An autoimmune disease expert’s opinion on psoriasis

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

Psoriasis is a lifelong condition. Skin plaques are the main symptom, but many people also experience joint pain. It requires lifelong monitoring by health professionals. While there is no cure for psoriasis, there are great medications that can help control the symptoms.

The news that you have it can sometimes be surprising. You may see your primary care doctor for joint pain, but you may not notice 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, depending on how much of your body is affected.

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

Your healthcare team

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

About 30% of people with psoriasis have arthritis. On average, the 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 provides people with the best care.

You may need to see other specialists along the way, depending on how your psoriasis affects you. There are people with arthritis who later develop inflammatory eye or bowel problems. You will need the help of an ophthalmologist or gastroenterologist.

Get the most out of your meetings

When you meet with your doctor, especially on 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 to be related to psoriasis. Your doctor will know if you need to look elsewhere, such as your eyes, gastrointestinal tract, or nails. If you have joint or back pain, get evaluated by a rheumatologist.

Learn more about the specific medications you are taking:

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

Treatment may vary depending on your diagnosis and condition. In general, however, anyone with psoriatic arthritis should take medication unless there is a specific reason it would be risky for you. Most people feel at least 50-75% better in the first 3-6 months of therapy and even better after that.

Unfortunately, remission – i.e. no joint swelling, no pain – is not possible for everyone. But we shoot because if you’re there, we want to be there.

Stay connected

See a doctor every 6 months. When psoriasis affects the joints, it is chronic and can cause quite aggressive damage and chronic pain, so you need to make sure your joints are healthy.

Apart from this, see your doctor if your pain increases, 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 bloody stools. 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 addresses all of these things.

Don’t underestimate how aggressive the disease can be. It is more likely that the disease caused the problems than the drugs taken. Psoriasis can appear at a fairly young age – many people find out they have it in their 20s and 30s. So it can take a long time for the disease to become active in the body.

We can always change the therapies and find the best one for you.

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


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