An Autoimmune Disease Expert’s View of Psoriasis

Brett Smith, DO, as told by Rachel Rafe Ellis

Psoriasis is a disease that you experience throughout your life. Skin plaques are the main symptom, but many people also experience joint pain. It requires lifelong monitoring by medical professionals. Although there is no cure for psoriasis, there are excellent medications that can help control the symptoms.

The news that you have it can sometimes come as a surprise. You may see your primary care physician because you have joint pain, but ignore the plaques because they are hiding on your back, scalp, chest, or groin.

If your psoriasis is mild enough, your primary care doctor should be able to prescribe topical steroids or other topical medications to help, depending on which part of your body is affected.

But many people with psoriasis need more than just topical therapy, especially if they have joint pain and swelling. If your psoriasis treatment goes beyond your primary care doctor, you need to see other specialists to get the treatment you need.

Your healthcare team

After the diagnosis, the first thing you will see is a dermatologist. If you have joint pain, you will see a rheumatologist. As a rheumatologist, I receive referrals from primary care physicians, dermatologists, and sometimes pediatricians.

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

You may need to see other specialists depending on how your psoriasis affects you. There are people with inflammation of the joints who later develop inflammatory problems with the eyes or intestines. You will need an eye specialist or gastroenterologist to help you with this.

Make the most of your meetings

When you meet with your doctor, especially during your first visit, come with questions and details that cast a wide net. Talk about any symptoms you have, even if they don’t seem related to psoriasis. Your doctor will want to know if you should look elsewhere for information, such as the eyes, gastrointestinal tract, or nails. If you have joint or back pain, ask about an examination by a rheumatologist.

Learn about the specific medications you will be taking:

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

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

Unfortunately, remission – that is, the absence of joint swelling and pain – is not possible for everyone. But we strive for that goal, because if you’re that kind of person, we want you there.

Stay connected

Check with 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 want to make sure your joints are okay.

Also, you should see your doctor if the pain gets worse, you notice joint swelling, 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 stool. This may be a sign that your disease is affecting more of your body. In that case, you may need a new therapy that better treats all of these things.

Do not underestimate how aggressive the disease can be. You are more likely to develop problems from the disease than from the medication you are taking. Psoriasis can appear at a fairly young age – many people find out they have it in their 20s and 30s. Therefore, the disease can manifest itself in your body for a very long time.

We can always change treatments and find the one that works best for you.

The goal is to find a medication that makes you feel comfortable. I know that sometimes medications can seem intimidating or scary, but we have a lot of experience using them. These medications can really help.

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