Psoriasis & Psoriatic Arthritis: Why You Should Know Both

Dr. Khor Yek Huan (Consultant Dermatologist)

Psoriatic arthritis – are you at risk?

Many psoriasis patients and their attending physicians are unaware that they have psoriatic arthritis. Find out if you should get an early screening on Not Alone With Psoriasis, a blog by Novartis — featuring dermatologist Dr Khor Yek Huan.

What Is Psoriatic Arthritis?

According to the Malaysian Psoriasis Registry, 14% of adult psoriasis patients have psoriatic arthritis.1 Unfortunately, a large proportion of psoriasis patients and their attending physicians are unaware that they have the disease.

Psoriasis is an auto-immune disease that isn’t just skin-deep; it can cause inflammation throughout the whole body, including joints2.

Psoriatic arthritis is a painful, disabling condition that affects the joints, tendons, and bones3. Unlike osteoarthritis, which typically affects older patients, psoriatic arthritis can present itself from the ages of 35 to 454.

Like psoriasis, there is no cure for psoriatic arthritis. Early screening and diagnosis is important to treat symptoms and prevent long-term damage to joints. Without treatment, psoriatic arthritis may be disabling and result in deformities.

How Do You Know If You Have Psoriatic Arthritis?

Psoriatic arthritis is often missed because it takes about 12 years to develop into joint issues5. Psoriatic skin lesions usually occur before the joint disease in majority of patients. (Joint pain may precede skin lesions in other patients.) Speak to your doctor at the earliest opportunity in case you do have psoriasis and may have developed psoriatic arthritis without realizing it.

There is little connection between the psoriatic plaque severity (severe skin lesions) and psoriatic arthritis severity (joints with arthritis).

early diagnosis psoriatic arthritis prevent joint damage

Everyone experiences different symptoms on a case-by-case basis; it is estimated that 25% of patients with psoriatic arthritis suffer neck or back stiffness and pain6.

Check for these symptoms of psoriatic arthritis7,8:

  1. Daily joint pain lasting longer than 6 weeks with evidence of current psoriasis, a personal history of psoriasis, or a family history of psoriasis
  2. Unexplained fatigue with difficulty moving around
  3. Early morning joint stiffness for more than 30 minutes
  4. Inflammatory joint pain that is more acute during prolonged rest and less acute in the evening after joint movements
  5. Dactylitis: swollen fingers and toes that look like sausages
  6. Nail changes: discoloration, nail pitting or damaged nail resembling fungal infection
  7. Uveitis: pink eyes
4 Signs Your Psoriasis Medication Isn’t Working

Which joints are commonly affected by psoriatic arthritis? Is there any pattern of joint involvement?

Types of psoriatic arthritis are usually defined by the location and number of joints affected. Commonly reported patterns are9:

  1. Asymmetric oligoarthritis: less than 5 joints are usually affected. The arthritis may affect one joint at one side of the body but not its opposing counterpart. This is the most common pattern reported in Malaysia10.
  2. Symmetric polyarthritis: multiple joints (more than 5) are usually involved. Commonly occurs at smaller joints on both hands and feet resembling rheumatoid arthritis.

  1. Distal interphalangeal arthritis: arthritis typically occurs at fingers or toe joints that are closest to the nail.
  2. Spondyloarthritis: arthritis that affects the spine. Patients usually begin experiencing unexplained lower back pain which becomes progressively more acute over time. Back and neck stiffness will follow if left untreated.
  3. Arthritis mutilans: the most devastating kind of psoriatic arthritis. Joints are so severely damaged that they can slip into each other just like the portions of a telescope. Luckily, this type of psoriatic arthritis is not common.

Self-Diagnosis vs Medical Evaluation

You can refer to a few screening tools such as the Psoriasis Epidemiology Screening Tool (PEST),

psoriatic arthritis joint pain symptoms

Toronto Psoriatic Arthritis Screen (ToPAS) and Psoriatic Arthritis Screening and Evaluation Tool (PASE) to assess yourself for early detection of psoriatic arthritis. However, these do not test specifically for the disease and they shall not replace a physician’s proper evaluation.

Screening and Frequency

As mentioned earlier, it is very important to detect and treat Psoriatic Arthritis as early as possible. In most circumstances, your attending physician will routinely screen for psoriatic arthritis every three to six months or during each routine skin follow-up. There is no singular test that confirms the disease. Your physician may perform a combination of physical examination, blood tests, MRI’s and X-rays of the joints, then combine their results with your clinical history to ascertain your diagnosis.

psoriatic arthritis diagnosis screening

Daily Life with Psoriatic Arthritis

If you have psoriatic arthritis, your everyday quality of life may deteriorate. First, because inflammation of your joints restricts physical movements, so daily tasks like climbing stairs, getting in and out of bathtubs, getting dressed, working, and exercising may be extraordinarily difficult. Secondly, patients report feeling embarrassed, helpless, and depressed due to their condition. They often endure low self-esteem and avoid socialising.11

Treatment for Psoriatic Arthritis

Choice of treatment varies according to disease severity, type of arthritis and availability of the medications.

Mild arthritis may be resolved with Nonsteroidal Anti-Inflammatory Drugs (NSAID’s) — oral steroid or steroid injection into the diseased joints is occasionally used for temporary pain control. Moderate to severe arthritis that involve the spine may require disease modifying drugs (DMARDs) and/or biologics injection.

Methotrexate is the first line of DMARD’s and it is effective in reducing skin lesions and joint symptoms. Other commonly used DMARD’s are Leflunomide, sulfasalazine and cyclosporin A.

Biologics are genetically-engineered proteins derived from human genes and they act by inhibiting specific components of the immune system that cause the inflammation in psoriatic arthritis. Given through subcutaneous injection or intravenous infusion, biologics such as inhibitors of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-17, IL-12 and IL-23 are effective in reducing both psoriatic arthritis and psoriatic skin lesions.

Both DMARDs and biologics treatment may result in side effects. Proper counselling and discussion are needed before treatment.

daily quality of life with psoriatic arthritis

These pharmacological treatments can be supplemented with physiotherapy, occupational therapy, lifestyle modifications — such as moderate exercise, stress-reduction techniques, and healthy diet — for maximum results.

reatment for psoriatic arthritis

As mentioned above, there is no cure for psoriatic arthritis. Like many other autoimmune diseases, symptoms tend to wax and wane, alternating between flare-up’s and periods of remission.

However, if you know what triggers your arthritis (such as stress or infection), you may be able to manage it with rest and lifestyle changes. Regular follow-up’s and good interactions with your treating physician is key to successful treatment.

Do inform your doctor if you experience severe and prolonged flare-up’s without a known trigger – this means you may need to switch your medication.

Visit our Facebook page to find out more information about psoriasis.

Read stories like this and more about psoriasis on our MyPsoriasis blog.

Visit #Ask4Clear and find the best dermatologist near you today!

If you enjoyed this article, read Biologic Treatment For Psoriasis: 4 Things You Need To Know

References



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Dr. Peter Ch’ng Wee Beng

Dr Ch’ng obtained his specialty training from the Royal College of Physicians in London. Subsequently, he obtained his Advanced Masters in Dermatology from the National University of Malaysia. He was previously the Head of Dermatology of the State of Pahang and Hospital Sungai Buloh.

His call to dermatology started way before he even contemplated doing medicine. His father suffered from severe psoriasis, and was in and out of hospital a lot in the late 1970s. His father’s condition made him see that skin disease is not just an aesthetic problem, as it can cause the patient and the entire family so much grief. His practice today reaffirms his belief, with many patients expressing deep relief and gratitude after their treatment.

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FB: @peterchngskinspecialist


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Dr. Ch'ng Chin Chwen

Dr. Ch'ng is a NSR registered consultant dermatologist. She graduated as a gold medalist from Univeristy Malaya in 2006. She obtained Membership of the Royal Colleges of Physician of the United Kingdom in 2010 and joined dermatology team in University Malaya in the same year. She completed Advanced Master in Dermatology (UKM) in 2014 and a visiting fellowship in Cutaneous Laser Surgery in Mahidol University (Thailand) in 2017. Her special interest include acne, psoriasis, urticaria, contact dermatitis/eczema and procedural dermatology.

Dr. Ch'ng started her instagram account @cccskindoc providing free skin care tips and education to public. She believes everyone deserves up-to-date and accurate information on skin care to embrace the skin that he or she is in.

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IG: @cccskindoc


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Dr. Khor Yek Huan

Dr Khor graduated from National University of Malaysia (UKM), Kuala Lumpur in 2002. He obtained his Internal Medicine specialty training from the Royal College of Physicians of London in 2007 and further subspecialized in Dermatology by obtaining his Advanced Master in Dermatology from UKM in 2013. Dr Khor served as the Head of Dermatology service for Perlis from 2013 to 2015 before transferring back to Penang. Currently, he is the Deputy Head of Department of Dermatology in Hospital Pulau Pinang. He is also a visiting consultant dermatologist at KPJ Penang Specialist Hospital and Northern Skin Specialist Clinic.

Dr Khor is active in academic activities, performing as an honorary lecturer for Allianze University College of Medical Sciences and Penang Medical College. He is active in research as well with the publication of original papers in dermatological journals and serves as a reviewer for Malaysian Journal of Dermatology. His dedication to the profession earned him Excellent Service Award from the Ministry of Health in 2009 and 2017.

Place of Practice

Email: nssc.penang@gmail.com


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