Smart-Take: Psoriatic Arthritis

Nearly eight million people in the United States suffer from psoriatic arthritis, a chronic autoimmune disease that affects the joints. Common symptoms include swollen fingers or toes with joints that are painful, red, warm to the touch, tender, or stiff. Sometimes changes to the nail beds of fingers and toes also occur.

While most people who are diagnosed with psoriatic arthritis have already been experiencing symptoms of psoriasis on their skin, sometimes the symptoms of both occur at or about the same time. The disease often appears between the ages of 35 and 50 and affects men and women in equal proportions, but it is more common among Caucasians than persons of Asian or African descent.

There is a range of therapies used to treat and manage psoriatic arthritis, such as drug therapies, joint replacement, steroid injections, and complementary or supportive care (see right).

DRUG THERAPIES

NSAIDs. Nonsteroidal anti-inflammatory drugs work by relieving pain and inflammation. Side effects of OTC and prescription versions of this class of drug can include stomach irritation, heart problems, and liver and kidney damage.

DMARDs. Disease-modifying antirheumatic drugs can slow the progression of psoriatic arthritis and save the joints and other tissues from permanent damage. Side effects vary but can include liver damage, bone marrow suppression, and lung infections.

Immunosuppressants. These medications act to curb the immune response responsible for psoriatic arthritis but also for protecting against infection (its key side effect).

TNF-alpha Inhibitors. These reduce an inflammatory substance to decrease pain and joint stiffness. Like immunosuppressants, this may increase risk of infection or may cause nausea, diarrhea, and/or hair loss.

SUPPORTING THERAPIES FOR PAIN MANAGEMENT

Complementary or supportive care may include lifestyle changes that can help patients manage the pain of psoriatic arthritis. Some ideas to discuss with your care provider include:

Diet. It’s clear that maintaining a healthy weight places less overall strain on the joints, and a healthy diet helps to stave off some of the ancillary health risks that often ride along with or aggravate the condition (high cholesterol, diabetes, and arterial hypertension). The jury is out on the real impact of diet on chronic inflammation, but some patients have reported relief by avoiding inflammatory foods like red meat, processed foods, refined sugar, dairy, and plants from the nightshade family (peppers, eggplant, and tomatoes). Foods typically included in an anti-inflammatory diet include Omega-3 fatty acid-rich foods like cold-water fish, flaxseed, olive oil, and walnuts.

Movement. Regularly exercising (non-stressful activities such as biking, swimming, and walking are good choices) helps maintain flexibility in the joints and strengthens surrounding muscle tissue. Patients can also learn to move differently by finding alternative ways to do everyday tasks (lifting heavy objects, opening doors) that minimize strain on finger joints, wrists, and knees.

Mindfulness. Meditation or a similar mindfulness practice may help to disrupt thought patterns and help minimize the perception of pain.

Hot & Cold Packs. Heating pads can help loosen muscles and relieve pain; cold packs, applied for 20-30 minutes several times a day numb the area and can dull pain.

As always, consult your regular healthcare provider about how these changes may be able to help.