According to the Annals of Rheumatic Disease, somewhere between 6 and 42 percent of people with psoriasis, a common skin condition involving scaly, itchy rashes, also have a serious joint disease called psoriatic arthritis. Psoriatic arthritis is an autoimmune disease in which the body’s natural defenses against infection attack its own tissues instead, causing damage, pain and swelling.
As with other inflammatory forms of arthritis like rheumatoid arthritis (RA), people with psoriatic arthritis may experience flares, periods of intense disease activity when symptoms are at their worst.
Psoriatic arthritis can affect joints throughout the body. For example, one of the first signs of PsA is often in the fingernails, which can become pitted, develop white patches or lift from the nail bed entirely. Another common feature is a sausage-like swelling along the entire length of the fingers and toes, a condition called dactylitis. Other people experience pain and stiffness in the lower back at the sacroiliac joint. Some will experience enthesitis, painful inflammation where tendons and ligaments attach to bones. This condition most commonly affects the heel (Achilles tendonitis) and the bottom of the foot (plantar fasciitis). The pain, fatigue, swelling and difficulty using joints may that result from this condition can limit your ability to participate in daily activities.
Accurate diagnosis and early, aggressive treatment of psoriatic arthritis are important. In PsA, the immune system, which normally protects the body, goes awry. It causes inflammation that if not properly treated, over time can lead to deterioration in joints and the structures (muscles, tendons and ligaments) that support them. Luckily, there are a number of treatments, both over-the-counter (OTC) and prescription, available. The former treat symptoms of both psoriasis and psoriatic arthritis, the latter address the actual causes of inflammation. In addition, there are many self-care strategies you can use to manage your symptoms and feel better overall.
Prescription Medications for Psoriatic Arthritis
In recent years, the array of prescription drugs to both treat psoriatic arthritis symptoms and to halt the disease process that causes inflammation has grown. Options your doctor, typically a rheumatologist who specializes in joint diseases, can prescribe include nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs), including a new category called biologic response modifiers (biologics). They can also prescribe topical agents to ease skin irritation and scaling of psoriatic lesions.
Prescription drugs for psoriatic arthritis include:
NSAIDs: These are usually taken by mouth, although some are available in topical form. They reduce inflammation along with the pain and swelling that accompanies it. Among the most well known are ibuprofen (Advil, Motrin, Nuprin) and naproxen sodium (Aleve), although there are many others. NSAIDs carry risks, including stomach irritation that could become severe. Acetaminophen (Tylenol), an analgesic, may be added to NSAIDs to provide additional pain relief, although it won’t address inflammation. NSAIDs carry risks most notably that of heart attack and stroke, along with stomach irritation that could become severe. COX-2 inhibitors like celecoxib (Celebrex) are specially formulated NSAIDs that cause less stomach damage.
Corticosteroids: These drugs are designed to mimic the anti-inflammation hormone cortisol, which is normally produced by the body’s adrenal glands. Prednisone, taken orally, can help reduce inflammation in the short term, but long-term use is inadvisable due to unpleasant side effects such as facial swelling and weight gain. Directly injecting corticosteroids into affected joints can provide temporary inflammation relief.
DMARDs: These drugs work to reduce or prevent joint inflammation and damage. They can be taken by mouth, by injection (either given at your doctor’s office or at home by you) or by infusion into the veins (only administered by a healthcare professional). According to the American College of Rheumatology, the DMARDs most commonly prescribed for psoriatic arthritis are sulfasalazine (Azulfidine), methotrexate (Rheumatrex, Trexall), cyclosporine (Neoral, Sandimmune) and leflunomide (Arava). Azathioprine (Azasan, Imuran) may also be prescribed.
Biologics: Developed over the last decade, this subset of DMARDs stop inflammation at the cellular level. Biologics approved to treat psoriatic arthritis include etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade) and golimumab (Simponi). These drugs target and suppress tumor necrosis factor alpha (TNF-alpha), a specific protein produced by immune cells to signal other cells it’s time to start the inflammatory process. While they have shown powerful results, they carry serious risks, including increased susceptibility to infection.
Inflammation from food sensitivities might be something to look into, whether wheat or something else.
Good Luck!
Do you have a rheumatologist? If so, have they considered a biologic at this point? For the pain, it might be time to bump up to a pain management doctor (usually an anesthesiologist).
I was several years in on the same meds as you are when it was time to step it up. If you read up on biologics and how they work you may find that the treatment makes a lot of sense. I'm on a program that picks up the copay, and as far as I can tell, most people are eligible. It may be safer for your liver than all that MTX.
The pain mgmt dr. has me on a long-acting muscle relaxer for the evenings (we tried several before finding one I liked), I'm also on the fentanyl patch after years of hydrocodone. I like this better, as there aren't big dips, just steady relief that takes the edge off. I also take Lyrica for the flu-like symptoms and pain of fibromyalgia, and gabapentin (Neurontin) for my pain receptors in general. You may not need nearly this much yet, but I wanted to share some options.
Correctly diagnosed three years ago with Psoriatic Arthritis, fibromyalgia, and Arthritis Mutilans in at least two fingers, possibly in the hips and sacroiliac.
I'm on MTX once a week, titrated up for three years now. It did help with the pits and waves in my nails, but not much else. Fortunately didn't lose my hair ;)
Began self-injectible Humira about 18 mos ago; started twice a month, now weekly due to the mutilans being so aggressive and the profound pain and fatigue. It does seem to be helping, but I still haven't been able to escape the occasional flares that knock me flat. I'll sleep for days, no matter how much caffeine or change to other meds I employ.
Since it's been about 16 years, I do have enough history to say that remissions do really occur, especially the younger you are, and I've had at least three. They lasted anywhere from six months to three years. I can't think of anything I did differently to bring one on, besides ridiculous amounts of rest. Then one day it felt like I could exercise a little (I used to be an aerobics instructor; you can imagine the frustration here) and that would lead to a little more until suddenly I felt almost normal.
I do believe the biologics are work the risks if you're sure of your diagnosis. I also go to pain management now, at the urging of my rheumatologist, and have had some success with trigger point injections in my neck and upper back, as well as cortisone in my hips. I recently had an epidural for my lower back because I was going to be sitting for three days at a convention, and it helped a lot (effects lasted about two months for me).
For me, the best thing mentally and emotionally has been acceptance. Not defeatism by any means, but the realization that all you can control is the sailboat, not the ocean. I have a very loving family that jumps on me if I push too hard and try to run interference before I go on a vacuum-binge or something. This wasn't the case with my late spouse and it makes a world of difference. I also have friends that know that every appointment is in "pencil" until the last minute, because I just don't know. I keep lists, since the memory, once amazing, can be unpredictable. I also took up knitting (I used to be an accomplished professional seamstress) since it can be done in almost any position in bed, the only place I'm comfortable.
Another challenge has been the absence of visible signs of illness. My family tends to look a little younger than they are, and I have healthy hair. My psoriasis does occasionally creep onto my face (sides of the nose, ears, eyebrows) but Humira completely zapped that for me. So, I usually don't look very sick. I'm sure a lot of you out there have dealt with that. Or people minimizing profound fatigue into plain tiredness. I once read that this kind of fatigue is to tiredness as lightning is to a match. Without being preachy, I've described it to friends this way: I'm lying on the bed, in the exact position I've been in since I collapsed there at 1pm or so. I need to use the restroom and I'm unbearably thirsty. There is a glass of water within arm's reach and a bathroom 8 feet away. A herd of elephants could be coming. I can't move.
Avoid frustration by finding things to do that give you a sense of accomplishment. The computer wears me out quickly, so I limit my time with the laptop, checking my smartphone instead. Don't expect a cure. There isn't one right now. But, we do live at a much better time for this disease than when I was first ill in 1994. And hold off getting an official diagnosis until you have health insurance! ;0
I am currently being diagnosed with Spondylitis form of PSa. I am 30, but move and feel like I am 80. The pain is very bad in my back, neck and hips. In addition I have been diagnosed with Fibromyalgia which also is very painful. The rheumatologist has suggest I take Enbrel. How have others done with this drug and have they had any major side effects or reactions? This is one of my only courses of action to get some relief as I am unable to take oral steroids or NSAIDs.
This has made a large impact on my life. I am unable to work, I have a hard time walking, or even doing basic things that so many others take for granted. I just want to be like other 30 year olds!
Any advice or help would be greatly appreciated!!!
Thank you,
Shoshanna
Finally found a rhematologist who listened and got diagnosis 4 years ago.I take Humira every week.sulfasalizine,(and a antacid type of drug to cope with that)
hydrocloroquine (quinine which is an anti malaria drug) it made a HUGE difference in my energy level! I also take gabapentine for the pain in my feet which helps hugely...I guess I have nerve damage in my ankles because of the constant swelling.I take asa with codine and a muscle relaxant for pain when I need it....depends on weather.. stress
& mind set too I think...sometimes i just decide to push thru but I usually pay for it later
I wonder what others do for exercize??Its so hard to find anything that does not involve standing and be able to get any sort of cardio workout...any suggestions would be great!
Had moderate psoriasis for 16 years, use dimethylfumarate (with coating to protect against flushing) for 3 years and this works great, skin is 99% ok.
Also have nail problems on hands and feet, dimethylfumarae offered some improvement but since I use Sililevo on the affected nails its 90% ok (nails become stronger). Only disadvantage is that my daughters laugh at me for using nail polish.
PsA was diagnosed a year ago but I suffer from the symptoms for 5 years. Some tendons (hip, shoulder) are calcified and painful,no joint problems, use NCAID Naproxen (2 x 250mg/day), calcifications are treated with ESWT/Shockware, fitness twice a week is a good pain relief (but dont overdo it, cardio better than heavy weight stuff), less alcohol and take care of your weight. This all helps a lot but does not fix it, I'm afraid this is as good as it gets. Recently started with Magnesium supplements but no idea if this works.
Rgds,
JW
I have had psoriasis for more than 35 years. 12 years ago I found out there are actually foods I can avoid eating that may make them better. It took about six months but the actually cleared up. I now use little or no medication for my skin. I also noticed that staying away from the same foods helps the joint pain. Here is the list pork, pineapple,citrus fruit,pop, alcohol,and caffiene. I also take vitamin E,D and fish oil that really make a big differance.
Wow, I feel the same way about the Methotrexate. I never thought I would. I really did not want to believe that this was the medicine that gets me to the next week. I too can tell when my day for the meds is due. My body starts to shut down making harder and harder to get through the day. I am happy to see Spring arrive, I am encouraged to take a walk. I hope to lose some weight too. The meds and the lack of energy make it very hard to lose weight. I find myself craving carbs, I think for the energy boosts. This April is 2 years for me. I too have highs and lows. Feel free to email me ldecherico@aol.com
Be Well! :) Laurie
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