An autoimmune disease expert’s perspective on psoriasis

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From Brett Smith, DO, as told to Rachel Reiff Ellis

Psoriasis disease is a disease that you have all your life. Skin plaques are the main symptom, but many people also experience joint pain. It requires lifetime observation by healthcare professionals. Although there is no cure for psoriasis disease, there are great medications to help control symptoms.

The news that you have it can sometimes come as a surprise. You can see your GP about joint pain, but don’t pay attention to plaques because they’re hiding on your butt, scalp, chest, or groin.

If your psoriasis is mild enough, a general practitioner should be able to prescribe topical steroids or other topical medications to help, depending on how much of your body is affected.

But many people with psoriasis need more than just topical therapies, especially if they have joint pain and swelling. If your psoriasis care is beyond what a general practitioner is capable of, you will need to see other specialists to get the treatment you need.

your health team

After you’ve been diagnosed, your first priority will be to see a dermatologist. If you have joint pain, see a rheumatologist. As a rheumatologist, I get referrals from GPs, dermatologists, and sometimes paediatricians.

About 30% of people with psoriasis later develop joint inflammation. On average, this inflammation occurs about 10 years after a psoriasis diagnosis. When people with psoriasis have joint pain, a dermatologist refers them to me. A collaborative approach with a dermatologist provides people with the best care.

Depending on how your psoriasis condition is affecting you, you may need to see other specialists. There are people with joint inflammation who later develop inflammatory eye problems or intestinal problems. You need an ophthalmologist or a gastroenterologist to help you with this.

Make the most of your appointments

When you meet with your doctor, especially on your first visit, you come up with questions and details that cast a wide net. Discuss any symptoms you are having, even if they are not related to psoriasis. Your doctor will want to know if they should look elsewhere for information, e.g. B. in your eyes, your gastrointestinal tract or your nails. If you have joint or back pain, ask to see a rheumatologist for an evaluation.

Find out about the specific medications you will be taking:

  • How often will I take it?
  • How will I take it?
  • What are the possible side effects?
  • What are the treatment goals?
  • How soon should I expect a difference in my symptoms?

Treatment depends on your diagnosis and condition. But in general, anyone with psoriatic joint inflammation should take medication unless there is a specific reason it would be risky for you. Most people will feel at least 50% to 75% better within the first 3-6 months of therapy, and better beyond that.

Unfortunately, remission – i.e. no joint swelling, no pain – is not possible for everyone. But we aim for that goal, because if that person is you, we want you to be there.

Keep in touch

See your doctor about every 6 months. When psoriasis affects the joints, it is chronic and can be quite aggressive in terms of damage and chronic pain, so you should make sure your joints are healthy.

You should also see your doctor if your pain gets worse, you notice a swollen joint, you feel stiffer, or your back hurts more.

Your doctor will also want to know if you have inflammation or pain in one or both eyes, or if you have diarrhea or blood in your stools. This could be a sign that your disease is affecting a larger part of your body. If so, you may need a new therapy that can better treat all of these things.

Don’t underestimate how aggressive the disease can be. You are more likely to have problems from the disease than from the medications you are taking. Psoriasis can appear at a fairly young age – many people are in their 20s and 30s when they find out they have it. So it can take a long time for the disease to become active in your body.

We can change therapies at any time and find one that works best for you.

The goal is to find medicines that will help you feel good. I know the medication can be intimidating or scary at times, but we have a lot of experience with it. These drugs can really help.


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An autoimmune disease expert’s perspective on psoriasis
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