What is psoriatic arthritis?
我t usually affects people who already have the skin condition psoriasis (sur-ry-a-sis). This causes patches of red, raised skin, with white and silvery flakes.
银屑病关节炎一个d psoriasis are autoimmune conditions. Our immune system protects us against illness and infection. In autoimmune conditions, the immune system becomes confused and attacks healthy parts of the body.
Both conditions can affect people of any age.
One of the main symptoms is pain, swelling and stiffness because of inflammation inside a joint. This is known as inflammatory arthritis.
我nflammation is normally a useful tool of a healthy immune system. The body sends fluid, mainly blood, to a part of the body to fight off infection. But when someone has a type of inflammatory arthritis, inflammation can cause pain, swelling and stiffness in joints.
银屑病关节炎can cause connective tissue called entheses (en-thee-seas) to become inflamed. Entheses attach tendons and ligaments to bones. When they become inflamed it’s known as enthesitis.
Enthesitis pain can spread over a wider area rather than just inside a joint. Affected areas can feel tender if you touch them or if there’s just a small amount of pressure on them.
我t commonly occurs in the feet. This can happen at the back of the heel or on the bottom of the foot near the heel. In some cases, this pain can make standing or walking difficult.
The knees, hips, elbows and chest can also be affected by enthesitis.
People with psoriatic arthritis can have swollen fingers or toes. This is known as dactylitis (dak-till-eye-tus), or sausage digit, to describe how whole fingers or toes swell up. It most commonly affects one or two fingers or toes at a time.
也可能导致疲劳，，，，which is severe and persistent tiredness that can’t be cured with rest.
What are the symptoms of psoriasis?
There are different types of psoriasis. The most common is chronic plaque psoriasis. This causes patches of red, raised skin, with white and silvery flakes.
我t can occur anywhere on the skin, but most commonly at the elbows, knees, back, buttocks and scalp.
Can psoriatic arthritis affect other parts of the body?
Having psoriatic arthritis can put you at risk of developing other conditions and complications around the body.
Seek urgent medical attention if one or both of your eyes are red and painful, particularly if you have a change in your vision. You could go to your GP, an eye hospital, or your local A&E department.
This can permanently damage your eyesight if left untreated.
Other symptoms are:
- blurred or cloudy vision
- sensitivity to light
- 看不到视野方面的事物 - 被称为外围视力的丧失
- not smoking
- staying at a healthy weight
- eating a healthy diet, that’s low in fat, sugar and salt
- not drinking too much alcohol.
These positive lifestyle choices can help to improve your arthritis and skin symptoms.
- blood in your poo
- diarrhoea for more than seven days
- 一个general feeling of being unwell
Non-alcoholic fatty liver disease
See a doctor if you have:
- extreme tiredness
- pain in the top right of the tummy, which can be dull or aching
- unexplained weight loss
- swelling in the legs, ankles, feet or tummy.
- 一个一个ccident or injury
There is also an element of chance, and it might not be possible to say for certain what caused your condition.
Psoriasis and psoriatic arthritis are not contagious, so people can’t catch it from one another.
银屑病关节炎can cause long-term damage to joints, bones and other tissues in the body, especially if it isn’t treated.
我f you’ve developed psoriasis in the past few years, and symptoms of arthritis have started more recently, this could suggest it’s psoriatic arthritis. But it doesn’t always follow this pattern.
诸如类风湿因子和抗CCP抗体等血液测试可以帮助您。银屑病关节炎的患者往往没有这些抗体。患有类风湿关节炎的人更有可能对其进行呈阳性 - 尤其是如果他们持续一段时间患有类风湿关节炎。这些测试无法确定某人是否患有银屑病关节炎，但是在考虑其他所有内容时可以提供帮助。
X-rays of your back, hands and feet may help because psoriatic arthritis can affect these parts of the body in a different way to other conditions.
Other types of imaging, such as ultrasound scans and magnetic resonance imaging (MRI), may help to confirm the diagnosis.
Who will be responsible for my healthcare?
You’re likely to see a team of healthcare professionals.
Your doctor, usually arheumatologist，将对您的整体护理负责。专家护士可以帮助监测您的病情和治疗方法。称为皮肤科医生的皮肤专家可能是负责牛皮癣的治疗。
- 一个职业治疗师，，，，who can help you protect your joints, for example, by using splints for the wrist or knee braces. You may be advised to change the way you do some tasks to reduce the strain on your joints.
- 一个足病医生，，，，who can assess your footcare needs and offer advice on special insoles and good supportive footwear.
Because there are several features of psoriatic arthritis, there are different treatment options. Some of these are just for symptoms, such as pain and swelling, while some can treat the condition itself and reduce its symptoms.
Types of treatments
For the arthritis:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- steroid injectionsinto affected joints
- disease modifying anti-rheumatic drugs (DMARDs)
- biological therapies.
For the psoriasis:
- retinoid tablets
Treatments for the arthritis
NSAIDs can reduce pain and stiffness, but they might not be enough to treat symptoms of psoriatic arthritis for everyone.
Some people find that NSAIDs work well at first but become less effective after a few weeks. If this happens, it might help to try a different NSAID.
Some people have found that taking NSAIDs made their psoriasis worse. Tell your doctor if this happens to you.
Disease-modifying anti-rheumatic drugs (DMARDs)
These are called疾病改良的抗风湿药（DMARDS）(dee-mards). Many DMARDs will treat both psoriasis and psoriatic arthritis.
Because they treat the cause of your condition rather than the symptoms, it can take several weeks or even up to three months before you feel an effect.
You may need to take more than one DMARD at a time. You can take NSAIDs and painkillers at the same time as DMARDs.
Like all drugs, DMARDs can have some side effects. But it’s important to remember that not treating psoriatic arthritis effectively could lead to permanent bone and joint damage.
When taking a DMARD you’ll need regular blood tests, blood pressure checks, and in some cases a urine test. These tests allow your doctor to monitor the effects of the drug on your condition but also check for possible side effects.
These newer DMARDs work on specific parts of the immune system to reduce inflammation. They’re taken as tablets you swallow.
生物疗法一个re drugs that target key parts of the immune system to reduce inflammation. You might be able to try them if other drugs haven’t worked for you.
Two groups of biological therapies are used to treat psoriatic arthritis – anti-TNF drugs and interleukin inhibitors.
Anti-TNF drugs target a protein called tumour necrosis factor (TNF). Interleukin inhibitors target interleukin proteins.
The body’s immune system produces both TNF and interleukin proteins to act as messenger cells to help create inflammation.
A biological therapy may be prescribed on its own, or at the same time as a DMARD, such as methotrexate.
The following anti-TNF drugs can treat psoriatic arthritis:
The psoriatic arthritis treatment pathway
There are now several excellent long-term treatments for psoriatic arthritis. It’s important to find the right one for you as soon as possible, to improve your quality of life and prevent this condition damaging your body.查看我们的银屑病治疗途径图(PDF, 1.2 MB) to find out the order in which these drugs may be taken.
There are a number of treatment options for psoriasis.
Ointments, creams and gels that can be applied to the skin include:
- steroid-based creams and lotions
- vitamin A-like (retinoid) gels such as tazarotene
For more information about the benefits and disadvantages of any of these talk to your GP, dermatologist or pharmacist.
我f the creams and ointments don’t help, your doctor may suggest light therapy, also known as phototherapy. This involves being exposed to short spells of high-intensity ultraviolet light in hospital.
Some DMARDs used for psoriatic arthritis will also help with psoriasis.
People don’t often need joint surgery because of psoriatic arthritis. Very occasionally a damaged tendon may need to be repaired with surgery. And sometimes, after many years of psoriatic arthritis, a joint that has been damaged by inflammation may need joint replacement surgery.
我f your psoriasis is bad around an affected joint when you have surgery, your surgeon may recommend a course of antibiotic tablets to help prevent infection. Sometimes psoriasis can appear along the scar left by an operation, but this can be treated in the usual way.
Keeping active is one of the best things you can do to feel better physically and improve your mood.
我t can help reduce pain and stiffness in joints. Being inactive can lead to muscles becoming weak, which can make symptoms worse.
Exercise won’t make your psoriatic arthritis worse. However, if your condition is making certain activities difficult, you might need to change the way you exercise.
我t’s ok to take it easy if your symptoms are bad, and you’ll need to find the right balance between rest and exercise. There are simple exercises you can do when sitting or lying down to keep your joints moving. Every little movement and step really does help in the long-term.
Starting off slowly, and gradually increasing the amount you do can be a good way to start exercising. If you have psoriatic arthritis, you can still be very active – though you may need to build up to this.
有许多好方法锻炼和我的关键s to find something you enjoy as this will help you to keep doing it.
You may find that exercising with your partner, a friend or a relative helps as you can support one another. Group fitness classes can be good fun, if you find the right one for you.
Keeping active is good for your emotional well-being and confidence, as well as making you feel better physically.
如果您正在努力运动，您的医生或physiotherapistcan give you support and advice.
Eating plenty of fresh fruit and vegetables, and drinking around two litres of water a day is also good for your health. Talk to your doctor, a dietitian or visit theNHS Eatwell Guide website如果您需要更多信息。
The right amount of sunshine can make psoriasis better, at least in the short term. Too much sun and sunburn though can make psoriasis worse. For this reason, it’s a good idea to talk to your doctor if you’re planning to go abroad.
Smoking can make psoriasis worse. It can also increase the likelihood of some of the potential complications – such as heart problems.
我f you smoke your doctor can give you advice and support to help you stop, or you can visit theNHS Smokefree website。
Some people with psoriatic arthritis find complementary treatments are helpful, but you should always talk to your doctor first if you want to try them.
Complementary treatments come from a variety of cultural and historical backgrounds. They’re different to mainstream or conventional medication and therapies that you’ll get from GPs, rheumatology teams or物理治疗师。
Examples of complementary therapies include:
- 针刺– fine needles are inserted at different points around the body to stimulate nerves and produce natural pain-relieving substances in the body known as endorphins.
- The Alexander Technique- 基于通过对身体的良好理解和意识改善姿势和运动的原则。教书的人说它释放了体内的紧张局势。
And there are alternative medicines that can be taken as pills or applied as creams. These can include:
- fish body oil– they contain fatty acids, known as omega-3, that are thought to have health benefits, including reducing inflammation. Though some evidence suggests it’s much better to get these from eating fish like salmon, sardines and mackerel, rather than taking pills.
- 葡萄糖胺– this is an important building block of cartilage, which is the substance that lines the ends of bones in joints to protect them. It’s thought that taking glucosamine sulfate may protect the joints, by slowing down the breakdown of cartilage and replacing lost cartilage.
我f you decide to try therapies or supplements, you should be critical of what they’re doing for you, basing your decision to continue on whether or not you notice any improvement.
You may be entitled to free support from your local authority to help make life around the home easier.
You could be offered aids that help with everyday tasks, as well as minor adaptations to your home, to help you get around. This support is available only to people in England who have a physical or mental condition that means they’re unable to do basic tasks and activities, such as:
- going to the toilet
我f you can’t do two or more of the above, and this has a significant impact on your well-being, you should be eligible.
This would entitle you to aids and minor adaptations up to the value of £1,000 per item. If you need an adaptation that will cost more than £1,000, you can apply for a disabled facilities grant.
Living with psoriatic arthritis
Help and support is available, and you have rights and options.
政府计划访问工作is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
Other available support might include:
- your workplace occupational health department, if there is one
- disability employment advisors, or other staff, at your local JobCentre Plus
- 一个Citizens Advice bureau – particularly if you feel you’re not getting the support you’re entitled to.
The following must be avoided when trying to start a family, during pregnancy and when breastfeeding:
我t will help if you try for a baby when your arthritis is under control.
我t’s also important that your arthritis is kept under control as much as possible during pregnancy. A flare-up of your arthritis during pregnancy can be harmful for you and your baby.
牛皮癣和银屑病关节炎可以在家庭中进行。如果您有两种状况，则可以传递可能会增加孩子风险的基因 - 尽管很难预测。随着治疗的不断改善，未来几年的银屑病关节炎患者可以期待更好的前景。如果您有任何疑问或疑虑，请与您的医生交谈。
Your experiences of psoriatic arthritis
Having a long-term health condition can affect your mood and confidence, which can have an impact on your work, social life and relationships. Talk things over with your partner, or a friend, relative or doctor if your condition is getting you down. Versus Arthritis has an在线社区这可能会使您与其他银屑病关节炎联系起来。
谈话治疗可能是有用的。例如,cognitive behaviour therapy (CBT) may help you. The aim of CBT is to help people deal with problems in a more positive way, by breaking them down into smaller parts. If you’re interested, your doctor may be able to refer you for CBT, or you could self-refer using theNHS Improving Access to Psychological Therapies (IAPT) service。
Staying physically active will help with pain and stiffness. It will also make you feel better about yourself. Continuing with your normal routine, hobbies and social life as much as possible can be good for your emotional health and well-being.
Good two-way communication and understanding can help. Encourage your partner and close relatives to learn about psoriatic arthritis. Let people know if you’re having a bad day. Family therapy sessions might help. The relationship charity Relate could be a good place to turn.
Research and new developments
2015年，我们的研究由我们的领导centre for genetics and genomics at the University of Manchesteridentified genetic variants associated with psoriatic arthritis, but not with psoriasis or rheumatoid arthritis. This helped to establish psoriatic arthritis as a condition in its own right. The findings could lead to the development of drugs specifically for psoriatic arthritis.
Later in the same year, our TICOPA trial looked at the benefits of early aggressive drug treatment for people with psoriatic arthritis – followed by an increase in drug dosage if initial treatment isn’t working. The trial found that patients treated this way, required fewer hospital- and community-based services (excluding rheumatology appointments) than patients receiving the standard care.
We are currently funding a study at the University of Glasgow that aims to find out whether a molecule called IL-37a can reduce inflammation in inflammatory arthritis, including psoriatic arthritis, and if it could be used to develop new treatments.
We’re funding a study at the University of the West of England looking at how to encourage and help people with psoriatic arthritis become informed about their condition, manage their symptoms, and feel able to make decisions about their treatment. Evidence shows that patients who adopt this proactive approach are more likely to be satisfied with care and have improved symptoms.
A research project at the University of Manchester is looking at whether it’s possible to identify people with psoriasis who are at high risk of developing psoriatic arthritis. This could lead to early intervention with treatment, or ideally preventative treatment.
我的银屑病关节炎引起了一些令人难以置信的difficult moments, and I don’t know how I got through them.
But I’m now enjoying life to the full, thanks to anti-TNF medication.
我在捷豹路虎（Jaguar Land Rover）担任经理，而我的工作环游世界。我是12岁的卡里斯（Carys）和安德鲁（Andrew）的妻子的妈妈。
The journey to here has included manysteroid injections分为各种关节，膝盖和许多痛苦的日子。
我was devastated and cried all the way home. I assumed my life was over and that I'd be in a wheelchair by 30. I was keen to get back to my exciting life in London, so arheumatologist排干我的膝盖，给了我类固醇注射。
For the next year I regularly had my knee drained and had steroid injections until the rheumatologist said the next step would be keyhole surgery.
我made a decision that day – I would never feel sorry for myself again. I picked myself up, dusted myself off and marched onwards to my dream – happiness.
我moved to the Midlands with work and met Andrew. After we got married, we wanted to have kids. So, I came off my medication, which was very poor advice from my rheumatologist at the time, as my condition spiralled. And my husband saw my arthritis in all its glory. I went from being independent and strong, to a woman who he had to help dress.
我spent my maternity leave in constant pain. The worst part was going to Rhythm Time classes and being the only mum who couldn't sit on the floor with her baby, I was on the only chair in the circle. It was hard but seeing Carys's smiling face looking up at me made my heart leap for joy.