Questions to Ask Your Doc About Psoriasis Progression

From healthcentral.com

What you need to know now to manage your condition tomorrow 

When you’re living with psoriasis, the itch and pain of raw, inflamed skin is bad enough. But as you’ve likely been told, there are multiple ways this disease can progress. For one in three people with psoriasis, skin itch and discomfort are only the beginning of the story; the condition can develop into psoriatic arthritis (PsA), leading to joint pain as well. But just because progression is possible doesn’t mean you’re a sitting duck for worsening symptoms. We asked top dermatologists to answer common questions about psoriasis progression and what can be done to stay one step ahead of this disease.

                                                                                GettyImages/SeventyFour

How Bad Can It Get? 

Like other chronic, inflammatory, autoimmune diseases, psoriasis is unpredictable and varies person to person. Some people have mild psoriasis and remain stable for many years, while others may develop more severe disease with serious consequences in a short amount of time. The exact causes of psoriasis are unclear, but it involves an overactive immune system that can impact the entire body. According to the Journal of Drugs in Dermatology, people with uncontrolled psoriasis have high levels of inflammation-causing proteins found not just in the skin, but also in the blood, causing inflammation throughout the body. Untreated, the prolonged inflammation can affect other organs including the heart, liver, kidneys, and intestines, as well as joints, muscles and eyes.

What Are My Odds of Developing Psoriatic Arthritis?

“Psoriatic arthritis affects over 25% of people with skin psoriasis and can develop years after the skin involvement shows up,” explains Kate Edwards, M.D., a board-certified dermatologist at Westlake Dermatology in San Antonio, TX.

While anyone with psoriasis can develop psoriatic arthritis, those with nail and scalp involvement should especially be on the lookout, as those types are closely linked with PsA. “Nail psoriasis can present as small irregular pits in the nails, oil spots, splitting, and thickening of the nail,” says Dr. Edwards. Early psoriasis treatment with advanced medications like biologic therapies may help prevent the development of psoriatic arthritis. “These are injections administered at home every one to three months that target a specific part of the psoriasis pathway, treating the condition from within,” Dr. Edwards explains. Since biologics decrease inflammation in the whole body, they can often prevent the development of joint involvement when initiated early enough, she says.

How Do You Evaluate Whether or Not My Treatment Is Working?

If you have psoriasis, you will hopefully be seeing your primary care physician or dermatologist regularly. Staying in contact with your provider is one of the best ways to stay on top of your disease. If you are not seeing an improvement in your psoriasis symptoms after three to six months of treatment, it is time to talk to your provider about your other treatment options, according to the National Psoriasis Foundation.

More specifically, your provider should be working with you to reduce the severity of your psoriasis so that it covers 1% or less of your body within three months after starting a treatment. You should also let your provider know if you have worsening side effects from the treatment or any new symptoms. If you do need to change treatment, you won’t be alone. In one study of those living with psoriatic disease, over half discontinued their original treatment before 12 months.

Should I Worry About Aching Joints?

If your psoriasis develops into psoriatic arthritis, early treatment is mission critical. According to the Johns Hopkins Arthritis Center, the earlier the treatment for PsA, the more likely you can prevent serious damage later.

But sore joints can happen for a variety of reasons, and it can be hard to tell if your aches are related to psoriasis, or just a normal part of life. Only your doctor will know for sure, but if you are experiencing any of these symptoms, you should make an appointment to see you provider and have things checked out:

• Inflammation where the tendons connect to the bone, especially on the bottoms of the feet, the Achilles' tendons, and where ligaments attach to the ribs, spine, and pelvis

• Inflammation or swelling of an entire finger or toe

• Pain in your neck, lower back, or sacroiliac joints

• Swelling, pain, or stiffness in any joint

• 
  

• Why Does My Psoriasis Come and Go?

There is no cure for psoriasis, but it is possible to put it on pause. That time when the disease is quiet is called remission. When the disease and its symptoms are reactivated, this is called a flare in the condition. A flare in psoriasis can happen for both unknown and known reasons including the exposure of certain triggers such as an extreme change in weather, medication becoming ineffective, or an increase in your stress levels.

Some experts believe that even when psoriasis is in remission and is without symptoms, there is still a molecular change to the healed skin that creates a sort of inflammatory memory where the psoriasis occurred which may make it easier to become inflamed again.

Can Psoriasis Affect My Eyes?

Uncontrolled inflammation related to psoriasis can also impact your eyes. Complications affecting the eyes such as lesions of the eyelids, uveitis, and conjunctivitis can all be associated with psoriasis. These eye related conditions occur in 10% to 12% of those with psoriasis.

According to a review in Experimental and Therapeutic Medicine, certain psoriasis treatments, including disease modifying antirheumatic medications, phototherapy, and some biologic medications can also cause eye changes. The most common eye change associated with psoriasis is dry eye syndrome (keratoconjunctivitis sicca) which occurs in about one out of five patients. There doesn’t seem to be an association between the severity of psoriasis and eye changes, which means that for anyone living with psoriasis, regular eye examinations are a must.

Why Do Some Meds Work for Some People but Not Others?

If your psoriasis symptoms are progressing, it’s natural to wonder what other people are taking that’s keeping their skin in remission. What works for them should work for you, right? Unfortunately, it’s not as easy as that, says Michele Green, M.D., a board-certified New York City dermatologist at Northwell’s Lenox Hill Hospital in New York City. There are several reasons why a psoriasis medication that works for one person might not work for another, including variations in the disease itself, individual differences in immune system dysfunction, and how the body processes the medication, Dr. Green explains.

Psoriasis is an immune-mediated disease, meaning an overactive immune system causes it. According to Dr. Green, “The specific pathways and cytokines, the proteins that signal between cells involved in the immune response can vary between individuals, even if they have the same type of psoriasis,” she says. “Medication targeting a particular pathway may be highly effective for someone with a strong involvement in that pathway, but less so for someone whose immune response is driven by a different pathway.”

Dr. Green says it’s important to remember that psoriasis is not a single, uniform condition. “There are various types, including plaque psoriasis, guttate psoriasis, inverse psoriasis, and pustular psoriasis, each with distinct characteristics and potentially requiring different treatment approaches,” she says. “The severity of psoriasis can also vary significantly, ranging from mild to severe. A medication that is effective for mild psoriasis may not be sufficient for severe cases.” Even within a specific type of psoriasis, the underlying immune system mechanisms might differ slightly from person to person, influencing treatment response.

Medications are also processed by the body differently in each person. Factors such as age, weight, kidney and liver function, and other medications can influence how a drug is absorbed, distributed, metabolized, and excreted, Dr. Green notes. “Some individuals may metabolize a drug more quickly, resulting in lower blood levels and reduced effectiveness, while others may metabolize it more slowly, potentially leading to increased side effects,” she adds. Drug interactions with other medications can also impact treatment outcomes.

That’s why it is essential to consult a dermatologist and receive a proper diagnosis to treat the condition specifically tailored to you, rather than relying on medication prescribed for others.

Finding the Right Team

Psoriasis care often begins with your primary care provider. If your condition worsens or other symptoms show up, it’s important that you add more specialized providers to your medical team including a dermatologist and if your joints are involved, a rheumatologist. Either of these specialists will then be able to refer you to other medical professionals such as a physical therapist, orthopaedist, or an ophthalmologist who are experienced with psoriatic disease. The National Psoriasis Foundation maintains a health care provider directory that may help you build a great team. You can’t always prevent psoriasis progression, but the more steps you take now to stay on top of your symptoms, the better your odds of slowing its advancement.

https://www.healthcentral.com/condition/psoriasis/questions-to-ask-your-doc-about-psoriasis-progression?ap=nl2060&rhid=67ec2b8321f52bf01b0cca01&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGchiJjMktbUg0XOK3gqD-fjU93F9-fSEVeBlmF-qg6wo2ii_jce9wsQKtU-NGPpjFcGXgtRwJPAOfOtsOrxWMXgDrauGcEgWbrSu07YLAqWIbvKq0

Psoriasis, Sleep, and Mental Health: What’s the Connection?

From healthcentral.com

A new study has uncovered a strong link between psoriasis, REM disturbances, and depression—suggesting the condition is anything but skin deep 

If you have psoriasis and struggle to sleep at night, your issue might be more than skin deep. New research reveals a strong connection between psoriasis, sleep problems, and mental health—with each condition potentially worsening the others. Psoriasis itself causes an overactive immune system to produce inflammation and rapid skin cell build-up, leading to itchy, uncomfortable patches that can disrupt sleep. “Stress, injury to the skin, allergens, certain medications, even infections, can all trigger a psoriasis flare,” explains Veena Vanchinathan, M.D., a board-certified dermatologist at Kaiser Permanente in San Jose, CA who is not associated with the study. These same triggers often disturb sleep patterns as well, making sleep management just as important as traditional treatments for managing psoriasis effectively.

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People With Psoriasis Sleep Poorly—and Feel Worse

In the recent study, presented at the American Academy of Dermatology Spring 2025 conference, Tina Bhutani, M.D., a board-certified dermatologist in private practice and volunteer faculty member at University of California, San Francisco, found that poor sleep doesn’t just cause daytime fatigue—it can amplify mental health issues and create a cycle of worsening psoriasis flares and increasing sleep disruption.

Dr. Bhutani and fellow UCSF researchers surveyed 487 people with psoriasis and 69 individuals without the condition, using validated questionnaires to assess sleep quality, depression, and anxiety. Psoriasis patients scored significantly worse across all measures—they had more trouble falling asleep, woke more frequently, experienced more insomnia symptoms, and showed higher depression and anxiety levels.

When examining the relationship between sleep and mental health specifically within the psoriasis group, the researchers found that even after adjusting for factors like disease severity or treatment, greater sleep impairment was significantly associated with anxiety and depression.

“Our results confirm the association between sleep quality and mental health in these patients,” says Dr. Bhutani. “But it’s not just that psoriasis patients tend to have sleep issues and mental health issues separately. The data shows the worse your sleep is, the more likely you are to also be experiencing anxiety and depression.”

Why Psoriasis Might Ruin Your Sleep

It makes sense that the itching and pain from psoriasis patches significantly impact sleep quality. Past research has shown that people with psoriasis are twice as likely to have sleep issues than the general population, with more than 85% of psoriasis patients reporting sleep difficulties. But physical discomfort isn’t the only culprit.

“There’s also research that suggests the heightened inflammatory process—the very thing driving the psoriasis—might interfere with the body’s sleep regulation system,” explains Dr. Bhutani.

Dr. Bhutani first became interested in this connection when one of her patient’s psoriasis dramatically improved after his sleep quality increased. “He had really tough to treat psoriasis and we had basically tried everything,” says Dr. Bhutani. “He came in one day and his skin was practically clear.” The patient’s wife had been treated for sleep apnoea, which had been disturbing both their sleep. Once she received treatment, both got better rest—and his psoriasis nearly disappeared. This case inspired Dr. Bhutani to investigate the sleep-psoriasis relationship further.

A Holistic Approach to Managing Skin Flares

The strong interconnection between psoriasis, sleep problems, and mental health suggests these aren’t simply co-occurring conditions—they’re actively influencing each other. Psoriasis symptoms directly interfere with sleep, and that lack of restorative rest takes a toll on mental health, creating what Dr. Bhutani calls “a potentially vicious cycle” of worsening skin, poorer sleep, and increasing depression and anxiety.

While more research is forthcoming, this study demonstrates why a holistic approach to psoriasis treatment is essential. “As dermatologists, we’re trained to treat skin diseases, but we also need to encourage our patients to seek help for sleep disorders, anxiety and depression, and other associated conditions, like cardiovascular disease and diabetes,” emphasizes Dr. Bhutani.

Beyond medication, making lifestyle changes that improve overall health can have a big impact on your psoriasis. Eating better, exercising more, managing stress, and, yes, improving sleep quality can all lead to fewer flare ups, clearer skin, and a happier outlook on life.

If your psoriasis symptoms are keeping you awake, talk to your doctor about topical treatments that can help soothe the itch and inflammation. After that, make sleep a priority by keeping your bedroom cool and dark to encourage your body to fall asleep and sticking to a regular schedule. “A consistent sleep schedule, same bedtime, same wake up time—even on weekends, can help you get higher quality sleep,” says Dr. Bhutani.

https://www.healthcentral.com/news/psoriasis/psoriasis-sleep-and-mental-health-connection?ap=nl2060&rhid=67ec2b8321f52bf01b0cca01&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGchiJjMoK5Mt6msMeIKLwRGhTe0k4H-66Kp_aBqVGjJ1WWpAYIo4sGKf43UE4Zv9gSLozlVi6vJPEjrbWjTbY_IEAm_JDNqBvKBGMxFY3q0URtcBw

Psoriasis treatments can be life-changing

From medicalxpress.com

If you suffer from psoriasis, vibrant, clear skin is no longer out of reach.

"The idea of clear skin for patients with psoriasis, which once was not really an achievable goal, is now something we can talk about as a possibility," says Rush dermatologist David C. Reid, MD. "This is because of how treatment has been revolutionized over the past decade."

Psoriasis is a common condition caused by inflammation that leads to patches of red, scaly skin—called plaques—on different parts of the body. It affects nearly 125 million Americans. The disorder crosses all ethnic, age and gender boundaries, but is most commonly found in adults between ages 30 to 40 and 50 to 70.

Symptoms

Red, scaly plaques are the most common symptom of psoriasis. It's frequently found on the elbows, knees and scalp, though the condition does not shy away from more visible areas like the face, nails and hands. But psoriasis is not one-size-fits-all. Some have only one isolated area of concern, while others possess much larger patches throughout the body.

Even as scientists are still investigating its causes, studies so far have pointed to genetic factors that can be exacerbated by environmental conditions such as a dry climate. Psoriasis symptoms also flare up during the winter, when we spend more time indoors and the cold, dry weather makes the skin more vulnerable.

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Quality of life

What scientists do know is that psoriasis is not contagious, a widely held belief that often leads some to stay away from those with the condition.

"It can affect the ability to participate in social interactions, to form relationships," Reid explains. "It has an impact on a patient's ability to work and engage in their profession fully. It can prevent sufferers from living their life in a full way."

This stigma means that the disorder is often accompanied by psychological difficulties. Those with the condition can experience a lower sense of self-esteem and even depression, according to Reid. Although doctors and advocates have tried to make it more widely known that it is not communicable, visible signs of psoriasis have nonetheless been associated with greater feelings of isolation in both social and professional settings.

Over time, people with psoriasis tend to avoid certain situations that bring attention to their physical symptoms, which can be devastating in the long term.

"We know this condition can have a considerable impact on patients' mental health over time," Reid says. "But there are also underlying associations with other systemic inflammatory illnesses."

Chronic psoriasis patients who go without treatment may be at a higher risk of strokes, heart attacks and other adverse cardiac events. Other conditions associated with psoriasis include diabetes and inflammatory bowel disease.

The most often noted disorder linked to the condition is psoriatic arthritis, which develops in nearly a quarter of psoriasis patients. Psoriatic arthritis can develop at any age but is frequently found in those between 30 and 50, about 10 years after psoriasis itself has developed. This joint pain caused by psoriatic inflammation can be debilitating. If left untreated, psoriatic arthritis can progressively destroy joints over time.

Treatment options

Treatment for psoriasis has been revolutionized over the past decade, with newer options proving much more effective in targeting different types of the disease.

Patients with mild psoriasis typically receive topical treatments for the affected area. These include over-the-counter creams, ointments and shampoos that are applied directly to the skin.

People who have moderate or severe cases can opt to have phototherapy. Also referred to as light therapy, it is a safe and effective treatment that typically uses narrow-band UVB rays. It does not have the damaging side effects of UVA light rays from the sun or tanning beds, and it can penetrate the skin to slow the growth of psoriatic plaques.

Prescription medications for psoriasis have seen some of the greatest innovations in recent years. Taken orally, by injection or by infusion, these medicines are called "systemic" since they work throughout the body, explains Reid. Most often prescribed for moderate-to-severe psoriasis, systemics provide patients with many more options for tailoring their treatment to their needs.

Three different types of medications are used to treat psoriasis:

• Oral medications, whether taken in pill or fluid form, help reduce psoriatic inflammation. Newer oral medications target molecules in particular immune cells, instead of the whole body.
• Immunosuppressant agents work by subduing the immune response that causes psoriatic inflammation. This often leads to a reduction in redness on the skin, the amount of psoriasis scales and swelling.
• Biologics are the newest type of treatment. Given as an injection or infusion, biologics are targeted therapies that block specific parts of the inflammatory pathway that are known to cause psoriasis.

Getting the help you need

When dealing with a chronic illness like psoriasis, it's vital to find a provider whom you trust and who knows all of the latest treatments so that they can tailor a plan to your specific needs. Reid says that this is crucial.

"The important thing is that we discuss the risks and benefits of all the treatments and outline the full spectrum of available options with our patients," he explained. "Because we really want them to be involved in the decision-making when it comes to their treatment."

https://medicalxpress.com/news/2025-08-psoriasis-treatments-life.html 

Can a Vitamin Help Calm Psoriasis? New Study Says Yes

From healthcentral.com

Recently published research shows getting enough vitamin B2—also called riboflavin—might help protect against psoriasis

Riboflavin, or vitamin B2, is having a moment. The essential micronutrient found in everyday foods made headlines earlier this year when Health and Human Services Secretary Robert F. Kennedy Jr. questioned its use, along with other additives, in processed foods.

“Many cereals and breads in the United States are fortified with riboflavin,” says Alison Ehrlich, M.D., a board-certified dermatologist in Chevy Chase, MD. While some may dispute its necessity, vitamin B2 plays a critical role in your body’s ability to function properly.

Riboflavin is a water-soluble vitamin found in foods you’re likely to have in your kitchen: milk, eggs, salmon, nuts, spinach, and fortified cereals. It helps convert food into energy, supports healthy skin, eyes, and nerves, and combats oxidative stress. And now, new research suggests it may be beneficial in preventing or managing psoriasis, a chronic inflammatory skin condition that affects 125 million people worldwide.

Breaking Down The New Research

The study, published in Experimental Dermatology, points to vitamin B2 as a potential ally in calming inflammation and reducing flare-ups. Scientists at the China-Japan Friendship Hospital in Beijing, China, came to that conclusion after reviewing the diets of more than 13,000 adults with and without psoriasis. They noticed people who consumed more riboflavin were less likely to have the condition—especially when they looked at individuals over the age of 40.

Then they zoomed in. Using transcriptome analysis, which looks at gene expression, the researchers examined skin cells and observed that low riboflavin levels triggered inflammation. When the vitamin was reintroduced, the stress response lessened, and the inflammation calmed down. Skin cells with psoriasis appeared to absorb even more riboflavin, leading researchers to believe the body uses the B vitamin to heal PsO-damaged skin and protect against more damage.

What Dermatologists Want You To Know About Riboflavin Research

This isn’t the first time scientists have studied the effect of riboflavin on psoriasis. Way back in 1958, a study in Archives of Dermatology reported mixed results from some of the first trials: some patients experienced reduced inflammation and irritation after taking large doses of riboflavin, while others saw no improvement. But the findings encouraged scientists to keep looking into vitamin B2.

“This new research provides more clues into how riboflavin affects psoriasis—both at a population level and at the cellular level,” says Veena Vanchinathan, M.D., a board-certified dermatologist in California’s Bay Area and a member of the American Academy of Dermatology.

What caught her attention: “The transcriptomic correlations with metabolic and inflammatory pathways of riboflavin are particularly interesting and worth further study,” she says. Transcriptomics looks at which genes are turned on or off in your cells to understand how they’re working or reacting.

Dr. Ehrlich, who also reviewed the study after it was published, agrees that the new findings are intriguing, but not game-changing. “It’s important to note the limitations,” she says. “This study doesn’t prove that riboflavin deficiency causes psoriasis. It could be that people with psoriasis simply eat less of the vitamin.” Additionally, the researchers didn’t look into the severity of the psoriasis—whether it was mild or widespread.

“We can say it’s an interesting finding,” says Dr. Ehrlich, “but it warrants further exploration in a well-designed, clinical trial.”

What This Means for Your Psoriasis

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This study probably won’t change how you handle your next psoriasis flare—you’ll still want to rely on dermatologist-approved treatments like topical creams and light therapy. But it may add a new tool to your psoriasis management plan: your plate.

Physicians should discuss a diet high in antioxidants and low in processed food with all patients who have inflammatory skin diseases,” says Dr. Ehrlich. A healthy diet is already linked with better psoriasis outcomes, and these new findings suggest adding more vitamin B2-rich foods might help, too. (The recommended daily allowance is about 1.2 mg/day.)

Foods high in riboflavin include:

• Cheese (0.1 mg/1 oz)

• Chicken breast (0.1-0.2 mg/3 oz)

• Cooked leafy greens, like spinach (0.4 mg/cup)

• Dairy milk (0.4-0.5 mg/cup)

• Eggs (0.2-0.3 mg/egg)

• Fatty fish, like salmon (0.2-0.3/3 oz)

• Fortified cereals and breads (0.6-1.3 mg/cup)

• Lean beef and pork (0.2-0.4 mg/3 oz)

• Nuts, like almonds (0.3 mg/1 oz)

• Organ meats, like beef liver (2.8-3 mg/3 oz)

• Yogurt (0.3-0.5 mg/cup)

“Well-balanced nutrition certainly plays a role in immune health and inflammation,” says Dr. Vanchinathan. “Sufficient riboflavin levels could potentially reduce the severity of your condition, but psoriasis is complex, and no single vitamin is a cure.” She also advises against taking supplements without talking to your doctor first.

Riboflavin supplements are generally considered safe, but popping a pill may be unnecessary for most people. “Vitamin B2 deficiency is considered extremely rare in the US,” says Dr. Ehrlich. So, if you’re already eating a variety of riboflavin-rich foods, a supplement probably won’t be beneficial.

The Bottom Line

Riboflavin may play a valuable role in calming inflammation and improving skin health for people with psoriasis, but more research is needed before doctors will recommend supplements. That said, eating more riboflavin-rich foods is a safe and healthy step. If this new study inspires you to order a spinach salad for lunch or reach for almonds at snack time, great. Filling your plate with nutrient-dense foods is a smart strategy for easing psoriasis symptoms and supporting your overall health.

https://www.healthcentral.com/news/psoriasis/vitamin-b2-riboflavin-and-psoriasis

Psoriatic Arthritis FAQs: Questions to Ask Your Rheumatologist

From healthcentral.com

Newly diagnosed? Brief yourself on these PsA must-knows, and then bring this list of questions to your doctor 

A diagnosis of chronic illness can leave you with more questions than answers and a complex disease like psoriatic arthritis (PsA) can be especially confusing. Psoriatic arthritis isn’t a condition people know much about, unless they have it or someone close to them does. If psoriatic arthritis has made an appearance in your life, you’re going to want to know what to ask your doctor. Read on to get a briefing on the major FAQs for this condition, and then bring this list, plus any other questions that pop up, to your rheumatologist appointment so that you can get answers.

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What Caused My Psoriatic Arthritis?

Psoriatic arthritis is an autoimmune condition that causes the body to attack healthy cells in the joints, as if they were a bacteria or virus that needs to be fought. The exact cause of psoriatic arthritis is unknown, but experts think a combination of genetics (a family history and specific inherited genes) and environmental factors (stresses to the body like infection, injury, psychological stress, and obesity) ultimately come together to trigger the condition, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

“Autoimmune conditions tend to be more common in females, but PsA affects females and males equally in adults,” says Dori Abel, M.D., a paediatric rheumatologist in Philadelphia.

How Will You Diagnose My Condition?

Since no single test can diagnose the condition, your doctor will take several steps to determine if psoriatic arthritis is causing your symptoms. These steps can include:

Taking a Full Family History

You are more likely to have psoriatic arthritis if a family member has psoriasis or psoriatic arthritis.

Performing a Physical Exam

“The most important test is a clinical exam, as there are certain signs and symptoms which are very typical for psoriatic arthritis,” says Lisa Mandl, M.D., a rheumatologist at Hospital for Special Surgery in New York City. During this exam, your doctor will ask about what symptoms you’ve been experiencing and examine your joints (looking for swelling and tenderness), skin, and nails to look for changes consistent with PsA and psoriasis.

Doing Lab Work

You may also have blood drawn and tested. Some biomarkers found in the blood, like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) signify inflammation, and that can tell your doctor that you likely have an autoimmune condition, per the Arthritis Foundation. However, they don’t automatically mean you have psoriatic arthritis. Other substances in the blood, like rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies, can rule out rheumatoid arthritis. Even if blood tests are negative, they can help determine what conditions you don’t have, Dr. Mandl notes.

Ordering Imaging Tests

X-rays, MRIs, and ultrasounds can find changes in the joints and surrounding tissues that signify psoriatic arthritis inflammation and damage.

Taking a Sample of Synovial Fluid

Synovial fluid is a lubricating liquid found in the joints that keeps bones from rubbing against each other and allows the joints to function smoothly. A synovial fluid analysis, which involves removing some of this fluid from a swollen joint and sending it to a lab to test for signs of inflammation, can also help rule out other conditions such as gout or an infection, says Dr. Mandl.

What Are the Most Common Symptoms of Psoriatic Arthritis?

Psoriatic arthritis symptoms and the order in which they show up, can vary from person to person. Most people with psoriatic arthritis have psoriasis first, but it’s also possible to have joint pain before experiencing any skin symptoms, per NIAMS. (It’s also possible to have PsA without psoriasis, Dr. Abel notes.) The most common symptoms of psoriatic arthritis include:

Joint Issues

Joint-related symptoms may include:

• Stiffness, pain, and swelling of one or more joints that’s often worse in the morning or after periods of inactivity

• Painful, sausage-like swelling of an entire finger or toe (dactylitis)

• Tenderness in the areas where tendons or ligaments attach to bones, like the back of the heel and sole of the foot

The joints of the fingers—and specifically, the distal interphalangeal joints (DIPs), which are the last knuckles before your nail beds – are most often affected by psoriatic arthritis, says Dr. Abel. However, she adds, it can also affect other joints, including the knees, ankles, elbows, wrists, spine, neck, and hips. Psoriatic arthritis is often asymmetric (meaning it doesn’t necessarily impact matching joints on both sides of the body), but when it affects many joints (more than five), it is likely to become more symmetric, Dr. Abel says.

Other Symptoms

Non-joint-related symptoms of psoriatic arthritis can include:

• Fatigue

• Scaly, inflamed patches of skin, commonly on the scalp, elbows or knees

• Nail changes, such as pitting (tiny dents), crumbling, or separation from the nail bed

• Eye inflammation that causes pain, redness, and blurry vision

• 
  

• How Will You Treat My Condition?

• "There are two types of initial treatment for psoriatic arthritis: treatment to improve your symptoms quickly so that you feel better, and treatments to stop psoriatic arthritis from getting worse over time and damaging your joints,” says Dr. Mandl. Factors like which body parts are affected, the severity of your symptoms, which ones bother you the most, other health problems you have, and your health insurance will all influence what treatment your doctor starts you on, per the Arthritis Foundation.

For example, “If someone only has a joint or two involved, we may just inject that joint with steroids,” Dr. Abel says. But when it’s more than a couple of joints, or if the arthritis keeps coming back in the same joint and you need repeat injections, “you want to be considering systemic therapy,” she says. Many people with psoriatic arthritis should expect to be on long-term therapy that keeps their disease under control and prevents progression and joint damage.

Treatments for psoriatic arthritis include:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs like ibuprofen, naproxen, aspirin, and nabumetone treat mild psoriatic arthritis by reducing inflammation and improving joint pain.

Corticosteroids

Steroids—most commonly prednisone—are used to quickly reduce inflammation and get symptoms under control. They can be helpful during a flare or as a bridge until a new treatment starts to work, which can take a few months, Dr. Abel says. Steroids can be taken orally or via injection.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

These drugs lower inflammation, reduce symptoms, and prevent joint damage by suppressing the body’s overactive immune system. Examples include:

• Arava (leflunomide)

• Azulfidine (sulfasalazine)

• Rheumatrex (methotrexate)

Biologics

A biologic is a type of DMARD made from a living microorganism or cell. These medications target specific proteins in the immune system to control psoriatic arthritis; most are taken by injection or IV. They’re classified according to what part of the immune system they zero in on. A few examples:

• Tumour necrosis factor (TNF) inhibitors. Remicade (infliximab), Enbrel (etanercept), Humira (adalimumab), Cimzia (certolizumab), Simponi (golimumab)

• Interleukin-17 (IL-17) or interleukin 12 and 23 (IL-12/23) inhibitors. Cosentyx (secukinumab), Tremfya (guselkumab), Siliq (brodalumab), Stelara (ustekinumab)

• T-cell inhibitors. Orencia (abatacept)

Are There Side Effects to Treatments?

All medications come with potential side effects and psoriatic arthritis drugs are no exception. The side effects that you might experience depend on the type of medication you’re taking.

• NSAIDs: Using NSAIDs long-term can cause stomach irritation and ulcers, internal bleeding, kidney problems, and heart problems.

• Corticosteroids: Steroids are meant to be used only short term because they can cause some pretty rough side effects with long-term use, including osteoporosis, high blood pressure, adrenal insufficiency, diabetes, mood problems, and glaucoma.

• DMARDS and biologics: DMARDs and biologics are the strongest and most effective medications for PsA. “They work to quiet the inflammation in joints and skin by lowering the immune system, which also puts you at a slightly increased risk of infection,” says Dr. Abel. Depending on the medication, side effects can include fever, mouth sores, hair loss, stomach upset, fatigue, and liver and kidney damage. When taking one of these medications, your doctor will send you for regular bloodwork to make sure you’re tolerating it well and that they catch any changes in the liver and kidneys early, Dr. Abel says.

If you’ve started a new medication recently, it’s important to let your doctor know if you’re experiencing any new symptoms, even if they seem unrelated, especially fever or any other significant illness, notes Dr. Abel.

What Lifestyle Changes Do You Recommend?

A few lifestyle shifts can help improve psoriatic arthritis symptoms and overall health.

Exercise

“It is important to be active, especially if you have not been because your joints have been hurting,” Dr. Mandl says. Exercise has been shown to reduce pain and improve physical function in people with PsA, according to research on optimal lifestyle management of PsA in Rheumatic & Musculoskeletal Diseases Open. The reason is unclear, but it could be because exercise has anti-inflammatory effects, helps with weight management, and improves mobility and strength in the muscles and tissues that support the joints. Increased physical activity also helps prevent associated conditions such as heart attack, stroke, and diabetes, Dr. Mandl notes.

Weight Management

Maintaining a healthy weight is an important part of living better with psoriatic arthritis. “People with psoriatic arthritis can be at increased risk of weight gain as they get older,” Dr. Mandl notes. Excess weight not only increases the risk of comorbidities like heart disease, stroke, metabolic disease, and diabetes, but fat tissue also contains inflammatory cells, so reducing it can be beneficial, per the RMD Open research. People who are overweight may also not respond as well to psoriatic arthritis medications, per research on obesity and PsA in Rheumatology and Therapy.

“Eating a healthy diet, such as a Mediterranean diet high in omega fatty acids, is also a good idea,” says Dr. Mandl. There’s not one best diet for PsA, but focusing on good nutrition and a healthy diet can help with weight maintenance and reduce the risk of cardiovascular disease and metabolic disease—both of which people with psoriatic arthritis have a higher risk of developing, per the RMD Open review. Some research also suggests that eating more anti-inflammatory foods can help promote lower levels of inflammation in the body, though there’s not a lot of strong evidence, the review notes. “The best evidence is for the Mediterranean diet,” says Dr. Abel. “That means focusing on whole grains, legumes, fruits, vegetables, lean meats, and proteins.”

Sleep

Getting good quality sleep may also help with disease management. For one, sleep deprivation affects the hormones that control hunger and satiety, and makes you more likely to overeat and choose unhealthy foods, per the RMD Open review. It also increases cortisol and promotes inflammation.

Do I Still Need to See My Other Doctors?

Short answer: Yes! Your rheumatologist will be your point person for all things psoriatic arthritis, but your other doctors still play an important role in your overall healthcare. For example, you’ll want to see your usual providers for age-appropriate cancer checks, like a pap smear, mammogram, and colonoscopy, Dr. Mandl says.

“You should also see a dermatologist yearly for a skin check, as many of the medications used for psoriatic arthritis increase your risk of non-melanoma skin cancers, including basal cell and squamous cell carcinoma,” Dr. Mandl notes.

Is It Normal to Feel Tired?

Unfortunately, yes. Fatigue is common among people with psoriatic arthritis. One study on fatigue in psoriatic arthritis in the Annals of Rheumatic Diseases found that almost half of all study participants experienced at least moderate fatigue, with over 27% experiencing severe fatigue. Another study on fatigue in psoriasis and PsA in Advances in Dermatology and Allergology also found that 28% of participants with PsA reported severe fatigue compared to 17% of those with psoriasis and 1.6% of the control group with neither condition.

Psoriatic arthritis may cause fatigue directly—constantly fighting inflammation drains your body’s resources—and indirectly, as a result of medication side effects, inactivity, anaemia, depression, and lack of sleep (due to pain). Since fatigue seems to be partially caused by inflammation and pain, getting the disease under control with the proper treatment can help improve your energy levels.

Exercise is also beneficial for combatting fatigue, Dr. Mandl says. “You have to wait until your inflammation is under control, and there is often a lag time between getting the inflammation under control and fatigue getting better,” she notes. “Once you start exercising, ramp up slowly, and don’t be discouraged if you are more tired initially.” Once you adjust to the activity and make it a regular part of your routine, it can be energizing.

“Taking care of one’s mental health is also really important,” says Dr. Abel. “There’s a lot of work being done in rheumatology in general and in psoriatic arthritis specifically about mental health because there’s a lot of overlap between depressive symptoms, fatigue, and psoriatic arthritis,” she explains. “If you’re depressed and don't want to move, that’s going to stiffen the joints. You also get endorphins from exercising, so if you don't do it, you can get depressed, and it’s this vicious cycle.” Seeing a therapist and being treated—either with therapy, medication, or both—for depression symptoms can help with overall psoriatic arthritis symptoms, especially fatigue, Dr. Abel says.

Remember, psoriatic arthritis is a systemic disease, so shoring up your overall health, both physically and mentally, is a great way to improve the condition and help you feel better day-to-day.

https://www.healthcentral.com/condition/psoriatic-arthritis/questions-to-ask-your-doctor