Psoriasis Arthritis: How to recognize and live with it

Psoriatic arthritis is a chronic inflammatory disease of the joints with skin involvement. Around 30 million patients worldwide live with it – women and men, young and old people alike are affected. Psoriatic arthritis is increasingly diagnosed between the ages of 30 and 50.

A few weeks ago we already dealt with the topic of concomitant diseases in psoriasis. Probably the most frequently occurring form is psoriatic arthritis (PsA for short). Many patients who suffer from psoriasis fear that sooner or later they will also suffer from psoriatic arthritis.

Every little pain in the joints is immediately associated with this possible extension of the skin disease. However, many people do not know exactly what psoriatic arthritis is and how it manifests itself and that a diagnosis no longer has to involve major cuts in life. Although the exact causes have not been fully clarified to date, the disease is nevertheless well treatable today, so that patients can live without complaints in many cases.

What exactly is psoriatic arthritis?

Psoriatic arthritis is a chronic inflammation of the joints. Mostly the hands and feet as well as the spine are affected. Joint pain and restrictions in movement are the result. The disease occurs in up to 30 percent of those affected by psoriasis.

In principle, psoriatic arthritis can appear at any age, but this disease of the joints typically develops between the ages of 30 and 50. As a rule, plaques on the skin precede the infestation of the joints. However, about ten percent of those affected lack the classic skin changes. Therefore, a diagnosis is difficult, as there is a high risk of confusion with other (rheumatic) joint diseases, such as chronic polyarthritis (rheumatism).

Although the exact causes of psoriatic arthritis are not yet fully understood, it is now known that PsA is a malfunction of the immune system. This imbalance of the immune system means that inflammation does not subside, but instead leads to permanent inflammatory processes. Although psoriatic arthritis is primarily a disease of the joints and skin, it can also cause discomfort in other organs, such as:

• eyes,
• kidneys,
• intestine and/or
• cardiovascular system.

In addition, those affected by PsA often suffer from concomitant diseases such as diabetes or depression.

Doctors assume that there are a whole range of triggers for psoriatic arthritis.

Among the triggers of psoriatic arthritis are

• obesity,
• stress,
• nicotine,
• hormonal changes,
• various drugs (e.g. beta blockers),
• genetic predisposition,
• alcohol and/or
• skin lesions.

How to recognize psoriatic arthritis?

The characteristic symptoms of psoriatic arthritis show themselves in the form of inflamed joints in connection with the skin changes typical of psoriasis. The inflammation of PsA usually causes pain, swelling and restricted movement, but often begins insidiously.

Most frequently affected at the beginning are the end joints, i.e. the last joints of fingers and toes. As psoriatic arthritis progresses, the swelling and inflammation often affects all joints of the finger and toe. However, other joints can also be affected, such as

• the spine,
• the knees,
• the hips and
• the shoulders.

If you notice one or more of the following points in yourself, this is a first indication of psoriatic arthritis:

• pain in the area of your joints,
• swelling of the fingers or toes,
• stiff body in the morning (after some exercise it gets better) and/or
• back pain.

Psoriatic arthritis symptoms typically occur in the morning – immediately after waking up – or in the evening. If you notice these characteristics, it is best to consult a doctor as soon as possible.

Because untreated, psoriatic arthritis can lead to deformation or, in the worst case, destruction of the joints. These then usually remain permanent and cannot be changed by further therapies.

The diagnosis of psoriatic arthritis

Psoriatic arthritis shows itself in 90 percent of all manifestations with so-called plaques on the skin. These mostly contain shiny silvery white scales on the skin surface.

In the other ten percent, the connection is not immediately obvious, which makes the diagnosis more difficult.

Basically, the detection of psoriatic arthritis takes place in three steps.

1. First, your doctor will examine your detailed medical history. By means of
   questionnaires and classification criteria, your history of suffering and the
   characteristics of psoriatic arthritis are assessed.
2. Afterwards the doctor will take a close look at your joints. He will take a close look at your joints and palpate them.
3. In the last step, further investigations are used. This can be an X-ray or ultrasound examination or you can literally look into the tube (this is called MRT or magnetic resonance therapy). On the other hand, your blood can be tested in the laboratory. This involves checking for signs of inflammation, rheumatoid factors or blood sedimentation.

Unfortunately, there is no clear sign that you suffer from psoriatic arthritis. This must be reassessed on a case-by-case basis.

Which doctor for psoriatic arthritis?

Your dermatologist (skin specialist) is an expert on the symptoms on your skin. Your
rheumatologist, on the other hand, is the specialist for inflammatory rheumatic diseases. In order to enable an optimal treatment for your individual clinical picture of psoriatic arthritis, a close cooperation between these two specialists is absolutely necessary.

The treatment options

The treatment of psoriatic arthritis is based on the other inflammatory rheumatic diseases. It is important to consider your specific course of disease. Because every therapy must be tailored to your symptoms.

Drugs for psoriatic arthritis

• It is important to know that some rheumatic drugs can worsen the skin. For this reason, patients with psoriatic arthritis are usually initially treated with non-steroidal anti-inflammatory drugs (NSAIDs). These have a fast and anti-inflammatory effect, but have hardly any effect on the skin.

• If your disease is already advanced, methotrexate (MTX for short) has been coming
  more and more into focus for some time. However, if this does not work,
  Ciclosporion can also be used.
• Biologicals (e.g. Adalimumab or Secukinumab), which are increasingly used in the treatment of psoriasis, also represent a real alternative. On the one hand, these are effective against joint inflammation and on the other hand, they are also effective on the skin. So you can fight two symptoms at once. Another advantage of biologicals is that most patients tolerate them relatively well.

Movement in psoriatic arthritis

Although treatment with medication is important, it is not the only way to treat the symptoms and complaints of psoriatic arthritis and thus to control the further course of the disease.

Exercise in general but also physiotherapy and occupational therapy are important steps that should be discussed individually with your doctor. The main focus is to maintain the mobility of your joints as far as possible and to protect them from the ground up .

Skin care as basic therapy for psoriasis-arthritis

As PsA in most cases also has an effect on the skin of those affected, an individually tailored skin care is urgently recommended at this point. Of course these should be care products suitable for psoriasis.

Nutrition in psoriatic arthritis

Nutrition plays a major role in PsA, as it does in psoriasis in general. There are numerous inflammatory foods that act as so-called triggers. A balanced, conscious and overall healthy diet can help you manage your psoriatic arthritis.

Ideally, you and your doctor will find a good mixture of all these treatment options. With it you actively shape the way you deal with your psoriatic arthritis and at the same time have a positive influence on your quality of life and your everyday life.

Tips for everyday life with psoriatic arthritis

Psoriatic arthritis, like many other chronic inflammatory diseases, can affect all areas of everyday life and can be very stressful for those affected, both mentally and physically.

There can be many stresses and strains that can make daily life seem very stressful. Nevertheless, you can actively shape your everyday life and help to get the disease under control. This requires a lot of patience and discipline, but you will soon realize that it pays off.

The following tips can help you manage your everyday life with psoriatic arthritis more easily.

Collect information about psoriasis-arthritis

Sound information about psoriatic arthritis will make it easier for you to deal with your illness. Your doctor can answer all your questions about PsA. Deal with the symptoms, question all relevant treatment options, exchange information with other affected people – our Facebook group is an ideal place to do this!

Adjusting working life with psoriatic arthritis

Is it not as easy for you to carry out your job as it was before the illness? Often even small adjustments, for example a workstation optimised from an ergonomic point of view, can help.

Watch your diet with psoriatic arthritis

Your diet can have an especially great influence on inflammatory reactions in the body. Unfortunately we can’t provide you with the perfect solution here – because “the only true” PsA diet doesn’t exist. Rather, it is a matter of consciously eating and avoiding foods that are conducive to inflammation. Well-balanced, varied and healthy – find out everything you need to know about nutrition in psoriasis.

Sport helps with psoriatic arthritis

Sport and psoriatic arthritis are by no means mutually exclusive. On the contrary – you should try to keep your joints flexible with specific sports activities and thus ensure a positive attitude towards life. How about a swim that is easy on the joints, for example?

Our conclusion about Psoriasis-Arthritis

As you can see, you should not take psoriatic arthritis lightly. The risk of permanent
consequential damage is too great.

If you should recognize the first signs, it is crucial to discuss these promptly with an expert. They can make a diagnosis using a variety of methods and agree with you on a specially tailored therapy.

And you yourself can also set the course for a normal routine in everyday life. Supported by new drugs, especially biologicals, the quality of life is also constantly improving.

Psoriatic arthritis, for example, no longer means that you have to be restricted in your life. But what will happen is that your life will become a little more complex. So you should definitely inform yourself well about the disease.

We can’t say it often enough – sorry to repeat -: knowledge is power in psoriasis. You will also have to go to the doctor (rheumatologist and dermatologist) regularly. As probably most of those affected can report, it is not easy to find a competent doctor. If you can even get an appointment. But that’s another story.

All in all, however, you must not get discouraged and enjoy your life – also or especially because of psoriatic arthritis. Some friends have told me that they live much better and more consciously since the diagnosis.

Go out, show that you’re stronger than the disease. In this way, you not only help yourself, but also give courage and self-confidence to thousands of other affected people.

Tell us about yourself, what motivates and moves you in life. How to manage your everyday life with psoriatic arthritis and which tips and tricks will help you to master the day. We are happy to provide the platform for this – as for example in our Facebook group!