From healthcentral.com
From stretching to cooling aids, there are ways to self-soothe with this challenging joint condition
An estimated one in five adults in the U.S. experience chronic pain. If you have psoriatic arthritis (PsA), you may be part of that statistic. For some people with psoriatic arthritis, pain is long-standing, especially during the time before an effective treatment is matched with your exact stage and set of symptoms with psoriatic arthritis. Understanding the cause of your pain and exploring the strategies to eliminate or manage it can help you take back your life.
Why Does Psoriatic Arthritis Cause Pain?
Your immune system is designed to protect you from invaders. However, psoriatic arthritis can cause the immune system to become overactive and create unwanted inflammation throughout our body. This inflammation often occurs in and around the joints, especially wreaking havoc on the entheses, which is where tendons connect to bones.
Jonathan Yu, D.P.T., a doctor of physical therapy at the Hospital for Special Surgery in New York City, says that due to excessive inflammation, he often sees individuals with undertreated psoriatic arthritis experiencing pain in their spine and foot and/or ankle. Other painful areas for people with psoriatic arthritis include the joints closest to the tips of the fingers and toes (known as the distal interphalangeal joints).
Exactly how much pain you feel and where it’s located varies from one person to the next in psoriatic arthritis, which can make it challenging for doctors to identify and treat. “Especially if someone has been inactive from stiff or sore joints, this lack of movement may have caused joint pain in other areas, away from the originally affected joint,” Yu explains. “For instance, with foot issues, sometimes if one foot is in pain, a person may be off-balance in their weight bearing, which then causes other issues if it is not treated.”
Tips for Relieving Psoriatic Arthritis Pain
Because psoriatic arthritis is a whole-body condition, the solution to reducing the associated pain can required a multi-layered approach.
Reduce Stress
At the root of psoriatic arthritis pain is inflammation—and that inflammation can be triggered by numerous factors, including stress, according to Alexis del Vecchio, M.D., attending physician at Baptist Health and research appointee at the Mayo Clinic in Jacksonville, FL. “Stress can worsen inflammation and is one of the main triggers for a psoriatic flare,” says Dr. del Vecchio, who recommends managing stress through non-pharmacological means like mindfulness training. Also, “regular exercise and a varied diet that focuses on lean proteins, fruits and vegetables” can help mitigate inflammation caused by stress, he says.
Aerobic Exercise
“Aerobic exercise is really important for reducing psoriatic arthritis pain,” says Yu. Admittedly, physical activity when your joints hurt from psoriatic arthritis can be tough to accomplish. “Especially in a flared state, exercise has to be approached carefully,” Yu acknowledges. “Try more low-impact exercises such as moving in a pool, biking, or gentle walking.”
Strength Training
“We aren’t necessarily talking about body building, but weightlifting to maintain strength and support the joints can also reduce pain,” says Yu. “As an example, if you have a sore knee, more strength in your quadricep muscle can support the knee joint and help you go up the stairs with less pain.” Similarly, a stronger core may help you better manage any hip pain associated with psoriatic arthritis. The specific type of strength training that will be most beneficial will depend on which joint is flaring, Yu says.
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Skin Care
Psoriasis is often a precursor to psoriatic arthritis and left untreated can be a source of pain and discomfort. People with psoriatic disease often complain that their skin burns, itches, stings, or is overall tender.
If this sounds like you, some TLC for your skin may be required, including avoiding skin care products that may be irritating and adding to your pain. The National Psoriasis Foundation has a list of over-the-counter skin products that have been created to be non-irritating and safe for those living with psoriatic disease. (Or check out HealthCentral’s expert-approved list, here.)
Heating Pad
Warming up your joints and surrounding muscles can help reduce stiffness and provide pain relief. According to the Arthritis Foundation, heat works by enlarging your blood vessels and increasing blood flow. This allows more of the good stuff—including blood, oxygen, proteins, and nutrients—to be delivered to the joint and surrounding tissues. If you have a sudden onset of swelling and redness from a flare, though, it is best to avoid heat.
Cool Down
On the flip side, sometimes cooling down a joint, also known as cryotherapy, can reduce pain in two different ways, according to Johns Hopkins Medicine. Cold therapy can reduce the swelling or inflammation that is tied to pain, and it may also reduce your sensitivity to pain. It can be as easy as applying an ice pack wrapped in a towel to protect your skin to your sore joint for 10 to 20 minutes several times a day.
Not sure whether to use heat or cold? As a rule of thumb, use ice for acute pain (it hurts right after you exercise); use heat for longer-term aches (anything past 72 hours). And when in doubt, ask an expert. “A physical therapist can help educate on when to use heat, when to use ice, when you should push and when to back off from activity,” says Yu.
Over-the-Counter Medications
Painful psoriatic arthritis flares may respond well to a class of anti-inflammatory analgesic medications called non-steroidal anti-inflammatory drugs (NSAIDs), says Dr. del Vecchio. While these medications can be helpful for pain management, they should be used with care.
“There is a misconception that if they are sold over the counter, medications are safe to use, but that is not always the case!” says Dr. del Vecchio. “Always follow the indications on the medication bottle, and do not take NSAIDs if your doctor told you not to, and especially if you have any history of high blood pressure, cardiac problems, poor kidney function, or bleeding, which can worsen all of the above.”
Medical Devices
There are multiple medical devices that can support your joints and prevent further injury. According to the Arthritis Foundation, canes, walkers, reachers and grabbers, button hooks, jar openers, and lever door handles can help with daily life. Electronic devices, such as transcutaneous electrical nerve stimulation (TENS) units, can be placed on your skin to stimulate nerves and muscles around the area of pain. Your doctor, physical therapist, or pharmacist can help you with the best device to help your pain.
Diet
There is no one diet that can cure psoriatic arthritis or that would be right for everyone. But research suggests that there are certain foods that add to inflammation in your body and potentially make the pain worse, while other foods are known to reduce inflammation. According to a review article in Frontiers in Immunology, these include:
Pro-Inflammatory Foods
Anti-Inflammatory Foods
Foods high in omega 3 fatty acids (fish and plant-based foods)
Green tea Spices such as cinnamon, cumin, and ginger
Legumes
Legumes
Nuts
Whole grains
Hand and Foot Care
Those with psoriatic arthritis are no stranger to hand and foot pain. From fingers to toes to heels, psoriatic arthritis can be a pain. While there is no cure for psoriatic arthritis, according to the Arthritis Foundation there are things you can do in addition to treatment to manage pain in your hands and feet:
Roll your foot across a frozen water bottle for 10 minutes at a time.
Keep your fingernails and toenails trimmed.
Be gentle with your nail cuticles (and ask others to be gentle as well).
Choose shoes with a wide toe box to keep toes from excess pressure.
Apply cold packs to your feet and hands 10 minutes at a time.
If you are seeing changes to your hands or feet, especially your fingers and toes, taking good notes to share with your doctor about the changes you are observing can be very beneficial. Psoriatic arthritis is known for causing serious inflammation in the digits—called dactylitis. If this is happening to you, it may be time to consult your rheumatologist about a possible change in your treatment.
Psoriatic Arthritis Pain Treatment
The goal of psoriatic arthritis treatment is to reduce the inflammation caused by an overactive immune system. Because the symptoms related to PsA are so varied and everyone is different, there may be some trial and error in the process of finding the best treatment that manages most of your symptoms. Your doctor may suggest one of the following:
NSAIDs
If your pain is mild or you are early in your disease course, your doctor may suggest you take nonsteroidal anti-inflammatory drugs (a.k.a NSAIDs). Available over the counter or in higher strengths by prescription, these medications can relieve pain and reduce inflammation. Aspirin, ibuprofen, and naproxen are commonly used NSAIDs to treat PsA pain.
DMARDs
This class of medication (disease-modifying antirheumatic drugs) can slow the progression of PsA and prevent further joint damage, according to the Mayo Clinic. The most commonly used DMARD for psoriatic arthritis is methotrexate. DMARDs work to suppress the body’s overall immune system, so your rheumatologist will follow you closely while taking this medication.
Biologics
These medications are protein-based drugs that are derived from living cells cultured in a laboratory. Because they come from living cells, they can also be quite expensive. They are a great step forward in psoriatic arthritis treatment because they can zero in on certain parts of the immune system, instead of suppressing the entire immune system.
Biologic medications, frequently delivered via injection or infusion, are often divided into groups based on the part of the immune system that they help control. According to the National Psoriasis Foundation, these include:
Interleukin 12 and 23 (IL-12/23) inhibitors
Interleukin 17 (IL-17) inhibitors
Interleukin 23 (IL-23) inhibitors
T-cell inhibitors
Tumour necrosis factor-alpha (TNF-alpha) inhibitors
PDE4 Inhibitors
Currently there is only one PDE4 inhibitor—apremilast—approved for psoriatic arthritis. This drug can be taken orally, and routine blood tests are not required. Apremilast is used for people with mild to moderate psoriatic arthritis, according to the Mayo Clinic.
JAK Inhibitors
First approved by the FDA in 2012 to treat other conditions, Janus kinase (JAK) inhibitors are not new therapies. They act similarly to biologics by interrupting inflammatory cell pathways. With an inflammatory condition, a break in inflammation signally can be very helpful to controlling pain. Some JAK inhibitors, which a typically delivered orally, come with warnings of major adverse reactions for some people, so it is important to discuss the risks and benefits with your provider.
Corticosteroids
Corticosteroids (a.k.a. steroids) are often used to reduce painful flareups while you are waiting for a longer-term therapy to start working. They are not recommended for long-term use due to a long list of potential side effects. Commonly prescribed steroids include prednisone and hydrocortisone.
Talking With Your Doctor
Not long ago, having psoriatic arthritis meant living with chronic pain in almost any joint. Thanks to many different new treatments, chronic pain is no longer the expected PsA outcome. Moreover, experts now know that exercise, diet, and mental wellness all play an important role in keeping psoriatic arthritis pain at bay.
If you are in pain, it is important to let your doctor know—this information will serve as a signal to your provider that a new treatment or plan for pain relief is needed.
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