If you’ve been diagnosed with psoriasis or psoriatic arthritis, or suspect you have it, you probably have questions. What is it, what does my diagnosis mean, what can I do about it? Maybe you’re experiencing symptoms of either disease and want to get to the bottom of what’s going on. Perhaps you already have another diagnosis, like rheumatoid arthritis or Crohn’s disease, and are now experiencing skin symptoms. Maybe you are a caretaker, friend, spouse or relative of someone with psoriasis/psoriatic arthritis. Or, perhaps you are an entrepreneur developing a product, digital service or company targeting chronic inflammatory conditions. Whoever you are, we hope this blog post will shed useful light on psoriasis and psoriatic arthritis.
What is Psoriasis?
Psoriasis is a chronic skin condition that causes skin cells (keratinocytes) to over reproduce. These hyperactive cells build up and form itchy, painful red patches, sometimes with silvery scales of dead skin. Symptoms vary, and may flare up in response to triggers like stress, injuries, smoking and hormones. However, diagnosis tends to be fairly straightforward. General practitioners or dermatologists diagnose psoriasis based on examination of patients’ skin, scalp, nails, and medical history. In more complex cases, a skin biopsy may rule out other disorders.
There is no cure. However, treatment may calm symptoms. Psoriasis treatments are numerous and varied. Perhaps most familiar are topical approaches: moisturizers, steroids, UV therapy (“phototherapy”). In the last 30 years, specialty medications, mostly biologicals, including monoclonal antibody drugs, have provided long-term relief to many psoriasis patients. These immunosuppressants target specific immune cells can inhibit the immune over-reaction. This works systemically to keep skin cells from growing as quickly. Another, complementary approach includes lifestyle management: reducing stress, preventing sunburn, humidifying dry air. Furthermore, some patients can identify and control triggers: food or alcohol sensitivities, strep infections, etc., that they can track and avoid.
What is Psoriatic Arthritis?
Psoriatic arthritis is an inflammatory arthritis that develops on average in 10-20% of patients with psoriasis. Immunologists think they stem from the same underlying hyperactive immune response. Additionally, This type of arthritis can affect any joint in the body, with persistent inflammation that, if untreated, leads to joint damage. Diagnosis of psoriatic arthritis is more complicated than that of psoriasis. For instance, general practitioners or rheumatologists may use blood tests and X-rays, in combination with a medical history, to establish diagnoses.
Although psoriatic arthritis is not osteoarthritis (not autoimmune) or rheumatoid arthritis (another autoimmune disease that affects joints), misdiagnosis sometimes occurs. The Arthritis Foundation provides tips for avoiding misdiagnosis of psoriatic arthritis as osteoarthritis, rheumatoid arthritis, or gout. If diagnosed, treatments are available for most psoriatic arthritis patients, including the same biologicals as used to treat severe psoriasis. Trigger management can also help with psoriatic arthritis symptoms.
The autoimmune etiology
Psoriasis and psoriatic arthritis have a common autoimmune etiology, but patients generally present with psoriasis first. As a skin disease, a dermatologist is likely the first specialist a psoriasis patient will see. PCPs will send patients with joint symptoms to rheumatology specialists for evaluation and diagnosis. Each specialty has different biases and preferences towards treatment due to their different focus on skin or joints. For example, dermatologists focus on skin symptoms and tend to be more conservative in choice of treatment. Dermatologists often overlook psoriatic arthritis, especially if patients do not mention joint symptoms. On the other hand, Rheumatologists tend to be more aggressive in treatment, but less sensitive to the cosmetic suffering of psoriasis patients. Bodypart–focused care is suboptimal if patients must coordinate their own medical teams for high quality care.
Statistics on Psoriasis & Psoriatic Arthritis
According to the International Federation of Psoriasis Association (IFPA), approximately 3% of the world population has psoriasis. In the United States alone approximately 150,000 new cases occur each year, comprising roughly 2% of the US population.
With contributions from IFPA staff members, the World Health Organization (WHO) published a Global Report on Psoriasis in 2016. This report states that between 1.3 – 34.7% of patients diagnosed with psoriasis are also affected by psoriatic arthritis.
With both genetic and environmental influences contributing to onset, pinpointing precise causes can be challenging. Whether you suffer from psoriasis, care for a patient, building an app or a company, or are generally interested, lifestyle changes may help. These include, for example, diet, exercise, stress management, and careful topical product choices. Moreover, such approaches can moderate symptoms, reduce flares, and complement or replace pharmaceutical treatments.
While the IFPA and other leading organizations work towards reevaluating the current state of psoriasis, our team at Your Autoimmunity Connection is connecting patients with one another and with currently available resources to help facilitate understanding of psoriasis and psoriatic arthritis.
Connecting you with resources
Brush up on the basics, or dive in for a comprehensive overview
The following pages each provide a comprehensive overview of psoriasis:
- Mayo Clinic: Psoriasis
- Explore all things psoriasis-related, from symptoms and causes to diagnosis and treatment, and how to choose the best doctor and department for your needs.
- Center for Disease Control & Prevention: Psoriasis
- Review the current state of diagnosis & treatment of psoriasis.
- Healthline: Psoriasis Facts and Statistics
- Recognize various types of psoriasis, possible complications, treatment options, and more.
- National Institute of Arthritis and Musculoskeletal & Skin Diseases: What is Psoriasis?
- Choose between “the basics” and an “in-depth” overview of psoriatic disease, browsing different categories from risk factors to symptoms, causes, treatments, and more.
- American Academy of Dermatology: Psoriasis Overview
- Read about the basics on your own, or watch a video of a dermatologist explaining what psoriasis is, why it develops in some cases, and how treatments may help.
Find the best specialist for your needs
- Healthline: Tips for Finding the Right Psoriasis Specialist
- Whether you are searching for a dermatologist, rheumatologist, mental health specialist, or other provider, find the right specialist to be the best “team player” for your needs.
- Psoriasis Speaks: Find a Dermatologist
- This psoriasis-focused website provides a search option that narrows by both location and types of conditions for which you are seeking treatment.
Find your patient community
- Everyday Health: Psoriasis Support Groups
- Learn how to find (or start) the right psoriasis support group.
- National Psoriasis Foundation: Talk Psoriasis Support Community
- Post your questions, read about other patients’ experiences, and access more resources to assist in managing your symptoms.
- Facebook Support Groups & Pages
- For ongoing dialogue, updates on psoriatic disease, and communication between patients from across the country or world, consider turning to online support groups & pages! A few active and engaging pages to start with include:
What’s happening in research?
Check out the following sources to get caught up on recent findings, informed of future directions, and tap into your potential for involvement as a patient:
- National Psoriasis Foundation (NPF): Research Initiatives
- Explore NPF-funded initiatives to cure psoriatic disease and improve the lives of those affected, and learn how you can support research, too
- Science Daily: Health & Medicine – Psoriasis
- Browse the latest psoriasis-related study findings, from potential underlying causes to triggers, preventative measures, and more
- Science 37: Psoriasis Clinical Trials
- Participate in clinical trials for which you are eligible, and help advance psoriasis research
- Your Autoimmunity Connection: Monthly Newsletters
- Receive up-to-date research and guidelines focused on autoimmune diseases and care.
What is one thing everyone should know about psoriatic disease?
We must remember that psoriasis and psoriatic arthritis fall within the larger category of autoimmune diseases, of which there are over 100 individual diseases. The American Autoimmune Related Diseases Association (AARDA) estimates that 50 million Americans suffer from one or more autoimmune diseases. A research study estimated that approximately 25% of patients with autoimmune diseases have a tendency to develop additional autoimmune diseases.
We hope that shining the spotlight on psoriatic disease this month connects you with beneficial resources and information. However, we would like to emphasize the need to take a holistic approach to tackle the autoimmune disease epidemic. By looking at all autoimmune diseases together, we can move away from the fragmented statistics that hide the magnitude of the problem and towards concerted action in reshaping research, diagnosis, and treatment. Our model is the revolution in cancer research and treatment that has come from viewing cancer as a group of diseases with common etiologies, thus garnering more resources than individual types of cancer.
Get acquainted with Your Autoimmunity Connection
- Check out our blog at www.drbonnie360.com for all things autoimmune – from updates in research to possible lifestyle modifications, patient stories, and more.
- Find us on Facebook here, or join our Facebook Forum to connect with patients across all autoimmune diseases.
- Read our patient guide on How to Achieve Your Optimal Wellbeing
- Read our Guide to Movement Therapy
- Check out our other spotlights here