Psoriatic arthritis: How do I cope?
In the concluding part of this article, Dr. Kaleel Cassim answers questions commonly asked by people who have psoriatic arthritis.
What are disease-modifying
Disease-modifying drugs help by attacking the causes of the inflammation in the lining of the joints.
These drugs act quite differently from anti-inflammatory drugs and hopefully will stop your arthritis from getting worse. Unlike anti-inflammatory drugs it may be several weeks before they start to have an effect on your joints. Therefore it is important to keep going with these tablets even if you think they aren't doing any good.
Will I need steroid treatments?
Steroids are often recommended as an injection to the inflamed joint or where the tendon attaches to the bone.
In general, steroid tablets (such as prednisolone) are not used for psoriatic arthritis. However, small injections of steroid are often recommended for joints which are particularly troublesome and for the painful bony sites where ligaments and tendons become inflamed.
What treatments will be used
for my skin?
Treatment is usually with ointments but if these don't help you may need tablet treatment and light therapy.
Ointments and creams can be of five types:
- tar-based ointments and creams (It may not be obvious that they contain tar.)
- dithranol-based ointments and creams (These can burn normal skin, so it is important to follow the instructions carefully.)
- steroid-based ointments, creams and lotions
- vitamin D-like ointments such as calcipotriol and tacalcitol
- vitamin A-like (retinoid) gels such as tazarotene.
If the creams and ointments do not help the psoriasis your dermatologist may suggest light therapy and/or tablets such as retinoids (which are similar to vitamin A). Light therapy involves being exposed to high intensity ultraviolet light for short periods and has to be carried out in a hospital.
Many of the disease-modifying drugs used for psoriatic arthritis will also help the skin disease. Similarly, some of the treatments for psoriasis may help the arthritis. For this reason dermatologists and rheumatologists will often work together in treating you.
How much rest and exercise ?
It is hard to generalize on this question - no two people are the same. Inflammation can cause generalized tiredness and you may find you need to take more rest than usual. On the other hand, it is very important to keep exercising the joints.
Inflammation can lead to muscle weakness and stiffness in the joints. Exercise is important to help prevent this and to keep the joints functioning properly. You will need to find the right balance for yourself but remember not to neglect either rest or exercise when you are trying to help your disease.
Chronic pain can get you down and may cause stress, anxiety and depression. Counselling can help, and so can relaxation techniques - these can be taught by a physiotherapist. Stress is not the cause of psoriatic arthritis but can make it feel worse - so it will help if you can find ways of reducing and dealing with stress.
Are any special diets
Many diets have been suggested for psoriatic arthritis but none have been found to be very effective.
A number of books recommend different diets for people with arthritis. However, some books contradict each other. Some may even recommend stopping your tablets in order to try the diet. Don't do this without discussing it with your rheumatologist. Sometimes the diet can reduce the need to take tablets but unfortunately this is rare. Fish oils from marine (sea water) fish may reduce the amount of anti-inflammatory drugs needed to control joint inflammation and may therefore be worth a try.
If you are overweight, you need to follow a weight-reducing diet because extra weight will add to the strain on your leg joints and back.
Will this disease affect my sex life or my chances of having children?
Your chances of having children will not be affected. Painful joints can be a problem and interfere with your sex life but there are ways round this.
Psoriatic arthritis will not in itself affect your chances of having children or a successful pregnancy.
For a woman who becomes pregnant, the arthritis often improves during the pregnancy. However, the arthritis may worsen again after the child has been born. It is worth remembering that looking after small babies is hard work and even harder if you have painful joints. Would-be mothers with psoriatic arthritis should therefore try to arrange plenty of help with childcare.
Some of the drug treatment given for psoriatic arthritis should be avoided when trying to start a family. For instance, sulfasalazine can cause a low sperm count (this is not permanent) and you should not try for a baby if you or your partner are on methotrexate or have been using it in recent months. If you are considering starting a family you should discuss your drug treatment with your rheumatologist.
What will the future hold for me?
Psoriatic arthritis can vary from a simple condition to a long-term problem requiring complicated treatment.
Most people with this condition will be on long-term treatment with anti-inflammatory and disease-modifying drugs. Generally, people with psoriatic arthritis are less disabled than people with rheumatoid arthritis, but their overall quality of life may be equally affected.
(The writer is Consultant Rheumatologist at Sri Jayewardenepura General Hospital)