What’s the Difference Between Psoriatic Arthritis and Rheumatoid Arthritis?

From healthcentral.com

While both these conditions involve your joints, some key points of distinction can help you tell them apart

Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are both chronic inflammatory diseases that impact the joints. Telling the conditions apart can be challenging, but there are differences between the two that a trained eye can detect, says Laura Coates, Ph.D., an associate professor and researcher of psoriatic arthritis at the University of Oxford in England. Psoriatic arthritis is characterized by joint inflammation and often includes skin psoriasis. Meanwhile, rheumatoid arthritis is characterized by joint inflammation that affects multiple joints, often in a symmetrical fashion (i.e., both knees or both wrists). 

How else are they similar and different? Let’s take a closer look at the ways these conditions overlap and what makes them unique.

Psoriatic Arthritis or Rheumatoid Arthritis?

The presence of psoriasis, an inflammatory skin condition, is often a clue that points to psoriatic arthritis rather than RA. Psoriasis occurs before the development of psoriatic arthritis in about 85% of patients.

There is also a gender gap between the two conditions: Psoriatic arthritis affects men and women equally, while more women than men develop rheumatoid arthritis, according to the Arthritis Foundation. Other key differences to look for include symmetry of symptoms: RA affects the hands, knees or ankles, and usually the same joint on both sides of the body (both hands as an example). RA is more common than PsA, affecting approximately one million people in the U.S., while psoriatic arthritis impacts roughly half that.

Meanwhile, although PsA symptoms differ between patients, peripheral joints are often involved, such as the fingers and toes. Back involvement is commonly associated with psoriatic arthritis (up to 70% of the time), and nail issues are often present. Dactylitiis, the swelling of a finger or toe, would also point to psoriatic arthritis. And unlike the symmetry of RA, PsA typically attacks joints on one or the other side of the body.

Key differences between rheumatoid arthritis and psoriatic arthritis include:

Rheumatoid Arthritis (common with RA but not PsA):

• Symmetrical joint involvement

• Cervical spine involvement (neck)

• Interstitial lung disease

• Rheumatoid Factor Positive

• IL-6 driven (inflammatory pathway)

• HLA-DRB1 alleles (genetic link)

Psoriatic Arthritis (common with PsA but not RA):

• Psoriasis

• Distal joint involvement

• Asymmetrical joint involvement

• Axial spine involvement

• Enthesitis

• Dactylitis

• Nail involvement

• IL-17A-driven (inflammatory pathway)

• IL-12/23-driven (inflammatory pathway)

• HLA-B27 alleles (genetic link)

Causes

How or why someone develops rheumatoid arthritis or psoriatic arthritis is not completely understood, but there are a few strong ideas. A combination of genetics and the environment is believed to play a role in both diseases. According to research in the journal Rheumatic and Musculoskeletal Diseases, one theory of how rheumatoid arthritis comes to fruition is the development of lung inflammation first, typically prior to joint symptoms, with the accompanying production of antibodies to citrullinated protein antigens. The gut and associated microbes are suspected of initiating psoriatic arthritis, according to the same source.

Family history, smoking or a viral infection may also play a role in the pathogenesis of both conditions. No matter the initial causes, both diseases trigger high amounts of inflammatory proteins (called cytokines) that are associated with joint pain and damage.

Comparison of Symptoms

In addition to the specific joints involved and symmetrical versus asymmetrical symptoms, there are other ways your doctor may be able to tell PsA for RA. According to Coates, tell-tale signs your doctor may look for include:

Psoriatic arthritis indicators:

• RF and anti-CCP seronegative blood tests

• Inflammatory markers often normal

• Absence of rheumatoid nodules

• Asymmetric oligoarticular manifestations

• Predilection for the distal interphalangeal joints

• Radiologic damage

• Spinal issues (in about 50% of cases)

• Skin manifestations (psoriasis)

Rheumatoid arthritis indicators:

• RF and anti-CCP seropositive blood tests

• Inflammatory markers usually raised

• Rheumatoid nodules present over bony prominences

• Symmetrical polyarticular manifestations

• Typically affects the metacarpophalangeal and proximal interphalangeal joints

• Radiologic changes

• Spine is largely unaffected

• Skin manifestations are atypical

Diagnosing Rheumatoid Arthritis and Psoriatic Arthritis

To determine if you have either condition, your provider will usually begin with a physical exam. If multiple joints are inflamed and are predominantly symmetric, this may indicate rheumatoid arthritis. Joint involvement is often, but not always asymmetric in psoriatic arthritis (the right elbow and left knee may be painful).

Your provider will also be on the lookout for which joints are impacted: RA typically affects the shoulder, elbow, wrist, hip, knee, ankle and foot joints. In psoriatic arthritis, the joints of the hands and feet, large joints of the lower extremities, the axial spine and sacroiliac joints are commonly affected. If you have back pain, where the back hurts may also be an important clue. Back pain is usually not present in rheumatoid arthritis other than cervical spine pain (pain in the neck region).

There may be other clues to differentiate the two conditions that are important in the diagnosis process. Dactylitis, inflammation of the entire finger or toe, can be common with psoriatic arthritis. Dactylitis impacts psoriatic arthritis patients up to 50% of the time, compared with approximately 5% of patients with rheumatoid arthritis.

The presence of nail disease may also help your provider make a diagnosis. Up to 80% of people with psoriatic arthritis have some sort of nail changes. Nails may have pitting, discoloration, thickening, or the nail may be pulling away from the nail bed, as examples.

Blood tests may also help your doctor with a diagnosis. Approximately 80% of people with rheumatoid arthritis test positive for rheumatoid factor (RF) and about 60% to 70% have antibodies to cyclic citrullinated peptides (CCP), according to the Cleveland Clinic. RF and CCP are absent in most individuals with psoriatic arthritis.

Different types of imaging tests may also be required. For example, x-rays may be used to look for changes to the bones, such as new bone formation related to psoriatic arthritis. Magnetic resonance imaging (MRI) or an ultrasound test may help your doctor look at soft tissue issues, such as enthesitis that may also be related to psoriatic arthritis or tenosynovitis (inflammation around the tendon) which may indicate rheumatoid arthritis.

To aid in your diagnosis, your doctor will also collect information about your family’s medical history. If a parent or sibling has psoriatic arthritis, that greatly increases your chance of developing psoriatic arthritis, with a recurrence rate between 30% to 55%, according to the Journal of Rheumatology. On the other hand, while there is a family risk associated with rheumatoid arthritis, genes only slightly increase the risk. Environmental factors are likely to play a stronger role, according to the American College of Rheumatology.

Even with an experienced provider, differentiating between the two conditions isn’t easy 100% of the time, says Coates. “Typical rheumatoid arthritis and typical PsA are quite different, but sometimes there are ‘gray’ cases in the middle that confuse us and can be tricky to separate,” she says.

Treating Rheumatoid Arthritis vs. Psoriatic Arthritis

Reducing inflammation and treating “upstream” symptoms of the diseases is the name of the game when deciding on treatment options for both rheumatoid arthritis and psoriatic arthritis, according to the journal Rheumatic and Musculoskeletal Diseases. Steroids or methotrexate are examples of medications that will reduce inflammation related to both conditions.

However, medications that target more downstream symptoms and that are more disease-specific are not effective for both conditions, says Joel Gelfand, M.D., a board-certified dermatologist and director of the Psoriasis and Phototherapy Treatment Centre at Penn Medicine in Philadelphia, PA. “Several medications are effective for psoriatic arthritis but not RA, biologics targeting IL-23 or IL-17 being some examples,” Dr. Gelfand explains. Similarly, a biologic targeting the IL-6 inflammatory pathway would be prescribed for rheumatoid arthritis and not psoriatic arthritis.

Interestingly, some of the medications approved for both conditions may be processed differently in the body based on the condition. For example, Dr. Gelfand and colleagues investigated the risk of liver disease in patients with psoriasis, psoriatic arthritis, and rheumatoid arthritis receiving methotrexate. They found that individuals with psoriatic disease were more susceptible to liver disease and methotrexate hepatotoxicity than were rheumatoid arthritis patients.

“There is the concept of the psoriatic liver, where the inflammation in psoriasis seems to promote fatty liver changes which could be aggravated by methotrexate,” Dr. Gelfand explains. “A variety of blood tests and imaging techniques are now available to detect liver fibrosis (scarring) before clinically significant liver damage occurs, so methotrexate can be used safely in most patients with psoriatic disease.”

Having Both?

Fortunately, the odds are great that you won’t get both conditions. According to Coates, “It’s hard to ever say ‘never’ in medicine but this is pretty much a no.” Sometimes, it just takes time to sort things out, she says. “I saw one patient who was originally diagnosed with PsA and psoriasis and had psoriatic arthritis-type pattern disease but then after a few years he developed new rheumatoid antibodies (that were definitely negative before) and his arthritis changed.”

Takeaways

Both rheumatoid arthritis and psoriatic arthritis are similar and overlapping because both are inflammatory conditions that impact joints. There are important differences between the two diseases, and it is important to get to an experienced healthcare provider such as a rheumatologist who is familiar with the subtleties of each. Early detection and treatment for both is mission critical. The quicker a correct diagnosis is made, the sooner treatment can begin and remission achieved.

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-vs-rheumatoid-arthritis 

Ask the Expert: What Strategies Can Help Manage My Psoriasis?

From healthline.com

Psoriasis can be a frustrating disease to manage if you don’t have the right tools to treat it.

There are numerous ways you can calm down your psoriasis in addition to medications or phototherapy.

• Quit smoking: Smoking worsens psoriasis and makes certain psoriasis medications less effective. Quitting and avoiding tobacco products can reduce the number of psoriasis flares you experience.
• Eat a well-balanced diet: Maintaining a moderate weight and eating a well-balanced diet will help your psoriasis remain calm.
• Avoid triggers: Avoiding your triggers, especially stress, is another way to help manage your psoriasis symptoms.
• Stay hydrated: Staying hydrated helps retain your skin’s moisture and makes you less prone to itching and scratching, which can aggravate psoriasis. Drinking plenty of water will keep your skin hydrated.
• Keep your skin happy: Daily lukewarm showers, gentle cleansers, and moisturizing your skin immediately afterward will help keep your skin moisturized and help prevent flaring.
• Get some sun: Getting about 10–15 minutes of natural sunlight can also help control psoriasis flares. Remember to do this before 10 a.m. or after 4 p.m. to reduce exposure to harmful UV radiation, which can put you at risk for skin cancer.

There’s no cure for psoriasis. There will be periods of flares alternating with clear skin throughout your lifetime. This can make you depressed and feel isolated. Joining a psoriasis support group can help you feel less alone and boost your confidence. Besides making a new friend (or two!), you may also learn new strategies to keep your psoriasis in check.

Is it better to keep psoriasis moist or dry?

Ideally, you want to keep your psoriasis spots moist, not dry. Psoriasis can make your skin dry and itchy. Keeping these areas well moisturized with a strong emollient, such as Vaseline or cream-based moisturizers, will soothe these symptoms.

People often complain about their psoriasis spots being so dry their skin cracks, which is uncomfortable and can put you at risk for infections.

The skin is our body’s first defence against harmful bacteria and other pathogens. Sealing these cracks will protect you from future skin infections, such as impetigo.

Also, dry, itchy skin can prevent you from getting a good night’s rest. Sleep is essential to your health, and having disrupted sleep because of dry, itchy skin can worsen your psoriasis.

Keeping your skin and psoriasis spots moist will soothe your skin and prevent your psoriasis from waking you in the middle of the night.

How often should you shower if you have psoriasis?

This is a great question that my patients with psoriasis often ask. Everyone is different, but most people with psoriasis enjoy taking a shower or bath every day to remove the scale on top of their psoriasis spots, especially those with scalp psoriasis.

I advise against more frequent bathing as this can overly dry out and irritate your skin. Remember, you want your skin as happy as possible to prevent potential psoriasis flares. Other helpful tips include:

• keep your showers brief (10-15 minutes)
• use lukewarm (not hot) water
• use gentle, fragrance-free, non-soap cleansers, such as Dove for sensitive skin
• gently pat your skin dry (no scrubbing!) before applying your topical medications and moisturizers

I recommend applying your medications to your psoriasis spots and moisturizing the rest of your skin with a strong emollient, such as CeraVe, Cetaphil, or Vaseline.

What clears psoriasis fast?

Although there’s no cure for psoriasis, there has recently been an explosion of research to develop effective and quick treatment options.

Several newer biologic medications boast rapid clearance of psoriasis spots, with many offering significant improvement or completely clear skin in as short as 3 months. (Sorry, nothing is going to remove your psoriasis spots overnight!)

It’s important to note that these medications are processed throughout your body and can have unwanted side effects, such as an increased risk for infections. There’s also no consensus on when these drugs should be stopped, making it a difficult decision as to when to start a biologic medication because psoriasis is a lifelong condition.

These newer medications are also considerably more expensive, so it’s important to keep this in mind when discussing biologic treatment with your dermatologist.

What triggers psoriasis to get worse?

There are many triggers for psoriasis, and not everyone has the same triggers. Many of these triggers can be avoided with lifestyle modifications.

• Smoking: Smoking is a common trigger and should be avoided as this not only makes psoriasis worse but can also make certain psoriasis medications ineffective.
• Alcohol: Alcohol is also known to make psoriasis worse, so drink in moderation. A common medication used for psoriasis is called methotrexate. This medication can damage your liver, so drinking alcohol while on this medication is a big no-no.
• Excess weight: Having excess weight can worsen psoriasis. Maintaining a moderate weight is super important when managing psoriasis. Certain psoriasis medications are dosed based on your weight, so the less you weigh, the less medication you will need and the fewer side effects you will experience.
• Diet: Eating a well-balanced diet will also help keep psoriasis flares at bay. The data on whether glutenTrusted Source makes psoriasis worse is still unclear, so I tell my patients to eat a well-balanced diet.
• Stress: Stress can also worsen psoriasis. Stress-busting activities — such as practicing mindfulness, yoga, exercise, or talking with a friend or therapist — can help manage stress and psoriasis.
• Weather: Cold, dry weather tends to dry out your skin, which can worsen your psoriasis. Make sure your skin is well moisturized, and use a humidifier when possible.
• Medications: Certain medications can trigger psoriasis, such as beta-blockers and lithium (avoid, if possible).
• Infections: Infections, such as Streptococcus bacteria (Strep), can trigger a variant of psoriasis called guttate psoriasis, which is more common among younger people.
• Skin injuries: Skin injuries — such as a piercing, tattoo, sunburn, cut, or surgery wound — can trigger psoriasis to develop at these sites through a process called the Koebner phenomenon.
• Hormones: Hormones can either make psoriasis flare or improve it, so it depends on the person.

There are many psoriasis triggers, but many can be avoided with lifestyle changes.

https://www.healthline.com/health/psoriasis/strategies-for-managing-psoriais?slot_pos=article_1&utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=psoriasis&utm_content=2023-10-24&utm_term=s:hl_n:pso&apid=39239719&rvid=058431b717dcfa59c0cdd27cd0a9313769e8b3dd4ad59d88efd0ded7ddb4774e 

Psoriasis vs. Ringworm: What’s the Difference?

From healthcentral.com

While they may share some of the same symptoms, these two skin conditions are miles apart 

You’ve got a round scaly, red patch on your skin. It itches. It flakes. You’ve scoured the internet looking at skin condition photos. It sort of looks like psoriasis? But it also looks like ringworm. So, which is it?

While they’re not caused by the same thing, ringworm (also known as tinea corporis) and psoriasis look and feel so much alike that they can sometimes be mistaken for one another. But knowing what you’re dealing with matters, especially because they’re treated in totally different ways. Find out how you can tell them apart, take care of them, and help prevent them from popping up in the future.

What Are the Differences Between Ringworm and Psoriasis?

There are good reasons why these two skin rashes might be mistaken for each other by the untrained eye. “These conditions both often have circular plaques or patches,” explains Anar Mikailov, M.D., a board-certified dermatologist at Barrington Park Dermatology in Rochester, NY, and co-author of Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, Ninth Edition. But, he says, there are some key differences in their scaly aspect. “With ringworm, the scale is usually at the edge of the circular patch, which is often slightly elevated, and the centre may have normal appearing skin.” With psoriasis, he says the scaling “often covers the entirety of the patch and can become quite hard and attached to the skin with bleeding when the scale is pulled off,” he explains.

Jodi LoGerfo, D.N.P., a doctor of nursing practice and a family nurse practitioner certified in family medicine and dermatology at Orentreich Medical Group in New York City explains that their causes are also different. “Psoriasis is an autoimmune disease that causes skin cells to multiply too quickly,” she says. “This creates patches of red, inflamed, skin with silvery scale. It can affect any area of the body and symptoms come and go over time, called flares.” Ringworm, on the other hand, is caused by a fungal infection on the skin—and despite the name, has nothing to do with worms at all.

Another big difference: Psoriasis is often hereditary and isn’t contagious, while ringworm is not hereditary and is contagious. According to the Centers for Disease Control and Prevention (CDC), it can be transferred to a person through contact with other infected people, animals, or objects.

Psoriasis. Getty Images/Antonio Cabrera

                                                                   Ringworm. Getty Images/phanasitti

Symptoms of Psoriasis vs. Ringworm

They both itch, can appear in a circular shape, and have a negative impact on your day—but, other than that, psoriasis and ringworm are very different conditions. Dr. Mikailov points to these main differences:

Location

According to the Cleveland Clinic, ringworm can pop up throughout the body including the hands and nails or under a beard, but may go by different names depending on the area. For example, on the feet it’s called athlete’s foot (but it’s still ringworm). Around the groin upper thighs and rectum, it’s called jock itch (but it’s still ringworm).

Psoriasis can appear in small patches or larges areas anywhere on the body, including the scalp, eyelids, ears, lips, skin folds, hands, feet, and nails, notes the National Psoriasis Foundation. However, unlike ringworm, it tends to cluster in plaques around the joints and become psoriatic arthritis. “This presents as stiffness in the lower back or fingers in the early morning,” says Dr. Mikailov. “It’s very important to treat psoriatic arthritis early, otherwise it can lead to severe joint deformity.”

Raised Areas

With plaque psoriasis, the entire plaque may be raised as the skin cells overproduce and build up. But ringworm is a different story. The term ringworm comes from the way the condition usually presents, as a raised scaly ring around a circular patch with uneven colouring. While a psoriasis flare may also arrive in circular patterns, the entire plaque—not just the outside ring—can be raised as the skin cells multiply rapidly and accumulate.

Symptom Recurrence

Both ringworm and psoriasis can recur. In the case of ringworm, the symptoms may come back if you come in contact with the fungus again. Psoriasis is a chronic condition, meaning that although you can effectively manage symptoms with medication, you likely have the disease for life, and skin flares can repeat if triggered by stress or another internal or external irritant. On the other hand, while a psoriasis flare may temporarily go away on its own, Dr. Mikailov points out that “skin fungal infections require medication pills or creams to clear. [They] typically do not clear spontaneously.”

Causes of Ringworm vs. Causes of Psoriasis

Psoriasis is most often genetic and brought on by contact with triggers including, stress, tobacco, infections, heredity, alcohol, hormonal changes and skin irritants, according to research published in Materia Socio Medica,. However, “there are some types of psoriasis that can develop as a result of a viral or bacterial infection and lead to what is called ‘guttate psoriasis,’” says Dr. Mikailov. “This is often seen after a strep infection or streptococcal pharyngitis.”

Ringworm is caused by fungus, and, according to the American Academy of Dermatology Association, because fungi loves to grow in humidity, people who live in humid climates are more prone to developing ringworm. Other folks who have increased chances of developing ringworm include people who sweat heavily, those who play contact sports, people who share towels, clothes, or razors without washing them, and people who have diabetes (diabetes can weaken the immune system, making it less effective at defending against infections, including fungal ones like ringworm).

How Psoriasis and Ringworm Are Diagnosed

Psoriasis and ringworm are both diagnosed by physical exam and, if necessary, skin biopsy. According to Dr. Mikailov, when it comes to ringworm, “sometimes a bedside test called a ‘KOH Smear‘ can be done where a small amount of skin is scraped off onto a glass slide, and then it is evaluated under a microscope.” If fungus is present, ringworm is the diagnosis. If not, it may be psoriasis or another skin condition.

Psoriasis Treatment vs. Ringworm Treatment

“Skin fungal infection requires an antifungal cream or pill whereas psoriasis requires immunosuppressive therapy such as a topical steroid cream, a pill, or injection therapy,” says Dr. Mikailov. And according to research in the journal Canadian Family Physician, other psoriasis treatment options include phototherapy, vitamin D3, and corticosteroids.

Phototherapy may also be used to treat ringworm—in fact, a 2022 study in Infection and Drug Resistance found that phototherapy combined with oral antifungal medications is a promising therapy for fungal infections. However, the CDC warns against the use of topical corticosteroids as an antifungal, as they can worsen ringworm symptoms.

In both cases, people are advised to wear loose-fitting breathable clothing when skin lesions are present. In the case of psoriasis, wearing looser clothing helps you to avoid friction and irritation. In ringworm, it’s about avoiding the moisture that feeds fungi, according to research in the journal Drugs in Context.

Other Ways to Avoid Ringworm

Even though ringworm is contagious, there are several steps you can take to protect yourself and your loved ones from this pesky condition. Here are the steps to avoiding ringworm, according to the Mayo Clinic:

• Educate yourself. Knowing how to spot the signs of ringworm can help you avoid it.

• Keep clean. Washing your hands often can help avoid the spread.

• Stay cool and dry. Fungus loves humidity, so think breathable clothing!

• Avoid infected animals. Steer clear of patches of skin on your pets where fur is missing—this could be a sign of ringworm and should be addressed by a vet.

• Don’t share personal items. Keeping your own towels and toiletries can help you from getting in contact with fungus.

Takeaway

Ringworm and psoriasis have enough similarities in appearance that they can be mistaken for each other. But they also have many differences. Psoriasis results from an autoimmune disease that causes rapid skin cell multiplication, while ringworm is caused by fungal skin infections and is contagious, unlike psoriasis. Differentiating their locations, raised areas, symptom recurrence, and causes, you can ensure proper diagnosis and treatment, helping prevent future occurrences.

Skin fungal infections like ringworm necessitate immediate but temporary medication, whereas psoriasis may clear temporarily on its own but may require systemic treatments in the long run. By understanding these distinctions, you can receive the appropriate care for your specific skin condition. When in doubt, however, don’t play a guessing game—head to your dermatologist for an official diagnosis.

https://www.healthcentral.com/condition/psoriasis/psoriasis-vs-ringworm

How Having Psoriasis Can Impact Mental Health: “I Wish People Knew the Emotional Side of Psoriasis”

From eatingwell.com

Read more about Nitika Chopra’s perspective in this exclusive interview

Psoriasis is a chronic condition that can cause inflammation in the body due to immune system dysfunction. It can present itself in different forms, from plaque psoriasis impacting the texture of the skin to psoriatic arthritis causing discomfort in your joints, tendons and ligaments. 

Chronic illness advocate, founder of the organization Chronicon and podcast host Nitika Chopra has been managing plaque psoriasis since childhood.

“I was diagnosed with psoriasis when I was 10 years old, and it was definitely a time in my life where it was really unexpected,” Chopra said in an interview with EatingWell. “It was challenging because it sort of grew from one small spot on my arm to covering basically 98 percent of my body within a year. It was a time where I was really young and wanted to just be playing with friends carefree, and my health really made that super challenging.”

In this exclusive interview, Chopra talked about her personal experience with psoriasis, from food swaps and her protein-packed eating pattern to what she wished she knew when she was initially diagnosed. Here’s what she had to say about her chronic condition—plus her recent partnership with Bristol Myers Squibb to help spread the word about psoriasis.

                                            PHOTO: BRISTOL MYERS SQUIBB

EatingWell: Since being diagnosed with psoriasis, what are some swaps that you have made in your eating pattern or lifestyle that have helped manage your condition?

Chopra: In terms of food, it’s really interesting to talk about because I remember that I loved junk food as a kid and really enjoyed my sweets. I never really thought about food in a greater sense; I just had these cravings and loved certain sweets. But as I’ve gotten older, one of the gifts of dealing with my body and having these different conditions is that it made me so much more aware of what I put into my body. Everything from stress management to taking care of my overall well being, ultimately making me feel better in general. I switched out the candy bars for a good dark chocolate, which is really nice—I think it’s important to have chocolate as often as you want to, but having a low-sugar dark chocolate instead has been really good for me. I’m drinking an oat milk latte that I make in the morning with stevia. I love that. Having less dairy, I don’t really have gluten, things like that that I just find make me feel better overall.

EatingWell: Could you walk us through what you eat in a day?

Chopra: I’m big on protein, I just think it’s so important, especially for women as we get older. I always start my day with a protein shake with oat milk and usually a workout or movement of some kind. After that, lunch is usually a Mediterranean-style or Greek salad for balance with delicious lettuce, some good cheese in there with some chicken. For dinner, it depends on what I’m feeling that day. It’s usually a protein-packed meal like salmon—I love to make salmon with a side of kale and some rice to make a little rice bowl. For snacks, I definitely gravitate towards a Luna bar or a protein bar. I have walnuts—I really like walnuts—and I’ll have a protein shake for a snack in the middle of the day because a lot of times when I’m feeling really hungry, I need something more sustaining. 

EatingWell: What are some misconceptions about psoriasis that you want to debunk?

Chopra: I get so many messages from people that are dealing with their self-esteem as they’re navigating their psoriasis. Most of the time the messages are along the lines of, “Nobody in my family understands” or “I’m the only one” or “I have a supportive partner, but I’m really self conscious.” I wish people knew that emotional side of psoriasis, that’s something I definitely dealt with growing up. It really impacted my self-esteem, and it was that constant push-pull of people thinking, “It’s just a skin disease, why are you having a hard time concentrating at school? Why are you having a hard time making friends?” It doesn’t really add up to most people, but that’s because they don’t realize it’s so much more than that.

That’s a huge reason why I’m so excited about this partnership with Bristol Myers Squibb and their Clear Understanding campaign because it is exactly that: we’re allowing people to have a clearer understanding of what psoriasis really is about. If somebody is struggling with it and they feel really isolated and really alone, they can go to the website Clear-Understanding.com and see that there’s this whole group of people that gets exactly what they’re going through.

EatingWell: Since being diagnosed at age 10, what’s something that you wish you knew then that you know now?

Chopra: Overtime, I have learned to have a lot of empathy for other people and what they’re going through. It’s so cliche, but I have learned that things are not always what they seem, and that’s something that I had to learn during the process of dealing with my psoriasis. It was something that I didn’t know would be such a gift. Going through it, I was upset, disappointed, frustrated and all of those things, but after a while, I thought, people are judging me because of how I look, and they have no idea who I am. They’re just seeing this person with this thing on their body, and they’re not trying to get to know who I really am. So I started to look at this as an opportunity. As a human being, it’s so natural to make a quick judgment, but I started to stop and think, “What if that person is grumpy because they have a really bad headache?” or “What if that person has an attitude because they’re going through a breakup?” I really started to look at the person on a much deeper level which I’m really proud of and relieved by because it makes life a lot more beautiful.

EatingWell: What’s something you personally do to try to keep your immune system strong and your skin healthy during cold & flu season?

Chopra: I honestly think one of the greatest things that I have done for myself and my health is to have really strong boundaries. I don’t know if people think of those two things as being really linked together, but I have to say no a lot when people invite me to something and there’s going to be a lot of people there, or there’s going to be people I don’t know and I don’t know where they’ve been. I wear my mask everywhere where there’s more than one person that I don’t know. That’s something I’ve been doing to keep myself really safe. I also think that the basics really work: making sure I get enough sleep, making sure I move my body enough, keeping myself active in a healthy way. And watching the foods I eat—although I still have cravings for junk food from time to time! But giving myself permission to take care of myself through my food is a really wonderful thing.

EatingWell: What does “eating well” mean to you?

Chopra: To me, it means checking in with myself and really honouring what I’m sensing I need at that moment. Not really trying to follow something that’s so strict because that can also get really intense, but being honest about what I want. Maybe I think I want the candy bar, but really I need some vegetables or something that’s more nourishing. That’s what eating well means to me.

https://www.eatingwell.com/chronic-illness-advocate-opens-up-about-psoriasis-8351157