Smart-Take: Psoriatic Arthritis

Nearly 8 million people in the U.S. suffer from psoriatic arthritis, a chronic autoimmune disease that affects the joints. Common symptoms include swollen fingers or toes, joints that are painful, swollen, 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 whites than persons of Asian or African descent.

There are a range of therapies used to treat and manage psoriatic arthritis, among them, drug therapies, joint replacement, steroid injections, and complementary or supportive care (see inset).

Drug Therapies
NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) 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 reduce pain and joint stiffness. Like immunosupressants, this may increase risk of infection, or may cause nausea and/or diarrhea and hair loss.

Supportive therapies for pain management
Supportive or complementary care may include lifestyle changes that can help patients to 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, 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). Food typically included in an anti-inflammatory diet include Omega-3 fatty acid rich foods like cold-water fish, flaxseeds, olive oil, and walnuts.

Movement
Regularly exercising (non-stressful activities such as biking, swimming, and walking are good choices) helps maintain flexibility in the joint, and strengthen 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, knees, et. al.

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

Heat/Cold Packs
Heating pads can help loosen muscles and relieve pain; cold, applied for 20-30 minutes several times a day, numbs it and can dull pain.

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