By Yousaf Ali, MD, FACR, Associate Professor, Division of Rheumatology and Vice Chair of Faculty Affairs, Department of Medicine, Mount Sinai Health System.
If you are one of the nearly one million people in the United States living with psoriatic arthritis, then you know the agony of waking up in the morning and trying to get those sore joints moving. But if caught early enough, permanent or worsening bone and joint deterioration can be prevented and symptoms can be improved. Delaying a psoriatic arthritic diagnosis by as little as six months can interfere with the patient’s ability to respond successfully to treatment or achieve remission. Therefore, early diagnosis and treatment of psoriatic arthritis is crucial.
Psoriatic arthritis is a genetic autoimmune disorder that is associated with the psoriasis skin disorder; although the arthritis pain and joint symptoms can sometimes occur before the skin condition manifests. Approximately 30 percent of psoriasis patients will develop psoriatic arthritis at some point and there may even be a link with comorbidities such as heart disease, diabetes, Crohn’s disease, obesity, and depression, according to the National Psoriasis Foundation. Therefore, a multidisciplinary approach including a rheumatologist, dermatologist and primary care physician is necessary in order to optimize treatment. Primary care physicians should not hesitate to refer patients to a rheumatologist when it comes to joint and muscle pain and they should not assume it’s just old age or overexertion.
Because early intervention is critical in preventing permanent joint damage or stopping its progression, medical trainee should learn how to recognize and treat psoriatic arthritis as part of their training. However, if a patient continues to suffer then he should act as his own advocate and discuss his symptoms in detail with his PCP so that treatment delays are minimized.
Common symptoms for psoriatic arthritis include overall fatigue, pain, stiffness and swelling of tendons and joints, and reduced range of motion, especially in the morning. But subtle symptoms can sometimes go unrecognized by providers when psoriasis is not visible. Subtle changes in the patient’s nails such as pitting and nail bed separation can be misdiagnosed as fungus so if there is no improvement then a diagnosis of PsA should be considered.
Treatments include anti-inflammatory oral medications and protein-based biologic drugs that are injected or infused to target the immune system. For exercise, I recommend low-impact, stress-relieving, non-impact types of exercise, such as swimming, walking and yoga. A healthy low-fat diet that is rich with fruits, vegetables, and fish is preferred.
To learn more about psoriatic arthritis or to speak with Dr. Ali, please come to the “Be Joint Smart” lecture sponsored by the National Psoriasis Foundation at the New York Marriot Marquis, Saturday, October 3rd from 10:30am-1:30pm.
To register for this free event, please click the link here.