic arthritis, she says. The reason this stiffness is more common upon waking with PsA? Joints tend to stiffen during sleep (as opposed to other parts of the body, which tend to relax). Similarly, if PsA is at play, you may notice stiffness with prolonged inactivity such as sitting for a long time, according to the Cleveland Clinic.

Enthesitis and Psoriasis

What else to monitor if you’re concerned your psoriasis may evolve into psoriatic arthritis? A symptom known as enthesitis: defined as tenderness, with or without swelling, at the entheses—the places where your tendons or ligaments insert into your bones. “Enthesitis could be the first presentation of PsA,” says Dr. Mikulik, who adds that this pain can occur in any of the over 100 entheses in your body, but most commonly is experienced at the back of the heel (Achilles tendonitis), the sole of the foot (plantar fasciitis), or tennis elbow. According to the Arthritis Foundation, one in three people with psoriasis will develop psoriatic arthritis, and one in three people with PsA will develop enthesitis.

Dactylitis

Another common sign of PsA that you should watch for is swelling of an entire finger or toe, known as dactylitis, says Dr. Mikulik. The condition is sometimes called “sausage digit” and is another form of enthesitis, according to the Arthritis Foundation. Dactylitis often occurs early in the disease and it may be the only sign of PsA for months or years, according to research in Seminars in Arthritis and Rheumatism. Dactylitis occurs in up to half of people with psoriatic arthritis. It typically involves the feet more than the hands and can affect multiple digits simultaneously.

Reduced Range of Motion

When your skin is flaring with psoriasis, any kind of movement can be painful. But if you’re find your range of motion is being restricted by joint—rather than skin—pain, this may also be a reason to talk to your doctor. The inflammation that is associated with PsA can reduce your mobility due to swelling in the cartilage and synovial tissue between your joints, which may inhibit them from moving within their normal abilities.

No Improvement in Pain

When your psoriasis is flaring, the pain from skin lesions being scratched raw can be excruciating. But keep your eye on joint pain as well, says Dr. Han. Pay particular attention to any pain that is not getting better or is progressing. Unlike other injuries, joint pain related to PsA will have a difficult time healing due to uncontrolled inflammation throughout the body. The pain associated with PsA can develop slowly, with mild symptoms, or it can develop quickly and severely, according to the National Psoriasis Foundation.

With Psoriasis, Early PsA Detection Is Important

Because some of the symptoms of PsA are similar to other conditions, determining if someone with psoriasis is developing psoriatic arthritis can be challenging and may require extensive detective work. But if your joint pain isn’t going away, keep asking questions. “Catching psoriatic arthritis early means we can prevent further progression of joint disease,” Dr. Han explains. According to Frontiers in Medicine, delaying a diagnosis of PsA as little as six months is associated with a poorer response to treatment; meanwhile, early intervention with PsA treatment is linked with improved clinical outcomes. The early symptoms of PsA may seem vague to some, but especially if you are living with psoriasis, it is important to let your provider know if you are experiencing any of the early signs of the disease.

https://www.healthcentral.com/condition/psoriasis/when-to-worry-about-joint-pain-with-psoriasis