Psoriatic (Sor-ee-at-tic) Arthritis is an autoimmune inflammatory arthritis, similar to Rheumatoid Arthritis, but with a negative RA factor. When we talk about ARTHRITIS, most people think of the good old fashioned wear and tear arthritis where the joint has lost it’s cartilage or lubricating factor, so that it’s bone on bone grinding. This kind of arthritis is known as OSTEO Arthritis.
There is another kind of arthritis, at the other end of the spectrum, called INFLAMMATORY ARTHRITIS. These are the AUTO-IMMUNE types of arthritis where your body attacks it’s own tissue, thinking your own tissue is a foreign invader. The immune system goes in to over-drive as it attempts to fight what it thinks is a bacteria or virus. White blood cells flood the area, in this case the joint, and this creates inflammation, which causes swelling, redness, heat and pain. In this realm of inflammatory arthritis, there is a further separation into two categories. On the one side is the Rheumatoid Factor, RF or RA positive, which includes Rheumatoid Arthritis, Systemic Lupus, Scleroderma, etc. On the other side is the “Negative RA Factor” side, meaning there is no RF antibodies present and is called SPONDYLO-ARTHRITIS (spon-de-low). The blood test that indicates this side of inflammatory arthritis is called HLA-B27 (Human Leukocyte Antibody) and includes the inflammatory arthritis categories as Psoriatic Arthritis, Ankylosing Spondylitis, Enteropathic Arthritis, and Reactive Arthritis.
I was first diagnosed with Psoriatic Arthritis in 2003. I was fortunate enough that my Primary Care Physician listened to my complaints and referred me to a Rheumatologist – a doctor who specializes in musculo-skeletal disease and systemic (whole body) auto-immune conditions. Having psoriasis (red patches with silver scales) does not necessarily mean you will have Psoriatic Arthritis. Psoriasis itself is an auto-immune condition caused by inflammation, and usually indicative of liver congestion according to the nutrition specialists and functional medicine specialists. When I was diagnosed, I had psoriasis on my elbows and there was a 5-10% chance of developing into Psoriatic Arthritis (PsA). Today, that number has increased to 30%. This is a clinical diagnosis, which means its a careful collection of symptoms, including a positive HLA-B27 genetic marker, joint pain – usually in the hands, feet and along the spine, particularly the Sacro-Iliac joints (SI joints) and the neck. The GOLD STANDARD for diagnosis is the SAUSAGE DIGIT, where one of your fingers or toes along the entire length of the digit becomes hot, swollen, purple or red and very painful – looking like a sausage.
PsA is a long term condition that waxes and wanes, but essentially becomes progressively worse by damaging the joints. My Rheumatologist (affectionately written as *Rheumy from time to time) explained to me at the time that any time there is pain and inflammation present in the joint, there is damage being done. Of course, I had to have this conversation because I am, or at least I was, the kind of patient who did not like to take medication no matter what… until he explained it to me as damage. The pharmaceutical options include anti-inflammatory medication (NSAIDs or steroids), a DMARD – disease modifying anti-rheumatic drug, and finally a Biologic – injections or infusion of medicine that targets a specific cell called TNF alpha – Tumor Necrosing Factor alpha.
The non-pharmaceutical prevention and care plan is where the magic happens, which I share about on my website, blogs and Facebook Live. You can follow an anti-inflammatory diet, get adequate sleep, exercise on a regular basis, and my all time favorites: chiropractic and massage. For me, my maintenance care plan is to get adjusted once per week and get a therapeutic massage every two weeks. I had to change my sleeping habits, which is challenging enough as it is, and I was in chiropractic school when I had to make my change. Basically, the more hours of sleep you can get before the midnight hour, the better your sleep hygiene. I had to learn how to pace myself, balancing high energy days with days of recuperation and rest. I had to become aware of the ebb and flow of the disease, also known as FLARE UPs and take extra self-care measures when I would have a flare up. Most people with these types of chronic pain illnesses (this includes Fibromyalgia) will notice a rather big flare up around January when the weather changes to cold and damp, and the stress of the holidays is over. A flare up always seems to rear it’s ugly head AFTER the stress has subsided. It’s just the nature of the beast.
With PsA, when it affects the fingers and toes, it’s usually the most distal joint, closest to the finger/toenail. PsA attackes the ENTHESIS (en-the-sis), which is where the tendon meets the bone. When this becomes inflamed, it’s called ENTHESOPATHY (En-thes-o-path-ee). This, to me, is such an intense, sharp, stabbing, electric-like pain in the edge of the finger when it is barely brushed against something. PsA also attacks the SI joints on either one side or both sides. It also loves to attack the neck.
The disease progresses either rapidly or slowly, depending on your environment, stress levels, self-care and how well you can manage inflammation. The first 10 years of my diagnosis, I rode horses, taught yoga and Pilates and worked as a massage therapist. I am often asked how can I do all of that without my hands hurting or my body hurting. For me, staying physically active, especially with giving massages, always made me feel better. When I give massage, it’s not just my hands, but my entire body goes in to my work. The other major contributor to managing this disease is to get regular chiropractic care and regular massages myself.
There are several more symptoms that go along with an inflammatory arthritis, which is why these are called systemic auto-immune diseases. There can be inflammation of the iris of the eye, called UVEITIS (you-vee-eye-tis) or IRITIS (eye-ry-tis), which is quite painful causing your eye to turn red and vision is blurry. There is definitely the factor of sleep disturbance where some people may not be able to get fully in to REM sleep, tossing and turning all night, or having pain that wakes you up at night. Fatigue is also a problem, mostly during a flare up, but also associated with chronic pain. There are also a lot of gastro-intestinal problems such as diarrhea, bloating, constipation, or all of the above.
If you have a family history of an inflammatory arthritis, or psoriasis, and you are experiencing joint pain, please don’t hesitate to contact me to discuss how chiropractic care and therapeutic massage can help you. At Fusion Chiropractic, we discover together what positive coping skills will keep you managing a functional lifestyle with pain relief.