“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.
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There's no uniform way to treat psoriatic
arthritis and I think it's a very
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physician dependent on the way it gets
diagnosed and the way gets treated.
00:00:09,585 --> 00:00:14,631
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Someone with psoriatic arthritis will
generally see their dermatologist and
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rheumatologist quite regularly.
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The dermatologist is a doctor
that focuses on skin conditions.
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Rheumatologists focus on joints and
also inflammation in general.
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So when somebody has a flare, they would
go in to see their rheumatologists,
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because the rheumatologist
could give them steroids and
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more accurately assess whether or
not this is a disease flare.
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Whether this requires admission, whether
this requires a change in their baseline
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disease-modifying anti-rheumatic drug.
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And they can also inject the joints
in the setting of a flare.
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And then a primary care doctor will
be very helpful every couple of
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months to check your blood pressure, check
your blood sugars and your lipids as well.
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Physicians generally won't refer to the
other specialists unless it's required.
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So unless you develop diarrhea or
blood in your stools, I wouldn't have
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a gastroenterologist screen my patients
for Crohn's or ulcerative colitis.
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And the same would go if
they have asymptomatic eyes,
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there's no way I would send to
an ophthalmologist unless it was required.
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But I think that the treatment and
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diagnosis of this condition
are very physician dependent.
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So there's no set regimen.
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But a lot of people do very,
very well and live a normal lifestyle.
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And are able to return to baseline,
have families, enjoy their weekends,
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go to work every day and
that should be what everyone strives for.
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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.)