Clinically Speaking: Questions to Ask Your HCP About Psoriatic Arthritis

What is a PsA flare-up and what does it look like?

Psoriatic arthritis is an autoimmune condition, meaning that your immune system, which is normally focused on fighting bacteria and viruses, is now recognizing your own skin, nails and joints as foreign, which leads to inflammation (swelling) in those structures. Untreated, your immune system will continuously attack the skin, nails and joints. A flare-up is a sudden worsening of your condition, and you may see red skin rashes; breakdown of the nails; and red, warm, swollen joints.

A flare-up might also happen if you have an infection, other active medical issues or increases in general life stress. Your diet, smoking, drinking alcohol and certain medications — including lithium and some beta blockers — can cause a flare-up as well, though the specific triggers vary from person to person. In most cases, however, there are no external factors that cause flare-ups; it's just your immune system miscommunicating and attacking your own body.

What symptoms should we look out for with PsA?

PsA causes issues with skin, nail and joints. Skin can look red and scaly, or have rashes. Your nails might change, including pitting, splitting fingernails and toenails, or other differences. Your joints might be swollen, painful or stiff, and this might be worse in the morning. Not all of these symptoms have to be present in each person to be having a flare-up — it will vary based on the individual.

Is PsA hereditary (passed from parent to children or grandchildren)?

Genetics do play a role and can make you more likely to have PsA, but it doesn't mean that everyone who is at risk will develop the condition. Researchers conducted studies using families and twins to confirm that PsA does have a genetic aspect, so it can be valuable to pay attention to a PsA diagnosis in another family member. Another study shows increased risk if family members have the condition.

When does PsA usually show up?

Though we aren't sure why, PsA typically shows up in your 20s through your 40s. Those who have psoriasis and are going to develop PsA typically see it around 10 years after their psoriasis diagnosis.

Does everyone with psoriasis develop PsA?

No. Around 30% of the people living with psoriasis develop PsA, but you can get PsA without having psoriasis first, and vice versa.

What are my treatment options?

If PsA is causing you a lot of pain or limiting what you can do on a day-to-day basis, there are a number of medications that a rheumatologist can use to treat your condition. There is hope of improving your situation.

The medications used are called "disease-modifying," because they are reducing the inflammation in the skin and joints by treating the immune system. This results in less pain, better function and damage prevention. There are some holistic natural remedies you can try as well, including taking supplements such as vitamin D, omega-3 and curcumin. Sunshine, warm weather and UV light therapy may also help.

Is a person with PsA at a higher risk for other conditions?

Unfortunately, having PsA means you are more at risk for heart disease, diabetes, high blood pressure, metabolic syndrome, liver disease, depression and anxiety. Some of these are thought to be the result of chronic uncontrolled inflammation. So, a goal of treatment is to reduce the inflammation that may lead to these other medical problems.

What are some exercise options for people with PsA?

If chronic inflammation is under control, you can exercise however you want, as long as it's not causing more pain. However, if you are having a flare-up or active PsA, you should focus on lower-impact activities, such as walking, cycling, swimming, yoga, pilates and tai chi. There is currently no evidence that exercise improves PsA, but it does have the following benefits:

• Strengthening muscles around joints that are chronically inflamed and unstable.
• Improving cardiovascular health, because PsA patients are at higher risk for heart disease and metabolic syndrome.
• Enhancing mood and positivity, which can benefit anyone with a chronic illness.

Are there different types of PsA?

There are a variety of types, but the treatments are the same for all of them. The types of PsA differ based on the location of the joint inflammation, such as the limbs versus the spine, how many joints are impacted, and the severity of the joint destruction. The types include:

• Symmetric PsA: both sides of the body, similar to rheumatoid arthritis
• Asymmetric PsA: a joint or joints on one side of your body
• Distal interphalangeal predominant PsA: the last digit in the fingers and toes
• Spondylitis PsA: mainly the spine
• Psoriatic arthritis mutilans: more erosive and destructive arthritis

How does my diet affect PsA?

There is not a lot of research into this, but it's likely that diet does affect PsA. Personally, I have had patients who have changed their diet to improve their overall health, leading to decreased pain, reduced weight, increased energy and better quality of life. In addition, knowing that people with PsA are at higher risk for cardiovascular disease and metabolic syndrome, heart-healthy diets matter. Try to eat high-quality plant-based foods such as vegetables, fruits, nuts, seeds and legumes while reducing high-inflammatory foods such as simple refined sugars, trans saturated fats and alcohol.

The most important next steps you can take are to continue to read about PsA to educate yourself on the symptoms and treatments, and to talk to your doctor right away if you are having symptoms or concerns.

Resources
National Psoriasis Foundation – PsA Screening Test

This resource was created with support from Bristol Myers Squibb.