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One million Canadians live with psoriasis—an often painful and embarrassing autoimmune disease—and up to 30 per cent of psoriasis patients will also develop psoriatic arthritis, a condition that can cause severe and permanent joint damage.
ER Physician Dr. Brett Belchetz tells us more about the disease — the risks, prevention, treatment and its connection to psoriatic arthritis. Be sure to click on the video above to hear more from Dr. Belchetz himself!
Psoriasis is generally thought to be a genetic disease that is triggered by environmental factors. The cause of psoriasis isn’t fully understood, but it’s thought to be related to a problem with immune cells in your body. Overactive immune cells speed up the life cycle of skin cells. This causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.
Who is at risk?
Those with a family history. Also, certain medications, such as beta blockers or NSAIDS, infections and stress can also play a role.
There is no way to prevent the illness. However, those with psoriasis can prevent flareups by:
- Using moisturizing lotion
- Being careful with your skin. Never pick at patches or scales, as this may make psoriasis worse
- Avoiding dry, cold air – tough in Canada, but using a humidifier can help
- Avoiding certain medications
- Avoiding scrapes, cuts, bumps, and infections
- Getting sun exposure, but not more than 20 minutes at a time, and avoid sunburns
- Managing stress
- Exercising, eating right, minimizing alcohol
There are many forms of treatment for the disease. Here are some options:
- Topical treatments such as:
- Vitamin D analogues, coal tar, salicylates
- Light therapy:
- Natural sunlight
- Oral/injected therapies:
- Oral immune suppressants
- Biologics, typically injected immune suppressants – usually used for moderate to severe cases
Psoriasis and psoriatic arthritis
Psoriatic arthritis is a form of arthritis that affects about 30 per cent of those who have psoriasis. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin patches appear. Unfortunately, if you already have psoriasis, there is nothing you can do to prevent developing psoriatic arthritis.
Symptoms of psoriatic arthritis
Joint pain, stiffness and swelling are the main signs and symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.
What comes first
Most people with psoriatic arthritis have skin symptoms before joint symptoms. However, sometimes the joint pain and stiffness comes first. In some cases, people can get psoriatic arthritis without any skin changes.
Here are some of the treatment options for psoriatic arthritis:
- NSAIDS for symptoms
- Disease-modifying antirheumatic drugs (DMARDs). These drugs block the body’s inflammatory response by targeting the immune system either broadly or in a targeted way, depending on the type.
- Immunosuppressants. These medications act to reduce activity in your immune system, which is out of control in psoriatic arthritis.
- Biologic agents. Also known as biologic response modifiers, These medications target specific parts of the immune system that trigger inflammation and lead to joint damage.
- Steroid injections. This type of medication reduces inflammation quickly and is sometimes injected into an affected joint.
- Joint replacement surgery. Joints severely damaged by psoriatic arthritis can be replaced with artificial prostheses
People with psoriatic arthritis can experience the condition differently. Some may have mild symptoms that aren’t very noticeable, while others may have more severe symptoms that affect daily life. Without treatment, severe cases can can cause extreme disability and negatively impact quality of life, so it’s key to manage it proactively.