Psoriatic arthritis (PsA) is a long-term condition that currently doesn’t have a cure. Regular treatments are essential in minimizing symptoms and flare-ups, as well as stopping the progression of the disease.
Treatment is primarily sought from two types of doctors: dermatologists and rheumatologists. The former deals with the topical (skin-related) symptoms, while the latter helps treat the underlying causes of the disease. To make sure you receive the most effective treatment possible, consider bringing the following questions to your next appointment.
Dermatologist
A dermatologist treats over 3,000 types of diseases related to the skin, mucous membranes, nails, and hair. Among these is psoriasis. While not all cases of PsA are caused by psoriasis, the Arthritis Foundation estimates that about 30 percent of people with the skin condition develop PsA. Most people with PsA have skin symptoms prior to joint pain. Such can benefit from dermatological treatments for their skin.
How do you know if I have PsA?
A dermatologist can’t diagnose PsA. However, if you have psoriasis, they will occasionally ask you about other symptoms such as joint pain and stiffness. These might be indicators that the disease has progressed to PsA.
PsA is classified as an autoimmune disease. Such diseases cause the immune system to attack itself — in the case of arthritis, this means that your body attacks healthy skin tissues and joints. This also causes widespread inflammation at the affected sites, which results in pain.
If your dermatologist suspects PsA, then they will likely refer you to a rheumatologist for further testing.
If I have PsA, do I still need to see a dermatologist?
This largely depends on the cause of your condition, as well as its symptoms. Because there is no single known cause of PsA (and autoimmune diseases in general), such conditions are difficult to diagnose. However, if you’ve had psoriasis prior to being diagnosed with PsA, or have skin symptoms, then you will still need to see a dermatologist for the treatment of rashes, lesions, and nail issues. While a rheumatologist helps treat PsA internally, they don’t specialize in managing the topical symptoms.
How will you help my PsA?
Your dermatologist will help treat the skin and nail symptoms of PsA. Treatments are all done in outpatient facilities. In some cases, a prescription ointment can help alleviate itchy, scaly skin rashes. More complex symptoms may require light therapy done in your dermatologist’s office. Your dermatologist will also help treat and prevent infections that might occur from open lesions.
Rheumatologist
A rheumatologist is a type of doctor that looks at disease from within the body. They specialize in rheumatic diseases — these include autoimmune and musculoskeletal diseases. For those with PsA, a rheumatologist is essential in diagnosing and treating the condition properly. This helps to minimize the damaging effects of PsA, while also improving quality of life.
How will you determine if I have PsA?
PsA can mimic other types of diseases, such as rheumatoid arthritis (RA). Therefore, testing is essential. A blood test for rheumatoid factor (RF) can determine whether your arthritis is related to RA or PsA. If you have PsA, the RF test will be negative for RA.
In addition to bloodwork, a rheumatologist will perform a physical exam to look at inflammation in specific joint areas. They may also collect joint fluids.
Your records are also essential to an accurate PsA diagnosis. This includes information from your primary doctor, dermatologist, and any other medical professionals who have treated your symptoms thus far.
What type of treatments will I receive?
A rheumatologist treats PsA internally. Medications are prescribed to lower inflammation, while others help to stop the body from attacking healthy cells and tissues in the first place. These include nonsteroidal anti-inflammatory drugs (NSAIDs), biologics, and disease-modifying antirheumatic drugs (DMARDs). Depending on the severity of your condition, you may need a combination of these drugs.
How long does treatment last?
Since PsA is a chronic condition, you will receive treatment indefinitely. Progression of the disease is most effectively stopped the earlier it’s diagnosed and treated. Early treatment reduces damaging inflammation.
The type of treatment and its timeline also depends on how severe your condition is. Severe forms of PsA require more aggressive treatments, while milder cases with few flare-ups may require fewer medications.
Do I need to see any other specialists?
A dermatologist is recommended for skin problems related to PsA. Also, if you have nail symptoms related to distal PsA, then dermatologic treatments can help.
Aside from a dermatologist, you may also receive a referral to a physical therapist if your disease has progressed. Physical therapy can help prevent the disabling effects of PsA.
Open communication with all PsA doctors
As a rule of thumb, you will need to share all treatment plans with each of the doctors you see in the treatment of PsA. This not only ensures that the treatments complement one another, but it also helps prevent possible drug interactions. Don’t assume that just because your doctors know you’re seeing other specialists that they know the exact treatments you’re receiving. Ensure that you communicate all your plans directly by keeping your own records.
Read more in Moderate to Severe Psoriatic Arthritis Pain ResourcesFrequently asked questions about psoriatic arthritis. (2016). Retrieved from https://www.psoriasis.org/psoriatic-arthritis/faqs
Psoriatic arthritis. (n.d.). Retrieved from http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/
What is a rheumatologist? (2015). Retrieved from http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Health-Care-Team/What-is-a-Rheumatologist
Why see a dermatologist? (2016). Retrieved from https://www.aad.org/public/diseases/why-see-a-dermatologist
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