From healthcentral.com
We’ve got ways to manage scaly skin and sore, swollen joints when they strike at the same time
During a flare of psoriasis (PsO) your skin can erupt with red, itchy scales. Psoriatic arthritis (PsA) causes inflammation and swelling in your joints, which can be quite painful. A flare of either disease can ruin your day (or even your week)—but what if both strike at the same time?
It can happen. Around one in three people with PsO also have PsA, according to the National Psoriasis Foundation. And Gabriela Cobos, M.D., a dermatologist and director of the Dermatology-Rheumatology Program at Tufts Medical Centre in Boston, MA, says that it’s not uncommon for her patients to have flares of both conditions simultaneously.
The visibility of psoriatic outbreaks on your skin can lead to embarrassment and unwanted questions from friends and strangers alike. Meanwhile, joint symptoms can turn even simple daily tasks—like opening jars or buttoning buttons—into agonising exercises. “Having [two] flares at the same time can have drastic effects on a patient’s quality of life,” Dr. Cobos says.
Here, we explore the connection between PsO and PsA, what triggers flares—and what to do if a dreaded double flare happens to you.
What’s the Link Between Psoriasis and Psoriatic Arthritis?
Psoriasis and psoriatic arthritis are both autoimmune diseases. You can think of your immune system like your body’s armed defence, says Atul Deodhar, M.D., a professor of medicine and the medical director of the Rheumatology Clinics at Oregon Health & Science University in Portland, OR. When you have an autoimmune condition, your military stages a coup—against yourself. “Your immune system is attacking your own body,” he explains.
In PsO, your immune system targets your skin cells, causing them to multiply too quickly, per the Mayo Clinic. Those cells pile up and form scaly patches called plaques. In PsA, the immune system also goes on the attack, but this time the joints are its target. In addition to plaques, you experience joint pain and swelling. Inflammation is a key component of both PsO and PsA.
Usually, skin symptoms appear first. Joint symptoms from PsA may not show up for about a decade after your initial PsO diagnosis, per Mayo Clinic. Not everyone follows the same path, though—some people have joint symptoms first. Others have psoriasis but never develop psoriatic arthritis.
Certain things increase your odds of developing both conditions, according to the Hospital for Special Surgery (HSS). Having severe psoriasis is one such risk. Being obese in early adulthood is another. Little dents called pits in your nails and/or eye inflammation called uveitis also seem to increase your risk for developing PsA, per the HHS.
What Triggers a Double Flare?
Certain things that you do or that you’re exposed to can set off bouts of psoriasis symptoms. The most common PsO triggers include infections like strep throat, a cut or other injury to your skin, and stopping your steroid medication too quickly, according to the Mayo Clinic.
PsA triggers are tougher to pinpoint, says Dr. Cobos. “A good number of patients will say stress. If they’ve gone through some kind of big emotional stress, they definitely feel that it correlates with flares of both their skin and their joints,” she explains. Which is why managing your stress levels with methods such as daily meditation, quality and consistent sleep, yoga, and other regular, moderate exercise is so important, she adds.
Dr. Cobos’s patients also tell her that nightshade vegetables—a produce group that includes tomatoes, white potatoes, peppers of all colours, and eggplant—can set off inflammation in their bodies. The evidence isn’t clear on whether nightshades are a true PsA trigger, but she tells her patients that if these foods seem to worsen their psoriatic arthritis symptoms, they should eliminate them from their diet for a time to see if symptoms improve. And if flares stay at bay? Say goodbye to any offending culinary culprits.
How Do I Know I’m in a Flare?
Symptoms like those listed below signal that you’re in a psoriatic arthritis flare, per The National Psoriasis Foundation:
Eye redness and pain
Low back pain
Morning stiffness
Pitted nails
Red, itchy skin patches topped with scales that spread or appear in areas where you didn’t have them before
Swelling, pain, and tenderness in one or more joints
Swollen fingers and toes that look like sausages
Tiredness
If you’re flaring, it’s time to check in with your dermatologist and rheumatologist about adjusting your treatment.
How Do You Treat a Double Flare?
Ideally, you don’t want to flare up at all. Getting on the right medication will prevent your symptoms from rearing up as often, or at all, say our experts.
If you have mild PsO, you may already be on a topical medicine, which works directly on your skin to manage plaques. Then, if your joints flare up your doctor might add a nonsteroidal anti-inflammatory drug (NSAID), Dr. Cobos says.
The drug most doctors start with to control symptoms of moderate-to-severe psoriatic arthritis is methotrexate. “Almost always this is the first drug to be used, because 20% to 25% of patients will respond nicely to methotrexate alone,” says Dr. Deodhar. “And it works on both the skin and the joints.”
If you’re still flaring while taking methotrexate, it might be time to bring a biologic drug into the mix. These medications, which come as an injection or an infusion, target different immune system proteins to calm the attack on your joints and skin and help bring down damaging (and painful) inflammation, according to NYU Langone Health.
Biologics come in many different classes, per the Arthritis Foundation. There are tumour necrosis factor (TNF) inhibitors, as well as other medications that block the protein interleukin-17, while still others block interleukin-23 (IL-23).
Which one of these medicines your doctor chooses for you really depends on which symptoms bother you most—psoriasis, or psoriatic arthritis. “When it comes to [treating inflamed] joints, [these drugs] are all equal,” says Dr. Deodhar. However, “IL-17 inhibitors and IL-23 inhibitors are better than TNF inhibitors when it comes to skin.”
Your medication regimen might need some tweaking to fully control your joint and skin symptoms. If your biologic isn’t working, our doctor might put you on a different biologic or try a newer type of medicine called a Janus kinase (JAK) inhibitor, which also treats skin and joints, says Dr. Cobos.
Healthy lifestyle habits can help, too. “Weight loss has been associated with decreasing the skin activity of psoriasis,” she explains. Shedding extra weight takes stress off sore joints, too.
Takeaway
It takes a village, as they say, to manage psoriasis and psoriatic arthritis—especially when they’re flaring at once. Populating that village starts with two key people: a dermatologist to treat your PsO and a rheumatologist to manage your PsA. Dr. Cobos says she always screens her psoriasis patients for psoriatic arthritis and stays in close contact with their rheumatologists if they have joint disease.
A heart specialist is also worth inviting into your village, Dr. Cobos advises. Inflammation from psoriasis and psoriatic arthritis can extend to other parts of your body, including your blood vessels, Dr. Cobos says.
Having PsO or PsA puts you at higher risk for cardiovascular disease, which is why she urges her patients to be as heart-healthy as possible. “That means making sure that you’re exercising an adequate amount per week and that you’re watching your diet,” she says. See your primary care doctor for regular check-ups, and get your blood pressure and cholesterol monitored to ensure that your heart stays every bit as healthy as your joints and skin.
This multi-pronged approach—managing stress, taking good care of yourself, assembling the right care team, not skipping your meds, and seeing your rheumatologist and dermatologist immediately when symptoms pop up—is the best way to stay two steps ahead of a double flare.
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