Speak Clearly: Perspectives on psoriasis

Being diagnosed with one chronic condition can feel daunting enough—but did you know 71 percent of people with psoriasis also have at least one co-occuring disease?1 These include depression, obesity, diabetes and cardiovascular disease.2,3 I am no exception, as following my psoriasis diagnosis I was diagnosed with psoriatic arthritis.

What is psoriatic arthritis? When I was first diagnosed, I didn’t know what it was, let alone understand what it meant for me. After many years of research, talking to my doctor and through my work with other people living with serious skin diseases, I’ve learned a lot about psoriatic arthritis. Now, I work to help others understand the disease, too.

Turns out, I am not alone in my diagnosis. More than 30 percent of people with psoriasis also have psoriatic arthritis, and it affects over 50 million people worldwide.3-5 Psoriatic arthritis is an inflammatory condition that has the potenial to go beyond red, scaly plaques on the skin, to affect the joints, causing painful inflammation and stiffness.6-9 Considering how many people with psoriasis also have psoriatic arthritis, I wanted to share some things I’ve learned: 

1.     It can occur at any age

While psoriatic arthritis can occur at any age, it is most commonly diagnosed between the ages of 30 and 50.5,8 This is just the average age most people begin experiencing symptoms; mine started in my late 20s, so you should be vigilant for warning signs of psoriatic arthritis regardless of your age.

2.     Recognizing psoriatic arthritis can be challenging

Aside from the red plaques on the skin that impact many psoriasis and psoriatic arthritis patients, symptoms of psoriatic arthritis, including joint inflammation, are not always visible making the disease difficult to diagnose.6 Many psoriasis patients begin noticing symptoms of psoriatic arthritis approximately ten years after their initial psoriasis diagnosis, but because symptoms of psoriatic arthritis may come in waves, people frequenly brush off their symptoms, mistaking them for soreness or stiffness related to daily activities like exercising or sitting for long periods of time.3,4

Not everyone with psoriasis develops psoriatic arthritis, and not everyone with psoriatic arthritis has psoriasis, so it is important to talk to your doctor right away if you are experiencing joint pain or any other signs of psoriatic arthritis.8

3.     No two patients feel pain in the same place

The inflammation caused by psoriatic arthritis can impact numerous joints on one or both sides of your body.6,9 Painful swelling can target any joint, particularly favoring the knees, ankles and shoulders.9 Severe swelling of the fingers and toes is also common.6,7 But pain from psoratic arthritis may not always be joint-related. Many people with psoriatic arthritis also experience changes to their nails.10 These changes may include seperation of the nail from the nail bed, noticeable ridges or tiny dents, called pits, appearing on the nail or discoloration of the nail itself.10 Other people experience inflammation in their eyes or fatigue.6

4.     Psoriatic arthritis can permanently damage the joints

If left untreated, psoriatic arthritis can lead to permanent damage or complete destruction of the joints, which is why you should consult your doctor if you notice any symptoms.6-9 For helpful information on how to start a conversation with your doctor, check out this doctor discussion guide.

Like psoriasis, a dermatologist can help you control your psoriatic arthritis, but a rheumatologist can also help you with any joint symptoms you may face.11 Consider bringing both a dermatologist and a rheumatologist into the loop when it comes to your psoriatic arthritis care—the more expertise the better!

5.     Psoriatic arthritis is treatable

Even though it is a chronic disease (meaning there is no cure), when diagnosed early, fortunately, psoriatic arthritis can be managed, and many people are able to live their lives free from the symptoms and pain that come with the disease.6,8 The right management plan can help you maintain your quality of life and may allow you to continue doing the things you love.

I was worried this disease was going to impact my ability to do the things I love, like travel and play soccer, but with the help of my dermatologist and rheumatologist, I’ve found the right management plan for me. I no longer worry about psoriatic arthritis holding me back. The more you know about the signs of psoriatic arthritis, the sooner you can raise any concerns you may have to your doctor and find the best treatment plan for you.

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References:

  1. Iskandar, I., et al. Demographics and disease characteristics of patients with psoriasis enrolled in the British Association of Dermatologists Biologic Interventions Register. British Journal of Dermatology. 2015;173(2):510-518.
  2. Oliveira Mde F, Rocha Bde O, Duarte GV. Psoriasis: classical and emerging comorbidities. An Bras Dermatol. 2015;90(1):9-20. doi:10.1590/abd1806-4841.20153038.
  3. Mease P., et al. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs. 2014 Mar;74(4):423-41. doi: 10.1007/s40265-014-0191-y.
  4. Mease, P. Et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol, 69(5), 729-735. doi:10.1016/j.jaad.2013.07.023
  5. Statistics. 2019. National Psoriasis Foundation. Available at: https://www.psoriasis.org/content/statistics. Accessed on: June 10, 2021.
  6. Psoriatic Arthritis. 2019. Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076. Accessed on: June 10, 2021.
  7. About Psoriatic Arthritis. National Psoriasis Foundation. Available at: https://www.psoriasis.org/about-psoriatic-arthritis/. Accessed on: June 10, 2021.
  8. Diseases & Conditions: Psoriatic Arthritis. 2019. American College of Rheumatology. Available at: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis. Accessed on: June 10, 2021.
  9. Psoriatic Arthritis. Arthritis Foundation. Availbale at: https://www.arthritis.org/diseases/psoriatic-arthritis. Accessed on: June 10, 2021.
  10. Belasco J, Wei N. Psoriatic Arthritis: What is Happening at the Joint?. Rheumatol Ther. 2019;6(3):305-315. doi:10.1007/s40744-019-0159-1.
  11. Boehncke, WH., et al. Association between clinical specialty setting and disease management in patients with psoriatic arthritis: results from LOOP, a cross-sectional, multi-country, observational study. J Eur Acad Dermatol Venereol. 2020 Jan 30. doi: 10.1111/jdv.16251. 

Get clear with your doctor

You deserve to feel confident in your skin, but how do you have a clear conversation about your psoriasis goals with your doctor? Sometimes speaking up can be the hardest part.

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