If you don’t reign in inflammation, problems can arise.
The joint pain caused by psoriatic arthritis (PsA) can be brutal on its own. Some people find that it inhibits them from fully participating in life. It may be painful to engage in your usual activities, to exercise, or even to go to work or get out of bed.
However, without treatment, PsA can cause even more problems. Treatment for PsA aims not only to reduce PsA symptoms, but also to reduce the risk of complications caused by unbridled inflammation in the body.
“The body’s not meant to live in a state of continued inflammation,” says Bobby Buka, MD, dermatologist and associate clinical professor at The Mount Sinai Hospital. “It wears the body down in the joints, [and] the skin, and also some unknown areas that we may not think about.”
For example, people with psoriasis and PsA have an increased risk of depression. In general, depression is more common among people with chronic illnesses, potentially due to the stress of dealing with the illness itself. However, there’s also some evidence to suggest that depression could be linked to inflammation as well.
People with PsA are also 43 percent more likely to develop coronary artery disease than those without PsA, according to the Arthritis Foundation. That’s partially because inflammation in the body creates damage to the blood vessels.
How Treatment Can Help
Today’s treatments for PsA work to not only reduce pain, but to control inflammation. One of the most effective treatments for moderate to severe PsA is biologics, a type of disease-modifying antirheumatic drug (DMARD) that targets parts of the immune system that fuel inflammation.
PsA is an autoimmune disease, meaning the immune system—which is supposed to protect the body against external threats—is mistakenly attacking your own body. In the case of PsA, the immune system is attacking the joint space.
When the immune system is in attack mode, it releases inflammatory proteins. These inflammatory substances are what causes pain, swelling, and redness. Although researchers haven’t yet figured out how to stop the immune system from attacking the joints altogether, biologics work by eliminating those inflammatory proteins that cause damage to otherwise healthy tissue.
Biologics have two major perks: They reduce inflammation in the joints (thus reducing pain, swelling, and long-term joint damage), and they prevent complications caused by chronic inflammation in the body.
When to Talk to Your Doctor
Many people with psoriasis might ignore mild joint pain, thinking it’s tolerable or not a big deal. Even if you can “deal with” your joint pain, your body may still be suffering from the effects of untreated inflammation.
“If you have psoriatic skin disease, and you have some joints that don’t feel right, that’s psoriatic arthritis,” says Dr. Buka. “If you have marginal symptoms that you may not think are related to your psoriatic skin disease, ask your doctor about it.”
Dr. Buka is a section chief at Mount Sinai School of Medicine. Dr. Buka is also a diplomate of the American Board of Dermatology and the Society for Pediatric Dermatology.
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I'm Doctor Bobby Buka, section chief at the Mount Sinai School of Medicine.
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Psoriatic arthritis is a type of arthritis that patients with psoriasis suffer from.
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And it affects the joint spaces, typically large joints like knees and shoulders.
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And it affects that synovial space, the space where two bones connect.
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Not everyone that has psoriasis gets psoriatic arthritis
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but the percentage is about 25 to 30%.
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Though we do know that the more severe the psoriasis is,
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the more likely that patient will suffer from psoriatic arthritis.
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If you have psoriatic skin disease,
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and you have some joints that don't feel right, that's psoriatic arthritis.
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The reason we have to get in front of psoriatic arthritis is to prevent it from progressing.
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All that inflammation in the synovial joint space will wear down
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that synovial lining and that causes a rubbing of bone to bone.
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So getting in front of it early means joints that will stay healthier much longer.
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We think psoriasis is an autoimmune condition.
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We know that there are two magnets:
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a T-cell that's part of our body's innate immune system,
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and an unknown antigen that that T-cell is attacking.
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Now, we figure that that unknown antigen is a part of our own body
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and that it's present more commonly in certain families,
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and in certain genetic makeups.
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What that antigen is, we haven't figure out.
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We know it's in the joint space, we know it's in the skin,
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we know it's in the coronary arteries.
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But what the magnet, this T-cell is attracted to, we still don't know.
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But it's loosely considered under the autoimmune umbrella.
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Autoimmune simply means that the body's attacking itself.
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The body's immune system has found something within ourselves
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that it doesn't like, that it considers external,
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that it considers a threat so the immune system attacks it.
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We wish that we could block those two magnets from colliding.
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We wish that we could figure out that antigen and get in the way
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between the T-cell and whatever it's attacking that's part of our own bodies.
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Right now, we're doing the next best thing.
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So, once those magnets collide
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and all these inflammatory proteins are released, we want to sponge those up.
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We want to get all of those inflammatory proteins out of the way
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so that innocent tissue doesn't get damaged in the mix.
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The body's not meant to live in a state of continued inflammation.
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And if we have these magnets connecting
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and we don't get in the way of treating psoriasis or psoriatic arthritis
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and we're living in this state of heightened immune response,
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it starts to wear the body down.
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It wears the body down in the joints, it wears the body down in the skin,
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and also some unknown areas that we may not think about.
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Like, depression is linked to psoriasis
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and coronary artery disease linked to psoriasis.
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So, it's really critical to get in the way of that inflammatory cascade
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and start sucking up those inflammatory mediators
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to prevent this heightened state of attack
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that's going on day to day without us even knowing it.
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So, if you have marginal symptoms that you may not think are related
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to your psoriatic skin disease, ask your doctor about it.
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Patient education: psoriatic arthritis (beyond the basics). Waltham, MA: UpToDate, 2019. (Accessed on January 8, 2020 at https://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics.) Psoriatic arthritis and your heart. Atlanta, GA: Arthritis Foundation. (Accessed on January 8, 2020 at https://www.arthritis.org/diseases/more-about/psoriatic-arthritis-and-your-heart.)