From healthcentral.com
Physicians who treat this challenging condition deliver the facts on what you can expect
When you live with an unpredictable inflammatory joint and skin condition like psoriatic arthritis (PsA), you’re bound to have questions about diet, medications, and more. PsA affects less than 1% of the population, meaning it’s possible you’re the only person in your neighbourhood or even town who has it. That means getting answers to those questions isn’t always easy. We asked rheumatologists to share some need-to-know advice about PsA, and help us understand this uncommon and challenging condition.
You Can Have Psoriasis and Not Develop PsA
Psoriasis (PsO), an inflammatory disease that causes itchy plaques to form on the skin, often co-exists with PsA. Sometimes, PsO is a precursor to PsA, but it isn’t true that everyone who has PsO will go on to develop its sister joint condition. A study in the Journal of the American Academy of Dermatology found that 30% of people with psoriasis eventually get PsA. But those results may not tell the full story since 41% of the psoriasis patients in the study did not know they had PsA before being evaluated as part of that research. “This underscores the fact that many patients with PsA may go undiagnosed,” says Philip Mease, M.D., director of rheumatology research at Providence Swedish Health and clinical professor at the University of Washington School of Medicine in Seattle, WA, who led the study.
“It’s not known which patients will develop PsA,” says Arthur Kavanaugh, M.D., a professor of medicine and director of the Center for Innovative Therapy at UC San Diego Health in San Diego, CA. “Typically the skin disease precedes the arthritis, often by five to 10 years.” But just because you have PsO doesn’t mean your joints will for-sure be impacted. There is, however, a correlation between the severity of psoriasis and the presence of PsA, says Dr. Mease. If your psoriasis is mild, you may be less likely to go on to have PsA, though anyone with psoriasis may develop the related form of arthritis.
Diagnosing PsA Can Be Challenging
As with many other autoimmune conditions, diagnosing PsA usually involves a review of symptoms, tests, and a physical examination by a doctor. “There are no blood tests that can diagnose psoriatic arthritis,” says Eric Ruderman, M.D., associate chief of clinical affairs for the division of rheumatology at Northwestern University Feinberg School of Medicine in Chicago. “It’s a clinical diagnosis that depends on the specific features of the arthritis, although there can be findings on X-ray that can help point to a diagnosis of psoriatic arthritis in those patients who develop joint damage from the disease.”
Dr. Kavanaugh adds that psoriatic arthritis symptoms can mirror those of other forms of arthritis, such as rheumatoid arthritis, osteoarthritis, or gout, which come with joint pain and stiffness as well. And not everyone has active skin symptoms when they seek medical attention, so it can be tricky to pin this condition down. “PsA is one of the types of inflammatory arthritis, but sometimes it is hard to differentiate from other types,” he says.
PsA Is Treatable, But Not Curable
“We don’t usually use the ‘C’ word in patients with autoimmune disease,” Dr. Mease says, referring to a cure. “On rare occasion, a person with autoimmune disease may go into a relatively permanent remission, but we are always aware that the condition can rear its head again. There are no treatments that can cure the disease at this time, though that may change in the future.”
The development of new, increasingly effective medications is helping doctors manage PsA in many patients, including those with serious symptoms. “With many current treatments, patients can do extremely well, even being in remission,” Dr. Kavanaugh adds.
Eating Well Matters
Eating a nutritious, balanced diet that supports healthy weight management is good for your overall health, even though there is no particular diet that has been shown to have any significant effect on PsA symptoms. “Diet is almost certainly crucial to our gut microbiomes, which can influence many diseases, including PsA,” Dr. Kavanaugh says. “However, we don’t know which particular food items play important roles for individual patients.”
Instead, maintaining a healthy weight through diet, exercise, and lifestyle might be a more helpful approach. “Obesity can contribute to more severe disease manifestations and weight loss can lead to improved symptoms, and greater response to treatment with immunomodulatory drugs,” Dr. Mease says. And it doesn’t have to be a lot of weight. “Losing 10% of weight is a goal in order to achieve improvement of symptoms, or at least 5%,” Dr. Mease says.
The doctors also note that, despite bold claims on the labels of many diet and herbal supplements, there is no evidence to suggest that any supplements can control PsA. While there are supplements that may support other aspects of your health while living with PsA, it’s important to consult with your rheumatologist before trying anything.
Careful Exercise May Ease Symptoms
Having any type of arthritis requires a careful approach to exercise. But when done correctly and in moderation, exercise can be a valuable tool in managing your PsA. “A lot of people worry that exercise may worsen arthritis, including inflammatory arthritis like psoriatic arthritis and rheumatoid arthritis,” Dr. Ruderman says. “It’s actually more likely that exercise, or at least physical activity, will be more helpful than harmful.” Regular physical activity can help reduce pain, improve joint function, and enhance overall quality of life.
Dr. Mease adds that the type of exercise you should pursue will depend on the nature of your PsA. “Being conditioned in general and keeping muscles and ligaments strong and supple can be helpful for arthritic joints, either through regular exercise or guided physical therapy,” he says. “There are exceptions, however. If a patient has active inflammation in a joint or tendon insertion area that may become more inflamed with exercise—such as an inflamed ankle or knee joint—then it would be best to hold off on active jogging.” If you need a place to start, try the moves in this article on building a stronger body with PsA.
Stopping Your Medications Suddenly Can Be Risky
As with most conditions that require regular medication use, PsA is best managed if you stick to your regimen. If you have questions about stopping your meds, for any reason, always consult with your doctor.
Dr. Kavanaugh explains that some people, especially those in remission, may be able to taper their doses safely, but few can quit them altogether without the disease recurring. And any tweak in your PsA drug regimen should only be done in collaboration with your doctor.
“Stopping it completely can lead to a flare,” Dr. Ruderman adds. “Any attempts at tapering medication should always be done in collaboration with your treating physician. I would not recommend stopping or even reducing medication without consulting your physician first.
https://www.healthcentral.com/condition/psoriatic-arthritis/things-everyone-should-know
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