A Patient Guide To - Walgreens
A patientguide topsoriatic arthritisand psoriasis
Table of contentsUnderstanding psoriasis andpsoriatic arthritisLearning how to manage psoriasis or psoriatic arthritis might feel like a challenge, especially atUnderstanding psoriasis and psoriatic arthritis 1Causes 1first. But understanding your diagnosis can help you take control of your health. There is no curefor psoriasis or psoriatic arthritis. But a number of available treatment options can help managesymptoms. This booklet provides information about psoriasis and psoriatic arthritis, what to expectPsoriasis 2Who gets psoriasis? 2Diagnosis 2Types 2Severity 2after diagnosis and how to manage symptoms to live a full and active life.Psoriatic arthritis 4Who gets psoriatic arthritis? 4Diagnosis 4Types 4Severity 4get better and worse over time. Starting treatment soon after your diagnosis can help you improve yourRelated conditions 6Living with psoriasis and psoriatic arthritis 7Staying on track with treatment 7Topical treatments 7Phototherapy 7Systemic treatments 7Biologic treatments 8Other treatments 8Lifestyle changes 8Emotional health 10Ongoing care 11References 12Resources 13Psoriasis and psoriatic arthritis are chronic, or long-term, conditions. They cause swelling in the body.Psoriasis causes itching, swelling and redness in the skin. Up to 30% of people with psoriasis developpsoriatic arthritis.1 This causes painful, stiff and swollen joints (see figure below). These conditions canoverall health.CausesFigure: Affected jointsThe exact cause of these conditions is not clear Experts think a few factors might play a role: Genes These conditions might be partly inherited This means the genes for developing them arepassed down through a family One in threepeople with psoriasis report having a familymember with the disease 2 However, not everyonewith a family history develops the condition Immune system These conditions might alsooccur because the immune system is not workingproperly Normally, the immune system seeks outand attacks bacteria or viruses that can causeillness It also helps the body recover from illnessor injury But in psoriasis and psoriatic arthritis, theimmune system is triggered by mistake Outside factors Other things, such as bacteria orviruses, infections, injuries, medications or stresscan trigger the conditions in people who areat risk Lifestyle Being overweight and smoking are riskfactors for psoriasis 3This publication is for informational purposes only It is not intended to be a substitute for professional medical advice, diagnosis or treatment Always seek the advice of your physician orother qualified health provider with any questions you may have regarding a medical condition Never disregard professional medical advice or delay in seeking it because of somethingyou have read in this publication If you think you may have a medical emergency, call your physician or 911 immediately Walgreens does not recommend or endorse any specifictests, physicians, products, procedures, opinions or other information that may be mentioned in this publication Reliance on any information provided in this publication is solely at yourown risk This publication was created by and is provided as a service of Walgreens 1
PsoriasisNormal skin cells take about one month to grow and fall off the body. In psoriasis, a problem with theTable 1 Types of psoriasisimmune system causes skin cells to go through the process in just a few days.4 This causes skin cellsto pile up on or near the surface of the skin.TypeInformationDescriptionPlaque1,4,5 Most common type, about 80% to 90%of cases Raised, red patches covered withsilvery-white scales Can range from coin-sized to palm-sized Most often on the scalp, knees, elbowsand lower backGuttate8 Less common type, about 10% of cases More likely in childhood andyoung adulthood Often comes on suddenly Often seen after streptococcalbacteria infection Small red spots, not as thick asplaque psoriasis Seen mainly on the chest and back, armsand legs Sometimes seen on the scalp, faceand earsErythrodermic5,9 Less common type, about 3% of cases Can cause increased heart rate andunstable body temperature Fiery redness covering nearly the entirebody Shedding of scales in large patches ratherthan smaller flakesThis can result in different types of skin problems, such as raised, red and scaly patches on the skincalled lesions. Irritated skin can form on many parts of the body. This might include the scalp, elbows,knees and legs.5 Skin problems can also affect the face, hands, feet and nails. These areas can itch,burn and sting.1 For many, the pain and discomfort can affect daily life.4,6Who gets psoriasis?DiagnosisAbout 125 million people around the world havepsoriasis This includes as many as 7 5 million in theUnited States 2,6 Psoriasis affects men and womenequally It can occur in any racial group But it ismore common among Caucasians Psoriasis candevelop at any age But it usually develops betweenthe ages of 15 and 39 1,6 In addition, it has beennoted that there is also an increase in the number ofpeople who are diagnosed with psoriasis betweenthe ages of 50 and 69 7There is no single test or tool to diagnose psoriasis Your doctor likely used many types of information,such as1:Inheriting psoriasis250%: Risk of developing psoriasis if bothparents have the disease10%: Risk of developing psoriasis if oneparent has the disease2% to 3%: Portion of the generalpopulation that develops psoriasis Family medical history Skin inspection Small sample, or biopsy, of affected skin for closerexamination in a lab Might occur with infection and swellingaround the ankles Can be life-threatening and needimmediate medical careTypesThere are five types of psoriasis (see Table 1) Mosttypes cause red lesions on the skin With sometypes, lesions might have a scaly surface Inverse10 More typical in overweight people Can occur at the same time as othertypes of psoriasis Commonly seen in skin folds nearthe genitals, under the breasts or inthe armpits Generally red and tender with little scalingPustular11 Rare Primarily seen in adults Many forms; one form (Von Zumbusch)can be life-threatening and needimmediate medical care White blisters of noncontagious pussurrounded by red skin May occur all over the body or on thehands and feetSeverityPrescribed treatment depends on the severity ofyour condition 4 Psoriasis can be mild, moderateor severe 4: Mild: Covers less than 3% of the body Moderate: Covers between 3% and 10 % of thebody Severe: Covers more than 10% of the bodyDoctors also assess the severity of psoriasisbased on 5: Location of lesions Effect on daily life23
Psoriatic arthritisPsoriatic arthritis is a chronic condition It causesswelling, stiffness and pain in and around the joints It usually affects joints closest to the fingernails ortoenails It can also cause changes in the nails Thiscan include separation from the nail bed or pitting 12Other common symptoms include12:TypesSeverityThere are five types of psoriatic arthritis(see Table 2) They can occur in different partsof the body Treatment depends on the severity and progressionof the condition 14 Doctors determine the severity ofpsoriatic arthritis by how many joints are affected atone time Eye pain and rednessTable 2 Types of psoriatic arthritis Fatigue Morning stiffness and tirednessTypeInformationDescription Swollen fingers and toesSymmetric arthritisAbout 50% of cases Tenderness, pain and swelling over the tendons,or the tissues that connect muscle to bone Occurs in the same joints on both sides of the body Similar to RA, causing joint pain and swellingAsymmetric arthritisAbout 35% of cases Usually affects one to three joints Does not occur in the same joints on both sides ofthe body Swollen fingers and toes might look like sausagesSpondylitisLess common Causes pain and stiffness in the neck, lower backand pelvis Can also cause problems in the hands, arms, hips,legs and feetDistal interphalangealpredominantLess common Usually affects joints near the ends of the fingersand toes Causes nail changes like pitting, white spots andseparation from the nail bed Sometimes confused with osteoarthritis, which iscaused by normal wear and tearArthritis mutilans Rare Most severe form Occurs in joints of the hands and feet Can cause deformed fingers or toes Linked with pustular psoriasisSome people also have symptoms in the back,wrists, knees or ankles This can make it hardto move Psoriatic arthritis can get better and worse overtime Early diagnosis and treatment can helpprevent permanent joint damage 5Who gets psoriatic arthritis?About 20% to 30% of people with psoriasis alsodevelop psoriatic arthritis 13 Many people havepsoriasis for some time before developing psoriaticarthritis Others develop psoriatic arthritis beforedeveloping psoriasis Psoriatic arthritis affects menand women equally 13 It can occur at any age But itusually appears between the ages of 30 and 50 13DiagnosisThere is no single test to diagnose psoriatic arthritis A rheumatologist, or doctor who specializes intreating arthritis, uses many types of information,such as12: Blood tests and other lab tests to rule out otherconditions, such as rheumatoid arthritis (RA)or gout Magnetic resonance imaging and X-rays ofthe joints Medical history, especially with psoriasis Physical exams for skin and nail changes45
Related conditionsSome people with psoriasis and psoriatic arthritismight be more likely to develop other healthproblems, including16: Cancer, including lymphoma and skin cancer Cardiovascular disease, which includes heartattack and stroke Depression Eye inflammation Hearing loss (with psoriatic arthritis) Inflammatory bowel disease, which includesCrohn’s disease and ulcerative colitisLiving with psoriasis and psoriatic arthritisPregnancy and breastfeeding17If you are pregnant or planning to becomepregnant, talk to your doctor about how tomanage your psoriasis or psoriatic arthritis In some women, symptoms improve duringpregnancy In others, symptoms get worse This can differ for each person and for eachpregnancy and birth Research suggests that women with severepsoriasis might be more likely to have a babywith a low birth weight Also, many womenexperience a flare soon after giving birth There is no cure for these conditions But there aremany ways to treat the symptoms Work with yourdoctor to find the best treatment for you Coal tar to reduce swelling, itching and scalingThe main goals of psoriasis treatment include 5: Steroids to relieve swelling and itching Effectively and safely clearing skin lesions Vitamin A medications, or retinoids, to slow skincell growth and relieve swelling Eliminating symptoms, or staying in remission Improving quality of life Vitamin D medications to slow skin cell growth,flatten lesions and remove scalesTreatment for psoriatic arthritis includes the samegoals, as well as18:Phototherapy Relieving painYour doctor might also recommend phototherapy This uses natural or artificial ultraviolet (UV) light It can help reduce swelling and other symptoms Some types of phototherapy might include 6: Preventing joint damage UVA or UVB lightFor many people, medication and lifestyle changescan help achieve these goals UVA light with psoralen, a drug that makes theskin more sensitive to treatment Type 2 diabetesStaying on track with treatmentSystemic treatments Weak bones, which includes osteopeniaand osteoporosisMedication therapies and lifestyle changes can helpimprove your symptoms But not all treatmentswork for everyone Talk with your doctor aboutwhat works best for you Your needs might changeover time Your doctor can adjust your treatmentas needed Systemic drugs are used for severe cases They areused when topical or phototherapy treatments donot work These drugs are taken by mouth or byinjection These can include 6:There are several treatments for psoriasis andpsoriatic arthritis Some are available over thecounter Others require a prescription Treatmentdepends on the severity of skin lesions orjoint problems Nonsteroidal anti-inflammatory drugs to helprelieve swellingTopical treatments Steroids to help relieve swollen jointsTopical treatments are usually the first type oftreatment given for psoriasis These are applieddirectly to the skin They can include 6,19:Biologic treatments Kidney disease (with psoriasis) Liver disease Metabolic syndrome, which includes heartdisease, abdominal obesity and highblood pressure ObesityAlso, some treatments are not safe whentrying to become pregnant, during pregnancyor while breastfeeding Talk with your doctorabout your treatment You might need toadjust your treatment temporarily Keeping joints working properly Reducing swelling Anthralin to slow skin cell growth Calcineurin inhibitors to decrease swelling andlesion buildup on the skin6 Salicylic acid to remove dead skin cells andreduce scaling Disease-modifying drugs to suppress the immunesystem and slow the disease process A phosphodiesterase inhibitor to stopinflammation Retinoids to slow skin cell growthBiologics target certain parts of the immune systemthat cause psoriasis or psoriatic arthritis Thesedrugs are taken by injection or intravenous infusion These can include 6:7
Living with psoriasis and psoriatic arthritis (continued) Tumor necrosis factor (TNF)-alpha blockers toreduce TNF-alpha, a chemical in the immunesystem that can cause inflammationOther therapies might also help control or improvesymptoms of psoriatic arthritis, including 21,22: Interleukin (IL) 12/23 blockers to reduce IL-12 andIL-23, chemicals in the immune system that cancause inflammation Cold or heat packs on affected joints to relieveswelling, stiffness or pain IL 17A blocker to reduce IL-17A, another chemicalin the immune system that causes inflammation Physical therapy and movement to improvejoint movementNo matter what therapies are part of your treatment,you should take them exactly as directed by yourdoctor—at the right times and the correct doses Do not stop your treatment without asking yourdoctor first If your treatment routine starts to feeltoo hard, ask your doctor or pharmacist for helpmanaging your therapy Staying on track withtreatment is important for controlling yoursymptoms and improving your health Lifestyle changesOther treatmentsPsoriasisOver-the-counter treatments can also help managesome symptoms But they are not usually strongenough to improve the skin on their own They areoften used with medicated treatments 4 Bath solutions Adding oils, colloidal oatmeal,Epsom salt or Dead Sea salt to a bath can helpsoothe skin You can soak in this type of bathsolution for about 15 minutes Then, dry off Apply a moisturizer immediately 20 Moisturizers Using fragrance-free moisturizers orlubricants regularly can help soothe the skin andhelp seal in moisture 4,20 Use a moisturizing soap Apply moisturizer right after bathing, showering orwashing your hands Occlusion Some skin treatments might be betterabsorbed when occluded, or covered with plasticwrap, or other waterproof dressings or cottonwraps 20 This might not be recommended forevery type of treatment Ask your doctor if this isright for you 8Psoriatic arthritisAlong with medication therapies, lifestyle changescan help you manage your symptoms Stayingactive, eating well and limiting stress can help youfeel better each day Physical activityRegular, gentle exercise can help keep your jointsflexible Staying active can also help the rest ofyour body stay healthy while you maintain a healthyweight This can reduce your risk of heart disease Itcan also lessen extra strain on your joints Exercisecan help relieve emotional stress that might makesymptoms worse You might consider gentle activities such as: Aerobic activities like walking or swimming Stretching and range-of-motion exercises, likegentle yoga or tai chi Strengthening routines like gentle weight trainingTalk to your doctor before starting any exerciseprogram You might also wish to work with aphysical therapist or exercise specialist Together,you can make an exercise plan that is right for you Be sure to balance exercise with rest This isespecially important during flares Ask your doctorhow long you should take a break from exerciseduring flares Healthful eatingProtecting your bonesStudies suggest that psoriasis and psoriaticarthritis might be linked with weak orbrittle bones 24,25 These conditions arecalled osteopenia or osteoporosis Steroidmedications, difficulty staying active andthe effects of psoriatic arthritis might allcontribute to these problems Work with yourdoctor to track your bone health Your doctormight order a bone density test to measurethe strength of your bones and your riskof fracture You can help protect your bones when you 26: Avoid smoking It is linked to bone loss Eat a well-balanced diet Get enough bone-building calcium andvitamin D in your diet Ask your doctor howmuch calcium and vitamin D is right for you Get regular exercise to strengthen bones Limit alcohol It can lead to bone loss There is no specific diet for psoriasis or psoriaticarthritis In general, experts suggest a healthful,b
Metabolic syndrome, which includes heart It can help reduce swelling and other symptoms might be more likely to develop other health . Related conditions. Some people with psoriasis and psoriatic arthritis problems, including. 16: Cancer, including lymphoma and skin cancer Cardi
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