As if flaky, itchy skin wasn't bad enough: one in three psoriasis patients also have some joints become inflamed. Without treatment, joint destruction can progress. Effective medications prevent this. It starts with small skin changes. Sometimes the fingernails or toenails show round depressions and unsightly yellow discoloration. At some point your joints, back or heel will hurt. Many different complaints that are difficult to classify. It often takes some time until the diagnosis of psoriatic arthritis (PsA) is finally made. Because the inflammation destroys the joints over time, it is important not to wait too long before seeing a doctor.
How does psoriatic arthritis occur?
In Germany, around two million people suffer from the chronic autoimmune disease psoriasis, medically known as psoriasis. The misdirected immune system recognizes the body's own tissue as foreign and fights it. The result is itchy, flaky skin.
In 30 percent of psoriasis patients, the body's defenses also attack various joints, which then become inflamed¹. These are usually the end phalanges of the fingers and toes. But larger joints such as the knee, hip, shoulder, sacrum and the spine or tendon attachments such as the Achilles tendon can also be affected. The longer the inflammation in the joint, the more it is destroyed.
The consequences for the everyday lives of those affected are far-reaching. The simplest movements become a challenge if your finger joints are stiff. This is just as noticeable in private life as it is at work. Many patients become more and more withdrawn; depression is a typical side effect of people with psoriasis arthritis.
Inflammation detected, inflammation banished
To prevent things from getting that far, early therapy is important. Modern medications can specifically inhibit inflammation and thus maintain joint mobility. But that's easier said than done - especially in the ten percent of cases in which PsA occurs before psoriasis is diagnosed. In around 80 percent, the joint problems only appear years or decades after the skin symptoms². The remaining ten percent get PsA at the same time as psoriasis. To ensure that the disease is recognized as quickly as possible, doctors have developed a patient questionnaire. The so-calledCHEETAH(German Psoriasis Arthritis Diagnostic questionnaire) asks about various symptoms:
- “Have you ever had joint pain that was accompanied by swelling of a joint?”
- “Have you ever had an entire finger or toe grow thick?”
- “Have you ever thought that you might suffer from joint disease?”
- “Have you ever suffered from back or buttock pain at least three days a week?”
These are some of 14 questions that those affected must answer. If you answered yes to at least four of these, you suspect psoriasis arthritis. A rheumatologist should be consulted now at the latest if the dermatologist does not specialize in psoriasis. The doctors work together to put together a suitable treatment that depends on how seriously the disease has progressed.
Anti-inflammatory painkillers are usually used as short-term therapy. They work against pain and at the same time inhibit the inflammatory reactions in the joints. So-called basic therapeutics have the long-term goal of permanently alleviating symptoms and preventing joint destruction. Like biologics, they are intended to ensure that PsA does not flare up again.
Biologics are biotechnologically produced antibodies that specifically inhibit the effects of inflammatory messenger substances. Your advantage: You not only reduce the inflammatory processes in the joints, but also those in the skin.
A life without complaints
Biologics usually work quickly. The symptoms diminish and, ideally, those affected are almost symptom-free. To ensure that it stays that way, you have to have your doctor check every three to six months to see whether the chosen therapy is working optimally³. If this is not the case, the treatment can be changed accordingly. Successful therapy means a noticeable improvement in the mobility of the joints and thus the quality of life of those affected.
In addition to medical therapy, PsA patients can take action themselves: for example, exercise is not just good for keeping the affected joints supple. When stressed, the muscles also release so-called myokines, which have an anti-inflammatory effect.
Anyone who decides because of hisPsoriasis with the topic of nutritionknows: There are foods that promote inflammation - for example meat, if it is consumed frequently - and others that inhibit it, such as fish and some vegetable oils. The German Society for Nutrition e. V. (DGE) has drawn up ten rules. If you stick to them, you will automatically eat a balanced and healthy diet. In combination with appropriate therapy and sufficient exercise, people with PsA can ensure that they can feel good again.
Sources:
1. Gladman DD, Antoni C, Mease P, et al.: Psoriatic arthritis: epidemiology, clinical features, course, and outcome. In: Ann Rheum Dis. 2005;64:ii14-ii17.
2. Herrmann, M. Psoriatic arthritis – when joints hurt. Psoriasis mesh. https://www.psoriasis-netz.de/magazin/fakten/psoriasis-arthritis-basisn/psoriasis-arthritis-%E2%80%93-wenn-lenke-wehtun-r1119/ (05/27/2021)
3. Ott, C. Psoriatic arthritis: Rapid treatment is crucial. CME 15, 30 (2018). https://doi.org/10.1007/s11298-018-6724-z
4. Graßhoff, H. (2020). Psoriatic arthritis – causes and treatment. Lecture. https://www.youtube.com/watch?v=3atg2C52HLM (05/27/2021)
5. Fux, C. (2015). Handbrake for inflammation. NetDoctor. https://www.netdoktor.de/magazin/handbremse-fuer-entzuendungen/ (05/27/2021)
