When to Worry About Joint Pain With Psoriasis
For some people, this condition can progress to joint disease. Here, signs to looks for.
If you havepsoriasis (PsO), you’re likely aware that it puts you at risk for another condition as well: psoriatic arthritis (PsA). A skin condition that evolves into a joint condition? Is that fair? Of course not! It can be nerve-wracking, then, every time you’ve got a new ache or pain. Because let’s be honest, who doesn’t have knee or back pain sometimes? We asked the experts to help us differentiate between run-of-the mill body pain and PsA-specific symptoms. The information they provide will help guide you through the ways you can potentially spot early signs of psoriatic arthritis when you have psoriasis—so you can be treated for both.
The Psoriasis-Psoriatic Arthritis Connection
无论您听到了多少次有关PSO和PSA之间的关系，完全理解连接仍然很棘手。毕竟，一种是皮肤的疾病，另一种是关节的影响。将它们结合在一起的是由过度活跃的免疫系统引起的炎症。关系更深入：根据2022年发表的分析Journal of the American Academy of Dermatology, approximately 20% to 30% of individuals with PsO also have a diagnosis of PsA.
Psoriatic Arthritis Symptoms to Look for With Psoriasis
Understanding when you should worry about potential PsA is key with psoriasis, since early treatment makes for the best outcomes. Unfortunately, that can be easier said than done. “It’s hard to separate ‘normal’ wear and tear on the joints from progressive, destructive psoriatic arthritis,” says George Han, M.D., a dermatologist at Lenox Hill Hospital in New York City. “It’s sometimes even hard to tell on an X-ray early on.” Instead, says Dr. Han, your doctor should advise you on specific clues in how your pain presents itself that help point to a psoriatic arthritis diagnosis.
Location of Joint Pain
Clue #1? Dr. Han believes it is important to considerwherethe joint pain is. Questions to ask yourself that may provide insight into whether PsA is involved: “Is the pain in a single or a few fingers only?” “Do you have joints that swell for no apparent reason?” “Is there tenderness along the Achilles tendon?”
Certain screening questions about the location of your pain can help identify the likelihood of PsA, agrees Zhanna Mikulik, M.D., a rheumatologist at The Ohio State University Wexner Medical Center in Columbus, OH. One area in particular to consider? The presence of low back pain, Dr. Mikulik says. While PsA can impact any joint, up to50％of people with PsA will experience inflammatory back pain and stiffness. Psoriasis patients with psoriatic arthritis who experience inflammatory back pain are usually worse in the morning and better with activity, according to Dr. Mikulik.
Joint Stiffness
If you have psoriasis, be on the lookout for joint stiffness, especially when you wake up, which could indicate early PsA, Dr. Mikulik says. “Morning stiffness in joints, for greater than 30-45 minutes and which requires movement to improve,” could point to psoriatic arthritis, she says. The reason this stiffness is more common upon waking with PsA? Joints tend to stiffen during sleep (as opposed to other parts of the body, which tend to relax). Similarly, if PsA is at play, you may notice stiffness with prolonged inactivity such as sitting for a long time, according to the克利夫兰诊所。
Enthesitis and Psoriasis
What else to monitor if you’re concerned your psoriasis may evolve into psoriatic arthritis? A symptom known as enthesitis: defined as tenderness, with or without swelling, at the entheses—the places where your tendons or ligaments insert into your bones. “Enthesitis could be the first presentation of PsA,” says Dr. Mikulik, who adds that this pain can occur in any of the over 100 entheses in your body, but most commonly is experienced at the back of the heel (Achilles tendonitis), the sole of the foot (plantar fasciitis), or tennis elbow. According to the Arthritis Foundation, one in three people with psoriasis will develop psoriatic arthritis, and one in three people with PsA will develop enthesitis.
Dactylitis
Another common sign of PsA that you should watch for is swelling of an entire finger or toe, known as dactylitis, says Dr. Mikulik. The condition is sometimes called “sausage digit” and is another form of enthesitis, according to the Arthritis Foundation. Dactylitis often occurs early in the disease and it may be the only sign of PsA for months or years, according to research inSeminars in Arthritis and Rheumatism。大多数银屑病关节炎患者中有症状炎。它通常涉及脚，而不是手，并且可以同时影响多个数字。
Reduced Range of Motion
When your skin is flaring with psoriasis, any kind of movement can be painful. But if you’re find your range of motion is being restricted by joint—rather than skin—pain, this may also be a reason to talk to your doctor. The inflammation that is associated with PsA can reduce your mobility due to swelling in the cartilage and synovial tissue between your joints, which may inhibit them from moving within their normal abilities.
No Improvement in Pain
当您的牛皮癣发作时，刮擦的皮肤病变的疼痛可能会令人发指。汉博士说，但也要关注关节疼痛。特别注意任何不断进步或正在进步的疼痛。与其他损伤不同，由于整个人体的炎症不受控制，与PSA有关的关节疼痛将很难治愈。根据国家牛皮癣基金会的数据，与PSA相关的疼痛可能会出现轻度症状，或者可以迅速而严重发展。
With Psoriasis, Early PsA Detection Is Important
Because some of the symptoms of PsA are similar to other conditions, determining if someone with psoriasis is developing psoriatic arthritis can be challenging and may require extensive detective work. But if your joint pain isn’t going away, keep asking questions. “Catching psoriatic arthritis early means we can prevent further progression of joint disease,” Dr. Han explains. According toFrontiers in Medicine,delaying a diagnosis of PsA as little as six months is associated with a poorer response to treatment; meanwhile, early intervention with PsA treatment is linked with improved clinical outcomes. The early symptoms of PsA may seem vague to some, but especially if you are living with psoriasis, it is important to let your provider know if you are experiencing any of the early signs of the disease.
PsA Prevalence:Journal of the American Academy of Dermatology。(2022.) “Incidence and Prevalence of Psoriatic Arthritis in Patients with Psoriasis Stratified by Psoriasis Disease Severity: Retrospective Analysis of an Electronic Health Records Database in the United States.”https://www.sciendirect.com/science/article/pii/s0190962221024944
Back Involvement:Mediterranean Journal of Rheumatology。(2022.) “Axial Disease in Psoriatic Arthritis: how can we Define it, and does it have an Impact on Treatment?” ·https://www.researchgate.net/profile/Nelly-Ziade/publication/360160621_Axial_Disease_in_Psoriatic_Arthritis_how_can_we_Define_it_and_does_it_have_an_Impact_on_Treatment/links/62659f74bca601538b652565/Axial-Disease-in-Psoriatic-Arthritis-how-can-we-Define-it-and-does-it-have-an-Impact-on-Treatment.pdf
Joint Stiffness:克利夫兰诊所。(2023.) “Psoriatic Arthritis.”https://my.clevelandclinic.org/health/diseases/13286-psoriatic-arthritis
Enthesitis:Arthritis Foundation. (2023.) “Enthesitis and PsA.”https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/physical-effects/enthesitis-and-psa
Dactylitis:Seminars in Arthritis and Rheumatism。“Dactylitis: A Hallmark of Psoriatic Arthritis.”https://www.sciencedirect.com/science/article/pii/S0049017217306261
Joint Pain Improvement:National Psoriasis Foundation. (2022.) “About Psoriatic Arthritis.”https://www.psoriasis.org/about-psoriatic-arthritis/#:~:text=Psoriatic%20arthritis%20(PsA)%20is%20a,between%20ages%2030%20and%2050.
Early Diagnosis:Frontiers in Medicine。(2021.) “Digital Approaches for a Reliable Early Diagnosis of Psoriatic Arthritis.”https://www.frontiersin.org/articles/10.3389/fmed.2021.718922/full
