Demographics And Comorbidities According To Psoriasis Status
Our study included 2616 patients with psoriasis and 10,464 participants without psoriasis. The comparison between demographics and comorbidities of the psoriasis and non-psoriasis groups are presented in Table . The mean age of patients with psoriasis was 45.2 years, with a mild predominance in men . In addition, patients with psoriasis suffered from more comorbidities such as diabetes, depression, anxiety, sleep disorder, and renal disease than did the participants without psoriasis.
Table 1 Demographic factors and comorbidities of study participants according to psoriasis status
How Will Psoriatic Arthritis Affect Me
Starting the right treatment as soon as possible will give you the best chance of keeping your arthritis under control and minimise damage to your body.
Psoriatic arthritis can vary a great deal between different people. This makes it difficult to offer advice on what you should expect.
It will usually have some effect on your ability to get around and your quality of life, but treatment will reduce the effect it has.
Psoriatic arthritis can cause long-term damage to joints, bones and other tissues in the body, especially if it isnt treated.
What Are The Symptoms Of Psoriatic Arthritis
The symptoms of psoriatic arthritis may be gradual and subtle in some patients in others, they may be sudden and dramatic. It may be mild, affecting only one joint or can be severe, affecting multiple joints. Not all patients experience all symptoms.
The most common symptoms of psoriatic arthritis are:
- Pain or aching, tenderness, and/or swelling in one or more joints – most commonly hands, feet, wrists, ankles, knees.
- Joint stiffness most notable in the morning or with prolonged inactivity such as sitting for a long time.
- Reduced range of motion in affected joints.
- Pain or stiffness in the lower back.
- Tenderness, pain, or swelling where tendons and ligaments attach to the bone , such as the Achilles tendon of the heel.
- Swelling of an entire finger or toe with a sausage-like appearance .
- Silver or gray scaly spots on the scalp, elbows, knees, and/or the lower spine.
- Small, round spots called papules that are raised and sometimes scaly on the arms, legs and torso.
- Pitting of the nails.
- Detachment or lifting of fingernails or toenails.
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Tips To Manage Psoriatic Arthritis Fatigue
If you have psoriatic arthritis and need a nap to get through the day, some simple changes can boost your energy and make you feel better.
You Wish More People Understood What Youre Going Through
Because psoriatic arthritis is not a particularly common condition , it can be hard to find someone else who’s going through the same thing you are. It took 12 years after my diagnosis to meet someone else with psoriatic arthritis, Dishner says. That means its important to create your own support system. Keeping your friends and family involved in your experiences with psoriatic arthritis and your treatment plan, says Markenson, may help them to better understand what you’re going through and how to help you.
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Does Cold Weather Affect Psa
There is very little research into PsA and weather. Some people with PsA find that it gets worse during the winter, report the National Psoriasis Foundation. Other people notice no difference in their symptoms from one season to another.
It is possible that having less exposure to UV light from the sun during winter may increase disease activity in PsA. When UV light hits the skin, the body produces vitamin D. Some research has linked low vitamin D to psoriasis and PsA.
Some experts believe that changes in atmospheric pressure may also play a role. Atmospheric pressure drops when a cold front is approaching. This may cause the joints to painfully expand.
Dry, cold air may also dry out the skin and aggravate psoriasis symptoms.
Doctors use two main types of medication to treat PsA: disease-modifying antirheumatic drugs and symptomatic drugs. DMARDs may help reduce disease activity and relieve the symptoms, while symptomatic drugs target symptoms alone.
Doctors may prescribe a combination of both drugs.
DMARDs for PsA include:
- conventional DMARDs, such as methotrexate
- tumor necrosis factor inhibitors, including:
Every Day Is Different And I Dont Know What Body I Will Wake Up To
Some days I feel fine other days its a struggle just to get out of bed. A psoriatic arthritis flare doesnt just mean painful joints, for me it also includes brain fog, fatigue, psoriasis flares, difficulty moving, and tender, swollen fingers and toes. This can have a huge impact on my mental health and self-esteem as every day is different, and I dont know what body I will wake up to.
Simple tasks become difficult during flares, and I can lose my train of thought mid-sentence, which makes me feel really self-consciousespecially at work. I worry that people take this as me being rude and not concentrating, but really its just the psoriatic arthritis brain fog and fatigue kicking in. Jude D., 28
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Give Yourself A Break
We live in a nonstop society where resting can be seen as a sign of weakness or inadequacy. However, taking a break between activities can give your mind and body a chance to recover and rejuvenate so you can perform the next task to the best of your abilities. Planning rest breaks, setting boundaries, and really listening to our bodies are all part of a healthy strategy to employ.
Treating Pain And Fatigue With Psa
Fatigue is another common symptom of PsA. âIn one study of 499 patients with PsA attending the University of Toronto PsA clinic, 49 percent had at least moderate fatigue, while severe fatigue occurred in 28.7 percent,â Dr. Gladman says.
Fatigue is more common in women with PsA and in patients who have a higher degree of pain, Dr. Gladman says. About 22 percent of people with PsA also have fibromyalgia. âFibromyalgia is a condition which includes both chronic pain and fatigue,â she explains. Pain from fibromyalgia is not confined to the joints and is often described as âpain all over.â
Like joint pain, the fatigue associated with PsA is due to inflammation, Dr. Gladman says. âFatigue will come and go with the inflammation. If fatigue is due to lack of sleep, it will improve when you get enough sleep. If fatigue is due to fibromyalgia, it may persist unless the fibromyalgia is managed appropriately,â she says. Treating fibromyalgia involves a program of medication, exercise and relaxation, she adds.
According to the joint American College of Rheumatology and NPF guidelines for treating PsA, âIt is recommended that patients with active PsA use some form or combination of exercise, physical therapy, occupational therapy, massage therapy, and acupuncture over not using these modalities as tolerated.â
Diagnosing and treating PsA early can help prevent or at least limit the joint damage that can occur in later stages of the disease, Dr. Gladman says.
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Psa Can Cause Chronic Joint Pain
PsA is a chronic disease characterized by arthritic inflammation of the joints, including dactylitis and enthesis. Enthesitis is inflammation where tendons and ligaments connect to the bone, while dactylitis is inflammation of the small joints of the hands and feet. This inflammation in the hands can make fingers look like sausages, such as Klockow experienced. In addition, PsA can affect the spine, similar to ankylosing spondylitis.
About 30 percent of people with psoriasis will develop PsA. According to the Joint American Academy of Dermatology/National Psoriasis Foundation Guidelines of Care for the Management and Treatment of Psoriasis with Awareness and Attention to Comorbidities: In the vast majority of adult patients, skin manifestation of psoriasis precedes PsA, often by years. Some people develop PsA and never notice or develop psoriasis. Technically, Klockow says, she was never told she has psoriasis.
As a chronic inflammatory disease, PsA is associated with joint pain, says rheumatologist Dafna Gladman, M.D., professor of medicine at University of Toronto and senior scientist at Toronto Western Research Institute in Ontario, Canada. The joint pain from PsA is likely to be chronic unless the inflammation is controlled, Dr. Gladman says.
Diet And Weight Management
As with psoriatic disease, obesity features inflammation, and it commonly occurs with PsA.
Weight gain can add to fatigue by making it harder to move around and by putting pressure on the bodys organs, including the lungs. It can also worsen joint pain from the extra strain on the joints.
Keeping a healthy weight can lead to better energy levels.
Tips for maintaining a healthy weigh include:
- eating plenty of whole grains, fruits, vegetables, and lean protein
- avoiding excess fat and added sugar and salt
- staying hydrated by drinking plenty of fluid, preferably water
- limiting or avoiding alcohol
A healthful diet can help a person:
- achieve and maintain a healthy weight
- improve body functions, such as digestion
- avoid other complications and comorbidities, such as diabetes and high blood pressure
- maintain a stable source of energy by preventing blood sugar fluctuations
People should avoid eating refined carbohydrates and simple sugars that may boost energy but lead to a drop soon after consumption.
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How Does This Condition Affect The Tendons & Ligaments
Enthesitis occurs in up to 50% of people with PsA.4 Symptoms of PsA in the tendons and ligaments include pain and inflammation. When enthesitis affects the heel of the foot, it is known as Achilles tendonitis.
At the bottom of the foot, enthesitis can cause plantar fasciitis. Enthesitis can also occur in the fingers, toes, pelvis, knees or upper body.5,6
PsA can be asymmetrical, occurring on only one side of the body. For example, all the joints in one finger on the left hand may be affected while the same finger on the right hand is unaffected. PsA can also be symmetrical, with the same joints affected on both sides of the body.2
PsA and enthesitis are chronic and can have periods of remission and flares.6
Schedule Your Rest Time
When living with a chronic disease, youll inevitably feel tired from time to time. You might find that the best way to manage your fatigue is to schedule it into your daily activities.
A quick nap or just lying down in the middle of the day could be just what you need.
You can also plan to do your most intensive tasks when you usually have the most energy. Consider dividing up your exercise or other activities into shorter segments.
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Maximize Your Psoriatic Arthritis Treatment
Few of us want to take more medication than we absolutely need to. However, if you are living with psoriatic arthritis, staying on a treatment plan that keeps your symptoms in remission is an important strategy. In at least 11 studies, those who were on biologics for psoriasis or psoriatic arthritis treatment reported reduced fatigue.
Managing Fatigue With Psoriatic Arthritis
Unlike feeling tired, a good nights sleep isnt a simple fix for fatigue, but it can help. In fact, developing good sleep habits is an important part of dealing with fatigue. Depending on the underlying cause of your fatigue, your rheumatologist may also recommend the following:
- Lifestyle changes
- Medication adjustments
- Therapy and mental/emotional help through support groups
Fatigue is complicated and feeling better is a gradual process, says Dr. Ogdie. It may take time, but it is possible to get back on track and feel better.
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One Of My Biggest Worries Was That I Would Have To Stop Running
I began running about three years ago, with a goal to run a 5k. I got hooked and that goal soon moved to a 10k, a half-marathon, and then finally a marathon. My running journey was going well, and I was improving quite quicklyuntil just over a year ago when I suddenly developed swelling in my ankles and wrists and became very fatigued.
One of my biggest worries when I was diagnosed with psoriatic arthritis was that I would have to stop running. But my rheumatologist told me to keep being as active as I could. Funnily enough, I can run with minimal pain in my joints, but peeling vegetables and scrubbing the shower can result in hours of dull aches in my wrists and hands. So even though my rheumatologist may not have meant that I should train for another marathon, this is exactly what I did! I became quite determined that psoriatic arthritis wouldnt stop me from achieving this goal, and although I had to take a few weeks off from training now and then, I managed to complete many months of training and ran my marathon in September of last year. Tracy U., 44
What Are The Symptoms Of Psoriasis
There are different types of psoriasis. The most common is chronic plaque psoriasis. This causes patches of red, raised skin, with white and silvery flakes.
It can occur anywhere on the skin, but most commonly at the elbows, knees, back, buttocks and scalp.
Psoriasis can cause small round dents in finger and toe nails, this is known as pitting. Nails can also change colour, become thicker and the nail may lift away from your finger.
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Inflammation In Pathogenesis Of Fatigue
Fatigue is often present in chronic inflammatory skin and joint diseases, systemic connective tissue diseases, cancer, infections, diabetes type I and other autoimmune diseases .
The mechanism by which fatigue is caused in chronic diseases is multidimensional. Studies conducted among mice with colorectal cancer show that muscle weakness was not associated with changes in expression of myosin isoforms, or with deterioration of muscle contractility in tested animals. In addition, inclusion of anti-cancer treatment resulted in a decrease of interleukin 1 and IL-6 in the brain, reduction of depressive symptoms and improvement of muscle strength without changes in muscle mass . In another experiment on an animal model, application of proinflammatory IL-1 resulted in weak willingness to make social contacts, increased drowsiness and reduced body weight of animals, and these symptoms disappeared after anti-inflammatory injections: IL-1 receptor antagonist and IL-10 .
It should be noted that fatigue accompanying chronic diseases depends not only on ongoing inflammation and its severity, but can also be a symptom associated with anaemia of chronic diseases, reduction of iron concentration associated with an increase in production of hepcidin induced by an increase in IL-6 level, decreased activity of the hypothalamic-pituitary-adrenal axis, resistance to glucocorticoids and adverse effects of the therapy .
Talk To Someone If You Feel Depressed
Depression and fatigue go hand in hand. People with psoriatic arthritis are at a greater risk of depression according to the National Psoriasis Foundation. The reasons for depression may go beyond the obvious discomfort and uncertainty of the disease. Scientists are now exploring a link between the inflammatory response and depression. Treating the immune response may have a direct, biomechanical effect on depression. Communicating how you are feeling can put you on the path to more energy.
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Youre Always On The Search For The Next Best Thing
In recent decades, there have been more advances in medications and studies confirming the benefits of certain therapies for psoriatic arthritis than ever before. Doing your own research and following up on it with your rheumatologist will help you and the doctor find and maintain the best treatment plan. Says Dishner, Its important to understand your options and to never give up hope.
Fatigue In Psoriasis And Psoriatic Arthritis
Psoriasis is a chronic skin disease of immune systems, occurring in approximately 2% of the population , which has a significant impact on the patients life, especially in the case of progression of severe lesions . Until recently, psoriasis as a disease was assessed only on the basis of the surface and clinical image of affected skin. However, recent studies have shown the relation of psoriasis severity with physical, emotional and social function . Psychosocial aspects of disease so far have been the subject of many studies , while the fatigue as a symptom that accompanies the disease was less often the subject of researchers interest. Chronic fatigue associated with psoriasis may affect up to 50% of patients , and up to 25% of all patients indicated the severity of fatigue as severe . In the recently published study of Skoie et al., severity of fatigue was found to be associated with depression, pain and addiction to smoking, but, contrary to expectations, did not depend on the severity of psoriasis . No association with the activity of disease evaluated with the Psoriasis Area Severity Index was also described by Tobin et al. however, fatigue rated as severe was twice as frequent in patients treated systemically than with phototherapy .
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