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Psoriatic Arthritis: A Discussion with a Patient | Johns Hopkins Medicine

February 29, 2020


(relaxing music) When I was about 20-years-old, I developed a skin issue on my arm, and it was diagnosed as psoriasis, and then, over the years, I started noticing a pain in my foot, and general fatigue and soreness. And then, a few years after that, I was diagnosed with depression. I met with multiple doctors for each of these issues, and they were treated independently. Just because of my job, I happened to talk to a rheumatologist, and discuss some of these issues, and that’s when it was discovered that possibly this was all connected. So I made an appointment, and was indeed diagnosed with psoriatic arthritis. I still don’t really know, though what psoriatic arthritis is. It is not just arthritis. Psoriatic arthritis is different from person to person. It is an autoimmune disease that occurs in about one in three people with the skin disease psoriasis. It can affect the small joints of the hands and feet, and also the large joints, like knees and ankles. It can cause inflammation of the tendon and ligament attachments, termed enthesitis. or swelling of fingers and toes, known as dactylitus. In some instances, psoriatic arthritis can affect the spine and pelvis, causing spondyloarthritis. Many people with psoriatic arthritis have active skin psoriasis, a history of it, or a family member with psoriasis. Nail psoriasis is extremely common in psoriatic arthritis. In addition to these manifestations, psoriatic arthritis can also cause pain, fatigue, and difficulty with daily life activities. It’s interesting to hear all the different ways that psoriatic arthritis can affect a person. For me, the biggest struggle has been with the fatigue. I’m young, and on the outside I look healthy, and I definitely struggle to accept sometimes, the way that the fatigue can affect my life. I might have plans with friends, for example, and then just be too tired to get out of bed. I also often feel like a general soreness or achiness in my body, that can really impact my day and slow me down. I’ve really found it difficult to accept this impact on my life, and it’s been hard sometimes to talk about it with my friends, and my family, who, again, don’t see any physical markers of the disease, and don’t really know anything about it. Fatigue is very common in psoriatic arthritis. And it is so important for patients, that it is now a required outcome in clinical trials. Several strategies can help with fatigue. One is to plan activities ahead of time, and make wise choices. Two, find a relaxing activity at the end of the day, and make sure you get enough sleep. Three, be physically active with an activity that you enjoy. Teaming up with friends and family can help keep you motivated, and many people feel energized, after physical activity. Have you discovered any strategies that work for you? I definitely prioritize my sleep. It’s hard not to. But even after a good night’s sleep, I rarely feel renewed or re-energized the next morning. I found though that stretching, first thing, can really help me to get going. I also often will try to walk or do yoga, and after doing yoga, in particular, I can definitely feel a positive difference in my body. That’s great. And what about therapies for psoriatic arthritis? What should I be aware of? There are many new treatments for psoriatic arthritis now. The biggest breakthrough has been the approval of biological medications, that slow down inflammatory pathways, activated specifically psoriatic arthritis. Rheumatologists can now prescribe individualized treatment plans to patients, depending on their own manifestations of psoriatic arthritis, and other health conditions. Psoriatic arthritis needs to be monitored, and treatment reevaluated on an ongoing basis. It is always a risk and benefit decision that the patient and the doctor take together, and update at every visit.

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