Home Remedies for PSORIATIC ARTHRITIS

Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis, a serious skin condition. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but arthritis can sometimes develop before skin lesions appear.

Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints. Without treatment — and regular exercise — psoriatic arthritis may be disabling.

Symptoms

Both psoriatic arthritis and psoriasis are chronic diseases that get worse over time, but you may have periods when your symptoms improve or go into remission alternating with times when symptoms become worse. Often, skin and joint problems appear and disappear at the same time.

General signs and symptoms of psoriatic arthritis include:

• Pain in affected joints
• Swollen joints
• Joints that are warm to the touch

Patterns of joint pain in psoriatic arthritis
Doctors have identified five types of psoriatic arthritis, and you may experience several of them over time. They include:

• Pain in joints on one side of your body. The mildest form of psoriatic arthritis, called asymmetric psoriatic arthritis, usually affects joints on only one side of your body or different joints on each side — including those in your hip, knee, ankle or wrist. Fewer than five joints are generally involved, and they’re often tender and red. When asymmetric arthritis occurs in your hands and feet, swelling and inflammation in the tendons can cause your fingers and toes to resemble small sausages (dactylitis) .
• Pain in joints on both sides of your body. Symmetric psoriatic arthritis usually affects five or more of the same joints on both sides of your body. More women than men have symmetric psoriatic arthritis, and psoriasis associated with this condition tends to be severe.
• Pain in your finger joints. Distal interphalangeal (DIP) joint predominant psoriatic arthritis is rare and occurs mostly in men. This type of arthritis affects the small joints closest to the nails (distal joints) in the fingers and toes. The nails, too, often show classic signs of psoriasis, including thickening, pitting and discoloration.
• Pain in your spine. This form of psoriatic arthritis, called spondylitis, can cause inflammation in your spine as well as stiffness and inflammation in your neck, lower back or sacroiliac joints. Inflammation can also occur where ligaments and tendons attach to your spine. As the disease progresses, movement tends to become increasingly painful and difficult.
• Destructive arthritis. A small percentage of people with psoriatic arthritis have arthritis mutilans — a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in your hands, especially the fingers, leading to permanent deformity and disability.

When to see a doctor
If you have psoriasis, be sure to tell your doctor if you develop joint pain. Psoriatic arthritis can come on suddenly or develop slowly, but in either case it can severely damage your joints if left untreated.

Causes

Psoriasis is a skin condition marked by a rapid buildup of rough, dry, dead skin cells that form thick scales. Arthritis causes pain and stiffness in your joints. Both are autoimmune problems — disorders that occur when your body’s immune system, which normally fights harmful organisms such as viruses and bacteria, begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as the overproduction of skin cells.

Genes and environment
It’s not entirely clear why the immune system turns on healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a close relative, such as a parent or sibling, with the disease, and researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

Having a family member with psoriatic arthritis doesn’t necessarily mean you’ll develop the disease, but it does mean you have a greater tendency to do so. Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

The role of TNF
In addition, a substance called tumor necrosis factor (TNF), which causes inflammation in rheumatoid arthritis, appears to play a large role in psoriatic arthritis as well. People with psoriatic arthritis have high levels of TNF in both their joints and skin.

Risk factors

Several factors can increase your risk of psoriatic arthritis, including:

• Psoriasis. Having psoriasis is the single greatest risk factor for psoriatic arthritis. People who have psoriasis lesions on their nails are especially likely to develop psoriatic arthritis.
• Your family history. Many people with psoriatic arthritis have a close relative with the disease.
• Your age. Although anyone can develop psoriatic arthritis, it occurs most often in adults between the ages of 30 and 50.
• Your sex. In general, psoriatic arthritis affects men and women equally, but DIP arthritis and spondylitis are more likely to affect men, whereas symmetric arthritis occurs more often in women.

Complications

Psoriatic arthritis can be painful and debilitating, and can damage your joints, even with treatment. Some types of psoriatic arthritis can cause additional difficulties, including:

• Swollen fingers and toes (dactylitis) . Psoriatic arthritis can cause a painful, sausage-like swelling of your fingers and toes. Swollen toes are a particular problem because they can make it hard to find shoes that fit properly. A podiatrist — a doctor who specializes in the feet — may be able to provide help if you have psoriatic arthritis in your toes or ankles. You may also develop swelling in your hands and feet that isn’t limited to your joints and that may develop before joint symptoms do.
• Foot pain. Another condition associated with psoriatic arthritis is enthesopathy, which causes pain at the point where tendons and ligaments attach to your bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).
• Back and neck pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and the joints between your spine and pelvis.

Preparing for your appointment

Most often, you develop skin problems before signs of arthritis appear, but it’s possible for arthritis to develop first or for both problems to be diagnosed at the same time. If you have psoriasis, your doctor will examine you carefully for joint problems, and vice versa.

You aren’t likely to need any special preparation for your appointment, but because both psoriasis and psoriatic arthritis are complicated conditions, it can be very helpful to prepare a list of questions to ask your doctor. These questions might include:

• If I have psoriatic arthritis, will it get worse than it is now?
• What kinds of symptoms and complications should I watch for?
• How is this different from other forms of arthritis?
• Will I be able to do everything I used to do, or will I be disabled in some way?
• Will I always have pain?
• What kinds of treatments are available?
• What are the side effects of those treatments?
• Can I treat this successfully with lifestyle changes, such as diet and exercise?
• What about alternative treatments?
• Do you have literature — or can you recommend a Web site — where I can learn more about this condition?

Another good suggestion is to bring a friend or family member with you to your appointment. It’s hard to absorb everything about a complicated condition, and another person may remember information that you miss.

Tests and diagnosis

No single test can confirm a diagnosis of psoriatic arthritis. Your doctor will assess your signs and symptoms and work to rule out other causes of joint pain, such as osteoarthritis and rheumatoid arthritis. Tests that help to distinguish psoriatic arthritis from other conditions include:

• X-rays. These can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
• Joint fluid test. In this test, your doctor removes a small sample of fluid from one of your joints — often the knee — for analysis in a laboratory. Uric acid crystals in your joint fluid may indicate that you have gout, rather than psoriatic arthritis.
• Sed rate. This blood test checks your erythrocyte sedimentation rate (ESR), commonly known as the sed rate, by measuring how far from the top of a glass tube your red blood cells fall in a given time. Generally, the blood cells fall faster and farther — that is, the sed rate increases — when inflammation is present. But because many conditions can cause inflammation in the body, including many forms of arthritis and other rheumatic diseases, an elevated sed rate alone can’t confirm the presence of psoriatic arthritis.
• Rheumatoid factor (RF). RF is an antibody — a protein made by the immune system — that’s often present in the blood of people with rheumatoid arthritis, but not in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.

Treatments and drugs

No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability. Often, a multidisciplinary approach is used to treat both skin and joint symptoms.

Medications
Medications commonly used to treat psoriatic arthritis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs such as aspirin and ibuprofen (Advil, Motrin, others) may help control pain, swelling and morning stiffness, and they’re usually the first treatment tried for psoriatic arthritis. Prescription NSAIDs provide higher potencies than do over-the-counter drugs. But all NSAIDs can irritate your stomach and intestine, and long-term use can lead to ulcers and gastrointestinal bleeding.

  Other potential side effects include damage to your kidneys, fluid retention and heart failure. In addition, NSAIDs may worsen skin problems. Still, these medications may be a good option for people with minor joint pain and stiffness.

• Corticosteroids. If you have mild psoriatic arthritis, your doctor might recommend corticosteroids to control infrequent joint pain flares. Corticosteroids can be taken orally, or they can be injected directly into aching joints. Corticosteroid injections provide almost immediate relief and improve range of motion — sometimes for months. But because injected steroids can cause damage, their use is usually limited.
• Disease-modifying antirheumatic drugs (DMARDs). Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. But because DMARDs act slowly, you may not notice the effects for weeks or even months. For that reason, your doctor may prescribe a pain reliever, such as aspirin, in addition to a DMARD. Examples of DMARDs include sulfasalazine (Azulfidine) and methotrexate. The latter, particularly, has potentially serious side effects, including lung disease and liver problems. Taking folic acid with methotrexate can relieve certain side effects such as a sore mouth and an upset stomach.

• Immunosuppressant medications. These medications act to suppress your immune system, which normally protects your body from harmful organisms, but which attacks healthy tissue in people with psoriatic arthritis. Commonly used immunosuppressants include azathioprine (Imuran), cyclosporine (Sandimmune, Neoral) and leflunomide (Arava).

  Immunosuppressants can have potentially dangerous side effects and usually are used in only the most severe cases of psoriatic arthritis. Because they suppress the immune system, all such drugs can lead to anemia and an increased risk of serious infection. And many of them can cause liver and kidney problems.

• TNF-alpha inhibitors. Your doctor may recommend tumor necrosis factor-alpha (TNF-alpha) inhibitors if you have severe psoriatic arthritis. These drugs block the protein that causes inflammation in some types of arthritis. Drugs in this category include etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade). TNF-alpha inhibitors can improve signs and symptoms of psoriasis, as well. All carry a risk of serious side effects, however, including some that can be life-threatening. Be sure to discuss with your doctor whether the benefits you’ll receive from these medications outweigh the risks. Keep in mind that these treatments, which must be injected, are very expensive, often costing thousands of dollars per treatment. If you and your doctor decide to use TNF inhibitors, check with your insurance company about coverage.

Surgery
Although surgery is rarely performed for psoriatic arthritis, your doctor may recommend some form of joint operation when other treatments fail to relieve your symptoms. Surgeons use various procedures to ease pain and restore mobility. Because these operations pose some risks, be sure you thoroughly discuss your options with your doctor.

Lifestyle and home remedies

Some of the most encouraging news about psoriatic arthritis is that you can do a great deal on your own to help manage the condition. What’s more, these measures provide relief without causing side effects:

• Maintain a healthy weight. Maintaining a healthy weight places less strain on your joints, leading to reduced pain and increased energy and mobility. The best way to increase nutrients while limiting calories is to eat more plant-based foods — fruits, vegetables and whole grains.
• Exercise regularly. Exercise is beneficial for everyone — including for people with arthritis. In fact, exercise alone can help relieve many of the symptoms of arthritic conditions, including pain and fatigue. You’re the best judge of how much you can do, but an appropriate activity level should make you feel the same or better afterward, not worse. Introduce new activities gradually and heed warning signs. If you experience new pain later in the day or fatigue the following day, you’ve probably done too much.
• Use cold and hot packs. Because cold has a numbing effect, it can dull the sensation of pain. Before using an ice pack, apply a thin layer of mineral oil over the painful joint. Place a damp towel over the mineral oil and then put the ice pack on the towel. Or, simply wrap a bag of frozen peas in a towel and apply to the sore area. You can apply cold several times a day for 20 or 30 minutes at a time. You can also use heat to relax tense muscles and relieve pain. Try an electric heating pad on the low setting — be sure to place a towel between your skin and the heating pad — or an inexpensive gel-filled pack found in most pharmacies. Taking a warm bath or shower also may help.
• Use proper body mechanics. Changing the way you carry out everyday tasks can make a tremendous difference in how you feel. For example, you can avoid straining your finger joints by using a can opener to twist the lids from jars, by lifting heavy pans or other objects with both hands, and by pushing open doors with your whole body instead of just your fingers. Ask your doctor about other ways you can protect your joints.
• Pace yourself. Battling pain and inflammation can leave you feeling exhausted. In addition, some arthritis medications can cause fatigue. The key isn’t to stop being active entirely, but to rest before you become too tired. Divide exercise or work activities into short segments. And find time to relax several times throughout the day.

Alternative medicine

Several natural approaches have been shown to be helpful for some people with psoriatic arthritis. You may want to investigate:

• Vitamins and minerals. Several large, long-term studies have shown that a carotenoid called beta-cryptoxanthin and the mineral zinc may help prevent some forms of arthritis. Beta-cryptoxanthin, a substance found in fruits and vegetables, is converted in your body into retinol, an active form of vitamin A. Top sources include papaya, red bell peppers, oranges, corn and watermelon. Zinc-rich foods include liver, sesame and pumpkin seeds, yogurt and shrimp. In general, eating a diet high in fruits and, especially, cruciferous vegetables — broccoli, cauliflower, Brussels sprouts — is associated with a reduced risk of arthritis and helps promote overall health.
• Glucosamine and chondroitin. Glucosamine and chondroitin are compounds that help make your cartilage strong and rigid. They’re also sold — together and separately — in supplement form in many drugstores and natural foods stores. Because they’re components of normal cartilage, it’s thought that glucosamine and chondroitin supplements may help the body repair cartilage damaged by arthritis. Although this hasn’t been proved, studies at the National Institutes of Health did find that glucosamine combined with chondroitin sulfate helped relieve moderate to severe pain. Chondroitin may also be helpful in treating psoriasis.
• Fish oil supplements. A number of studies have shown the value of fish oil supplements in reducing arthritic pain, swelling and stiffness. Fish oil also appears to enhance the effectiveness of anti-inflammatory medications such as ibuprofen. An added benefit is that fish oil can lower high blood pressure and triglycerides and reduce the risk of cardiovascular disease overall.

Coping and support

Psoriatic arthritis can be particularly discouraging because the emotional pain that psoriasis can cause is compounded by joint pain and, in some cases, disability. If you’re struggling to cope, consider trying to:

• Learn as much as you can about psoriatic arthritis. Find out how the disease progresses, your prognosis and your treatment options, including the newest information on diet and exercise. The more you learn, the more active you can be in your own care.
• Learn to manage stress. The chemicals your body releases when you’re under stress can help you deal with demanding situations. But there’s a downside. Those same chemicals can suppress your immune system and aggravate both psoriasis and arthritis. Trying to cope with worsening symptoms may make you feel even more stressed, setting up a destructive cycle. Although it’s not possible to eliminate stress from your life, you can learn to manage it.
• Maintain a strong support system. The support of friends and family can make a tremendous difference when you’re facing the physical and psychological challenges of psoriatic arthritis. Just having someone to talk to can give you strength. For some people, support groups can offer the same benefits — this may be especially important if you’re worried about burdening your loved ones. Talk to your doctor or contact your local Arthritis Foundation chapter.

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The service is provided as general information only, and should not be treated as a substitute for the medical advice of your own doctor.