Understanding the basics of psoriatic disease

Psoriatic disease refers to a pair of related inflammatory disorders—psoriasis and psoriatic arthritis. One affects the skin, while the other affects the joints, but both share a common factor—abnormal immune activity that promotes inflammation.

Psoriasis

Psoriasis is a chronic skin disorder that can cause a number of uncomfortable symptoms. The most common type of psoriasis is plaque psoriasis, which causes thickened patches of raised skin, called plaques. These plaques have a silvery/scaled texture, and can appear anywhere on the body, though most commonly appear on the elbows, knees, lower back, and scalp.

In addition to plaque psoriasis, there are other types of psoriasis, which can cause a wide variety of symptoms. These symptoms range from small, round dots with thin scaling on the surface (guttate psoriasis), to vivid lesions in the folds of the skin (inverse psoriasis), and pus-filled blisters (pustular psoriasis). There are even two types of psoriasis that can be life-threatening: Von Zumbusch pustular psoriasis and erythrodermic psoriasis. Both types are rare, but cause widespread symptoms across the body, and can be accompanied by a number of serious complications, including fluid loss, severe pain and itching, fever, and increased heart rate. Both require immediate medical care.

Though it causes skin symptoms and can be triggered by irritation and injury to the skin, psoriasis is not strictly a skin condition—it is associated with abnormal immune activity and inflammation. Symptoms manifest when inflammatory immune cells enter the skin and disrupt the normal lifecycle of skin cells.

However, this inflammatory response is not only limited to the skin and can affect other areas of the body, including the joints.

Psoriatic arthritis

As many as 30 percent of people with psoriasis will develop psoriatic arthritis, where abnormal immune activity results in symptoms like swelling, tenderness, pain, and stiffness in the joints—and can lead to permanent joint damage and disability.

Psoriatic arthritis typically develops after the onset of psoriasis, and for most people occurs about 10 years after psoriasis symptoms begin. However, for some people, psoriatic arthritis symptoms appear before skin symptoms or begin simultaneously with skin symptoms. Symptoms can appear gradually or suddenly, and psoriatic arthritis can affect any joint in the body—small joints in the hands and feet, larger joints like the knees and hips, and even the spinal column.

In addition to affecting the joints, psoriatic arthritis is linked to several other symptoms and issues, including nail psoriasis, swelling of the fingers and/or toes (called dactylitis), swelling of the tendons or tendon sheaths, and inflammation in the eyes. Additionally, both psoriasis and psoriatic arthritis are associated with an increased risk of other health conditions, such as cardiovascular disease and type 2 diabetes.

Treatment

Treatment for psoriasis depends on a number of factors, including the areas of the body affected and the impact that the disorder has on a person’s quality of life. People with mild psoriasis may only require topical treatments. Those with more severe psoriasis may need systemic treatments, such as immunosuppressant drugs or biologic therapies.

Treatment for psoriatic arthritis also depends on multiple factors, including the joints affected and the severity of symptoms. People with mild and occasional symptoms may be able to manage psoriatic arthritis with non-steroidal anti-inflammatory drugs (NSAIDs). For more severe or persistent symptoms, a person may require systemic (body-wide) treatments; several systemic treatments for psoriasis are also indicated for psoriatic arthritis. Physical therapy may also be a part of a treatment plan to promote and protect the mobility of joints.

Maintaining a healthy body weight, staying active, eating a healthy diet, and limiting or eliminating exposure to factors that promote inflammation (such as alcohol and cigarette smoke) are also recommended for both psoriasis and psoriatic arthritis. These lifestyle factors are important for reducing the risk of other diseases and promoting overall physical and mental health as well.

The most important thing to do if you have psoriasis, psoriatic arthritis, or both is to work with a healthcare provider who understands psoriatic disease and can help you find a treatment plan that works for you.