Psoriasis Sufferer Experiencing Joint Pain? You May Have Psoriatic Arthritis
Prevention and Treatment Thirty percent of psoriasis sufferers will develop joint pain and inflammation — a lesser-known form of arthritis known as psoriatic arthritis — that can cause permanent joint damage if left untreated.
ight years ago, paramedic Stephen Duffy began experiencing joint pain in his toes and feet. While he was just 35 years old at the time, Duffy attributed his symptoms to the beginnings of old age. It wasn’t until he was referred by his family physician to rheumatologist Dr. Proton Rahman that he was diagnosed with psoriatic arthritis.
“Approximately 30 percent of individuals with psoriasis will have joint pain related to it,” explains Dr. Rahman, a rheumatologist and genetic epidemiologist at Memorial University in St. John’s, Newfoundland. “It’s different from degenerative arthritis that is common as we get older,” Dr. Rahman says. “Psoriatic arthritis is due to inflammation.”
Psoriatic arthritis is typically treated with anti-inflammatory medications. But, research developments have helped rheumatologists like Dr. Rahman deliver more targeted therapies to psoriatic arthritis sufferers.
Duffy had mild psoriasis as a child but his joint inflammation became more severe than the skin problems he suffered. Hamilton-based dermatologist Dr. Ronald Vender says that psoriatic arthritis can occur prior to a psoriasis diagnosis, at the time of diagnosis or, most commonly, later on in life. “As one of the potential co-morbidities, we’re constantly asking [psoriasis patients] if they’re suffering from any joint pain or morning stiffness,” explains Dr. Vender, who says that many of his patients don’t associate their joint pain with their skin disorder. “This inflammation is throughout their whole body. Skin and joints are two aspects of their inflammation among other areas that can be affected as well.” As a systemic disease, psoriasis can also affect tendons, the heart, gut, and eyes along with joints and skin.
Psoriatic arthritis is typically treated with anti-inflammatory medications. But, research developments have helped rheumatologists like Dr. Rahman deliver more targeted therapies to psoriatic arthritis sufferers. “There is a much better understanding of key pathways, we call them cytokines, that drive the disease process,” he says. “It was recognized that one of the cytokines that propagates psoriatic arthritis is TNF. Drugs that inhibit TNF have been helpful.” Dr. Vender has also found success in treating his patients with a new advanced anti-inflammatory medication that targets these cytokines, in a pill form. “This new oral therapy is used as an anti-inflammatory that can help the skin and joints together,” he says.
If psoriatic arthritis continues untreated, permanent damage to the joints can occur, making early diagnosis an integral factor in successful treatment. Dr. Dafna Gladman, Director of the Psoriatic Arthritis Program at Toronto Western Hospital, has studied the diagnostic delay of psoriatic arthritis. “If patients came into the clinic within two years of diagnosis, they did much better than those that came in after two years of diagnosis in terms of progression of damage,” says Dr. Gladman. Further information from a St Vincent’s University Hospital study reveals even stronger evidence to the benefits of early treatment, Dr. Gladman explains. “It showed that if there was a delay of more than six months from the time of onset of symptoms to the time the patient saw a rheumatologist, they did much worse.”
Dr. Vender encourages those with psoriasis to talk to their doctors if they’re experiencing joint pain. “In patients that suffer from skin psoriasis, they should be aware that any aches and pains in the joints or morning joint stiffness can be a clue to a diagnosis of psoriatic arthritis,” he says.
For psoriatic arthritis sufferer Stephen Duffy, proper diagnosis has made all the difference in his quality of life. “I had to get my daughter to help me get my boots off. I was that sore,” Duffy remembers. But, two days after starting a new medication, he was walking on a treadmill at a brisk pace for an hour — something he wouldn’t have imagined doing earlier. It’s the type of turnaround that Dr. Gladman hopes that all psoriatic arthritis sufferers can achieve. “The new medications have certainly been life changers for many of our patients, no doubt about it.”