From gq.com
By Caitlin Carlson
Experts share how to identify psoriatic arthritis, and how to stay active if you’re dealing with the condition
It's easy to chalk up stiff fingers, sore knees, or an achy heel to aging (the joys!) or tough workouts. But for some active men with psoriasis, those symptoms may point to something else: psoriatic arthritis, a form of joint pain and stiffness that affects those with the skin condition psoriasis.
You might have psoriasis for a couple of years without joint involvement, but that doesn't mean you’re out of the woods, says Khattri Saakshi, MD, a board certified dermatologist, at Mount Sinai and one of only a handful of triple-board certified physicians across the United States. In fact, the typical delay between a psoriasis and psoriatic arthritis diagnosis is seven to 12 years, according to research published in the Journal of Clinical Medicine. If you don’t have diagnosed psoriasis or any of the accompanying skin symptoms, 10 to 15% of psoriatic arthritis patients develop joint symptoms before any skin issues from a psoriasis perspective show up, Dr. Saakshi says.
There is good news in all of this: Experts say there are now safe and effective medications to manage the condition, and people with psoriatic arthritis can—and should—keep exercising, which may even help alleviate symptoms.
While it’s always wise to see a doctor about your particular symptoms, here are some things to keep in mind if you’re wondering if your joint pain may actually be psoriatic arthritis—and how to keep moving if you do get a diagnosis.
Psoriatic arthritis is an inflammatory condition of the joints that can also impact where tendons and ligaments attach to bones.
Because early detection is key, Dr. Saakshi recommends discussing joint symptoms or morning stiffness with your dermatologist, who can refer you to a rheumatologist, (a doctor that specializes in conditions of the immune system), at every follow-up appointment. “Early diagnosis and treatment is super, super, super important because data says that even a six-month delay in diagnosis has irreversible changes,” Dr. Saakshi says. “We don't have any medications that reverse damage that has happened, it only prevents the progression of damage.”
It’s also important to point out that while many autoimmune conditions are more common in women, psoriatic arthritis is one of the exceptions, says Mayo Clinic Rheumatologist Nolan K. McBride, MD. “Men and women are equally likely to be affected overall,” he says, although women may have more severe symptoms compared to men.
When Dr. Saakshi sees patients, one of the first questions she asks is whether they have stiffness or joint pain that wakes them up at night, or first thing in the morning. Melanie H. Smith, MD, PhD, rheumatologist at Hospital for Special Surgery, agrees this is a “classic” differentiator between sports soreness/injuries and psoriatic arthritis: “With psoriatic arthritis, patients often tell me it feels like I'm moving through molasses,” when they first wake up, she says. “You can definitely feel sore in the morning after a hard workout, but usually you can still move pretty normally after two to 10 minutes as opposed to an hour,” Smith says. “When someone's telling me ‘I'm stiff in the morning’ or ‘I feel worse in the morning than I do in the afternoon,’ to me that is a flag that this is not mechanical issues or a gym injury,” she says. Men in particular have more spine involvement, called axial disease, than women, Smith says, which may cause low back pain that's worse in the morning.
Another “tell” of psoriatic arthritis, Saakshi says, is resting pain or stiffness that comes on after sitting much of the day as well as decreased range of motion.
Smith adds joint swelling to the list, which can be one of the first symptoms of the condition and doesn’t tend to accompany typical post-workout soreness. “In the hands, if there are defined joints, let's say one knuckle is painful, swollen, but the other ones aren't, that can also be a sign that something's up.” The technical term for this is dactylitis, but it’s sometimes referred to as “sausage digits,” Saakshi says. McBride agrees, adding “I always ask patients for changes they can see. Obvious swelling and discoloration of a joint or tendon warrants investigation.” With psoriatic arthritis, “some people also describe feeling flu-ish,” or achy all over, Smith says.
Perhaps the biggest difference between diagnosable psoriatic arthritis and soreness, McBride says, is how long the symptoms last. “Even some of the worst cases of post-workout soreness should start to improve after 48 hours,” he says. Joint pain, excessive stiffness, significant tenderness, or worsening of pain with touching or pushing on the area, especially lasting for days to weeks, should be discussed with your doctor, he adds.
For those with skin psoriasis and no joint concerns now, it’s important to recognize features that may suggest an increased risk for arthritis, McBride says, which may include scalp psoriasis, psoriasis affecting a large portion of the body, and changes to the nails called pits.
Smith points out that family history is a big part of this, too, so find out if anyone in your family has the condition. In patients that have psoriasis, another risk factor for developing psoriatic arthritis is obesity, Smith says. “I spend a lot of time talking to my patients about trying to get to a healthy weight or maintain a healthy weight, eat healthy, control your cholesterol, get exercise daily. All of those things are really important.”
Saakshi says that the question of when and how to exercise comes up with many of her patients. “In the midst of a flare of your joints, it might be a little harder to exercise just because of the component of pain,” she says, but gentle low-impact movement could actually help. And while she can’t point to any hard data on whether exercise can prevent flares, “muscle strengthening around the joints is super beneficial,” she says. Smith agrees: “If you have a gym injury, oftentimes part of the answer is to rest,” Smith says. “With psoriatic arthritis, rest isn't necessarily going to make it better.”
Still, Saakshi cautions against pushing past pain and the range of motion your joints allow at any point in time. “The saying ‘no pain, no gain’ does not apply when you have an inflammatory condition like psoriatic arthritis,” she says.
She encourages patients to try lower-impact activities like swimming, cycling, walking, yoga, or Pilates, if higher-impact activities like running exacerbate symptoms. “It really comes down to how significant the flare is.” McBride adds that enthesitis, inflammation where the tendon attaches to bone, can up your risk for injury, so if this is the case, avoid explosive movements (think: box jumps) and use lighter weights for moves that impact affected areas. “Isometric exercises have been shown to be helpful for those with joint inflammation that is otherwise preventing full range of motion,” McBride says. “Stretching should be an integral part of every day, especially for those with inflammation in the back, to maintain mobility and function.” Smith says that working with a trainer or a physical therapist can also be helpful in these cases.
Once you get a diagnosis and start treatment, you may have more exercise options. “The goal is to have patients have no joint swelling or pain and to be able to do the activities they want to do,” Smith says.“ If that includes running marathons, that is definitely reasonable.”
Unchecked or chronic joint inflammation can lead to permanent damage to the bones, Smith says. “Something we worry about, especially in patients who have long-standing, not completely treated disease, is cardiovascular risk, like risk of heart attack,” Dr. Smith says.
The experts agree that there should be a low bar as for when to see a rheumatologist about any of the aforementioned symptoms. At the end of the day, intervening sooner rather than later is the best choice for your health, McBride underscores. “I want to keep my patients healthy and moving for as long as possible, so they can enjoy doing the activities they love. We are lucky to have so many options now to help people meet that goal.”
