Certain Medications May Lead To Flares
Several drugs that are commonly taken to treat other medical conditions can exacerbate psoriatic arthritis symptoms, says Ogdie-Beatty.
Lithium, for instance, which is used to treat bipolar disorder, can aggravate psoriasis conditions that are especially resistant to treatment. Antimalaria drugs, including chloroquine and hydroxychloroquine , can also trigger a bout of psoriasis.
Inderal , a beta-blocker used to treat high blood pressure and other conditions, such as tremors and anxiety, also may worsen psoriasis.
Other drugs that can lead to flares include some antibiotics benzodiazepines like the anti-anxiety drug Xanax and even NSAIDs commonly used to treat pain, such as ibuprofen.
Also, be very careful about using the steroid medication prednisone, warns Ogdie-Beatty. When patients come off it, it can cause a bad flare, she says.
How to avoid this trigger Be sure to tell your doctor about any prescription or over-the-counter medications or supplements you are taking in case your psoriatic arthritis treatment plan requires an adjustment.
Alcohol And Cigarette Smoke
Both alcohol and smoking can worsen PsA and psoriasis symptoms. Quitting smoking may help to clear skin and improve overall health.
Alcohol can also interfere with the effectiveness of medications for treating PsA. One study reported in the International Journal of Dermatology confirms alcohol can exacerbate psoriasis symptoms. This report also suggests an increase in alcohol-related deaths in people with psoriasis, as compared to those without the condition.
Focus On Sleep Hygiene
Exercise also helps improve your sleepa big plus, since the National Alliance on Mental Illness notes how poor sleep is a known contributor to many mental health issues, like not dealing well with stress, plus upticks in anxiety and depression, too. So get proactive about your sleep hygiene. You probably already know the right stepsmaintain a regular sleep schedule promote a tranquil sleep environment avoid exercise, alcohol, and caffeine right before bed and try practicing deep breathing and relaxation techniquesbut they only work if you commit to them. So make a point of starting tonight.
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Can Psoriatic Arthritis Affect Other Parts Of The Body
Having psoriatic arthritis can put you at risk of developing other conditions and complications around the body.
The chances of getting one of these are rare. But its worth knowing about them and talking to your doctor if you have any concerns.
Eyes
Seek urgent medical attention if one or both of your eyes are red and painful, particularly if you have a change in your vision. You could go to your GP, an eye hospital, or your local A& E department.
These symptoms could be caused by a condition called uveitis, which is also known as iritis. It involves inflammation at the front of the eye.
This can permanently damage your eyesight if left untreated.
Other symptoms are:
- blurred or cloudy vision
- sensitivity to light
- not being able to see things at the side of your field of vision known as a loss of peripheral vision
- small shapes moving across your field of vision.
These symptoms can come on suddenly, or gradually over a few days. It can affect one or both eyes. It can be treated effectively with steroids.
Heart
Psoriatic arthritis can put you at a slightly higher risk of having a heart condition. You can reduce your risk by:
- not smoking
- staying at a healthy weight
- exercising regularly
- eating a healthy diet, thats low in fat, sugar and salt
- not drinking too much alcohol.
These positive lifestyle choices can help to improve your arthritis and skin symptoms.
Talk to your doctor if you have any concerns about your heart health.
Crohns disease
Non-alcoholic fatty liver disease
A Greater Sense Of Well
Sometimes patients who have psoriasis have poor self-esteem and end up with depression, says Dr. Dao. Exercise can help mental health and decrease depression.
Personally, exercise has helped make me feel mentally stronger, says Scholl. When I exercise, I feel like I am no different than anyone else and that I can work toward fitness goals the same way people who dont suffer from PsA do.
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Talk Openly With Your Doctor
Be sure to discuss any depression, anxiety, and stress you are experiencing with your doctor, says Dr. Chandran. If youre truly struggling, a therapist might help. Sometimes, were so focused on the physical symptom of this disease, such as pain and joint inflammation, that mental and emotional health does not receive enough attention. Shame and stigma can still be associated with mental health issues, he notes. But these diseases are just like any other, and the more you communicate with your doctor about them, the better they can be managed.
How Psoriasis And Psoriatic Arthritis Affect The Scalp
For many patients, the scalp is the only part of the body where psoriasis occurs or its the first location where the autoimmune disease develops.
Research shows that at least a quarter of people with plaque psoriasis, the most common type of psoriasis, initially present with lesions on the scalp.
Its very common for psoriasis to affect the scalp statistics show a range of 40 percent to 80 percent of people with psoriasis have scalp involvement, says Mount Kisco, New York, dermatologist David Bank, MD, who is also an assistant clinical professor of dermatology at Columbia Presbyterian Medical Center in New York City. It may occur in isolation or with psoriasis in other areas.
Scalp psoriasis can run the gamut from mild to severe .
Sometimes, in addition to the scalp, plaques also cover nearby areas such as the forehead, back of the neck, and the skin around the ears.
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People With Psa Have An Elevated Risk For Anxiety Too
So, PsA is a triple-threat: Anxiety, which is characterized by feelings of tension, worried thoughts, and even spikes in blood pressure, is also common among people with this condition. A University of Pennsylvania study showed that people with psoriatic disease had a 31% increased risk of anxiety compared with participants who did not. And a 2019 British review of studies involving more than 30,000 people found that one in three people with PsA reported experiencing mild anxiety, while one in five people with PsA said they battled moderate levelsmaking PsA a significant anxiety risk factor.
Every Day Is Different And I Dont Know What Body I Will Wake Up To
Some days I feel fine other days its a struggle just to get out of bed. A psoriatic arthritis flare doesnt just mean painful joints, for me it also includes brain fog, fatigue, psoriasis flares, difficulty moving, and tender, swollen fingers and toes. This can have a huge impact on my mental health and self-esteem as every day is different, and I dont know what body I will wake up to.
Simple tasks become difficult during flares, and I can lose my train of thought mid-sentence, which makes me feel really self-consciousespecially at work. I worry that people take this as me being rude and not concentrating, but really its just the psoriatic arthritis brain fog and fatigue kicking in. Jude D., 28
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What Are The Symptoms
Different types of psoriasis have different symptoms. Read our psoriasis post to learn more about different types of psoriasis. Even people with the same type of psoriasis may experience different symptoms. This may also depend on the severity. Most often, symptoms are found on the knees, elbows, trunk and scalp and include:
- Itchy, red, scaly patches on skin
- Thick or ridged nails
- Joint pain
Lasts At Least A Few Days
Dr. Husni also says that a psoriatic arthritis flare usually doesnt go away after an hour or two. If you get better right away we dont really consider that a flare, which usually lasts over a couple of days or a week, she says. But, if the symptoms are really severe, you should still call your doctor even if its only been a short time. Theres no magic number of days or hours its more of how it affects your activities of daily living, Dr. Husni says.
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Extra Weight Can Increase Inflammation
The evidence that excess weight increases the risk of developing psoriasis and that it can exacerbate symptoms of psoriatic arthritis is fairly clear, according to Bekele.
If youre overweight, youre also likely to have more severe disease, he emphasizes, including increased joint pain and more skin involvement.
The difficult thing about having psoriatic arthritis and managing weight is that it can be a bit of a vicious cycle. Its complicated, because if youre in a lot of pain, youre less active, which can lead to further weight gain, says Bekele.
A review published in Rheumatology and Therapy in September 2020 affirms that patients with psoriatic arthritis are more likely to develop obesity and the conditions that go along with that, including high blood pressure, diabetes, and cardiovascular disease.
Again, inflammation may be the issue: Fatty tissue, the authors of the study wrote, is thought to promote a chronic low grade inflammatory state, and inflammation is associated with psoriatic arthritis.
People who are obese may also not respond as robustly to medication, says Bekele, specifically a class of medication known as biologics. A study published in 2018 in PloS One found that as a persons body mass index increases, the effectiveness of their medication decreases.
But losing just a little weight can help, too: Just 5 percent can ease symptoms, according to a report in Annals of the Rheumatic Diseases.
Psoriasis Triggers And Avoiding Flare
Psoriasis is common, affecting about 125 million people worldwide. While its not entirely understood, medical experts believe psoriasis is an immune response. The immune system causes skin cells to regenerate quicker than usual. There is no cure, but there are ways to avoid psoriasis triggers and avoid symptom flare-ups. Weve gathered some common triggers and treatment options that may help control symptoms.
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Psoriasis And Your Relationships
Psoriasis and family life
Usually the person with psoriasis is the one who suffers most. However, sometimes the whole family can feel the psychological distress of psoriasis. Tension can arise for a number of reasons. These include feelings of isolation, rejection, embarrassment and not being understood. To keep family life as happy as possible it is important to:
- Communicate: explain how you are feeling. Dont bottle things up as this will only create tension.
- Be calm: even if you feel upset. Remember that stress will not only make you and your family feel upset, it can also make your psoriasis worse. Fill in a thought table and try to change those negative thoughts before they get out of hand.
Psoriasis and forming new relationships
Some people with psoriasis report that they feel afraid to enter into new romantic relationships. They actively avoid relationships that may lead to sexual contact. They fear that once the psoriasis is discovered they will be rejected. These fears are often unfounded, as they are usually not based on actual past experience.
To overcome this fear it is important that you challenge your negative thoughts about forming new relationships.
It may be useful to fill out a thought table like the one in the previous section. Instead, if there is someone you are attracted to but are too anxious to approach, then maybe it would be useful to try out some of the relaxation techniques. These may help you to ease this anxiety.
Medical Treatment Of Psoriatic Arthritis
Treatment depends on how much pain you are in. You may only need treatment during flare-ups and when you have symptoms. If this is the case, you may be able to stop treatment when your flare-ups subside and your symptoms are less active. Medical treatment for psoriatic arthritis includes the following.
Immunosuppressants can help rein in your overactive immune system.
Nonsteroidal anti-inflammatory drugs can lower inflammation and reduce pain.
Tumor necrosis factor-alpha inhibitors decrease the molecule tumor necrosis factor, which initiates inflammation in the body and leads to morning stiffness, swollen or tender joints, and pain.
Disease-modifying antirheumatic drugs can slow the progression of psoriatic arthritis.
Steroidsmay be injected into an affected joint to quickly reduce inflammation.
Joint replacement surgery repairs or replaces severely damaged joints with artificial ones made of plastic and metal.
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Get To Know Your Disease
The positive news is, living with PsA can become manageable as you figure out how it affects you. If the disease is new to you or early to you, flares are much more uncertain and scary, Dr. Husni says. Once youve had it for a longer period of time, flares become a lot less scary. This is a good time to have psoriatic arthritis because there are a lot of treatments available, more than we ever had before.
Not Taking Meds On Time
Even if you feel fine, its still important to take your medication as prescribed to prevent psoriatic arthritis from flaring up again. Sometimes people miss some medication doses and they flare, Dr. Husni says. Then we look back with the patient to figure out why and they say, Oh, I was a little late taking it.
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How Psoriatic Arthritis Flares Are Diagnosed
Because PsA flares dont have a set definition, the diagnosis is made in large part through communication with your doctor. The first thing we do is we look at the history: whats been happening before the flare, Dr. Husni says. We want to know what the triggers are for your disease and we want patients to see the connection.
A skin flare is a bit easier to identify, and a diagnosis would be made with a rheumatologist and dermatologist. We work very closely with the dermatologist its important that they are involved in the treatment decision, Dr. Husni says.
PsA flare-ups can be so hard to pin down that both professionals we talked to suggested keeping a brief diary of your symptoms to help your doctor diagnose when they are happening, and why.
I recommend that people keep a symptom diary over time so that they can keep track of the conditions that might have preceded their flares in their lifetime, so that they can respond more proactively in the future, Crow says. Unfortunately often its most clear in retrospect. You can use our ArthritisPower app to track your symptoms and disease activity and share your results with your doctor.
How Psoriatic Arthritis Is Diagnosed
The diagnosis of psoriatic arthritis can best be made by a rheumatologist who is familiar with the many subtleties of this disease. X-rays can sometimes assist in the diagnosis. A careful history and a detailed physical examination with particular attention to the joints, skin, and nails are most important. Once the diagnosis of psoriatic arthritis is made, your rheumatologist will devise a treatment strategy for you.
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When To Speak With A Doctor
A person should speak with a doctor when they are experiencing any form of chest pain, regardless of whether they have a PsA diagnosis already. They should also speak with a doctor if they have PsA symptoms, such as painful joints or scaly patches of skin.
It is important to call 911 or the number of the nearest emergency department straight away if the following symptoms occur:
- severe chest pain
- a feeling of tightness, squeezing, or pressure in the chest
- difficulty breathing
- pain in the arms, jaw, neck, upper back, or stomach
- lightheadedness
Tips For Relieving Stress
Although stress causes a negative impact on the bodys immune response, not everyone experiences the effects of stress the same way. Studies have demonstrated that peoples cardiovascular and endocrine responses to stressful experiences are dependent on their appraisal of the situation and their thoughts about it. Optimism and coping have shown to moderate the effect of stress on the immune system.5
Several techniques can be employed to manage stress:2
- Relaxation response One of the most effective ways in reducing stress is to use activities or techniques to create the relaxation response in the body. Relaxation approaches include deep abdominal breathing, visualization, prayer, meditation, yoga or tai chi.
- Physical activity Exercise, such as walking, benefits the body by deepening the breath and by relieving muscle tension. Physical activity that combines movement, deep breathing and mental focus, such as yoga, tai chi, and qi gong, can help induce calm.
- Social support Receiving emotional support from friends, family and companions can help during times of stress and crisis.3
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Psoriasis Cortisol And Inflammation
Even though the most people think that high cortisol is bad they utterly omit the fact that after years of suffering with chronic inflammation and even specific diagnosis like psoriasis the chances they have high cortisol levels are poor.
Psoriasis is an inflammatory condition and cortisol is a strong anti-inflammatory hormone so having high cortisol levels in psoriasis is logically inexplainable.
Also we should take into the consideration the fact that having high cortisol levels does not necessarily mean the body reacts to it adequately. The receptors in the cells may be downregulated so much that even significantly higher levels of cortisol wont cool the inflammation enough.
I believe that cortisol resistance explains a lot of problems with inflammation we face these days.
Generally it is not about the high cortisol. In most cases it is about the cortisol resistance if it has something to do with cortisol.
Image source: F. Z. Zangeneh and A. Fazeli. THE SIGNIFICANCE OF STRESS HORMONES IN PSORIASIS. Acta Medica Iranica 2008 46: 485-488.
Cortisol significantly modulates the inflammatory pathways thus affecting the symptoms of chronic inflammatory diseases. And it is not just the diseases we all know about to be explicitly inflammatory like rheumatoid arthritis, psoriasis, Crohns disease, Lupus,
