“There’s no uniform way to treat psoriatic arthritis.”
“There’s no uniform way to treat psoriatic arthritis,” says Nicola Berman, MD, rheumatologist at Lenox Hill Hospital in New York City. “It’s very physician-dependent in the way that it gets diagnosed, and the way it gets treated.”
Because psoriatic arthritis, or PsA, is a condition that causes systemic inflammation in the body, it can create a number of inflammatory symptoms beyond the skin or joints. When this occurs, individuals with PsA may need to work with specialists to make sure all their PsA complications are being properly treated.
The primary doctors in a medical team for PsA are a rheumatologist and dermatologist. Rheumatologists are doctors who diagnose and treat rheumatic conditions, which are musculoskeletal and systemic autoimmune conditions. They help manage the arthritis pain and prevent deformities for patients with PsA.
“When somebody has a flare, they would go in to see their rheumatologist,” says Dr. Berman. The rheumatologist can prescribe steroids, and it’s also their job to assess whether the pain is truly a disease flare and not some other health issue.
Dermatologists help treat the psoriasis symptoms associated with PsA. People with PsA almost always have the red, itchy plaques caused by psoriasis, and a dermatologist can help find the right treatment for psoriasis symptoms. The dermatologist can be a crucial member of the treatment team since psoriasis symptoms are often visible and can affect the patient’s self-esteem.
Another important member of the medical team for PsA is the primary care doctor. Every couple of months, a primary care doctor should check the individual’s blood pressure, blood sugar, and cholesterol levels. This is due to the increased risk of heart disease and diabetes among people with psoriatic disease.
Depending on a patient’s needs, they may need to add additional specialists to their medical team. “Physicians generally won’t refer [a patient] to the other specialists unless it’s required,” meaning the patient is displaying problematic symptoms, says Dr. Berman.
Some potential specialists that might make up a medical team for PsA include:
A gastroenterologist to treat inflammatory bowel diseases
An opthamologist to treat eye inflammation
A cardiologist to treat heart disease
An endocrinologist to treat type 2 diabetes
A psychologist and/or psychiatrist to treat depression
Or a registered dietitian to help treat diabetes, heart disease, obesity, or general inflammation.
While there’s no set treatment for PsA, the individualized approach seems to do well for patients. “A lot of people do very, very well, and live a normal lifestyle, and are able to return to baseline, have families, enjoy their weekends, go to work every day—and that should be what everyone strives for,” says Dr. Berman.
Comorbidities associated with psoriatic disease. Portland, OR: National Psoriasis Foundation. (Accessed on May 20, 2019 at https://www.psoriasis.org/about-psoriasis/related-conditions.)
What is a rheumatologist? Atlanta, GA: American College of Rheumatology, 2018. (Accessed on May 20, 2019 at https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Health-Care-Team/What-is-a-Rheumatologist.)