An Autoimmune Disease Expert’s View of Psoriatic Disease

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

Psoriatic disease is a condition you have your whole life. Skin plaques are the main symptom, but many people also get joint pain. It requires lifelong observation by medical professionals. Although there isn’t a cure for psoriatic disease, there are great medications to help control the symptoms.

The news that you have it can sometimes come as a surprise. You may see your primary care doctor because you’re having joint pain, but be unaware of plaques because they’re hiding on your backside, scalp, chest, or groin.

If your psoriasis is mild enough, a primary care doctor should be able to prescribe topical steroids or other topical medications to help, depending on how much of your body is involved.

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

Your Health Care Team

After you’re diagnosed, you’ll primarily see a dermatologist. If you have joint pain, you’ll see a rheumatologist. As a rheumatologist myself, I get referrals from primary care doctors, dermatologists, and sometimes pediatricians.

About 30% of people with psoriasis go on to have joint inflammation. On average, that inflammation comes 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 gives people the best care.

You may have to see other specialists along the way, depending on how your psoriatic disease affects you. There are people with joint inflammation who get inflammatory eye problems or intestinal problems later. You’ll need an eye specialist or a gastroenterologist to help you with that.

Make the Most of Your Appointments

When you meet with your doctor, especially for your first visit, come with questions and details that cast a wide net. Talk about any symptoms you’re having, even if they don’t seem related to psoriatic disease. Your doctor will want to know if they should look anywhere else for information, like your eyes, gastrointestinal tract, or nails. If you’re having joint or back pain, ask about an evaluation by a rheumatologist.

Find out about the specific medications you’ll be taking:

• How often will I take it?
• How will 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 joint inflammation from psoriatic disease should be taking medication unless there’s a specific reason that it would be risky for you. Most people are going to feel at least 50% to 75% better within the first 3-6 months of therapy, and even better beyond that.

Remission — meaning no joint swelling, no pain — isn’t possible for everybody, unfortunately. But we shoot for that goal, because if you’re that person, we want to have you there.

Stay in Touch

Check in with your doctor every 6 months or so. When psoriatic disease affects the joints, it’s chronic and can be quite aggressive in terms of damage and chronic pain, so you want to make sure your joints are OK.

Aside from that, you should make a visit to 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 of your eyes, or if you have diarrhea or blood in your stool. This could be a sign that your disease is affecting more of your body. In that case, you might need a new therapy that can treat all those things better.

Don’t underestimate how aggressive the disease can be. You’re more likely to have problems from the disease than you are from the medications you take. Psoriasis can come on at a fairly young age — many people are between 20 and 30 years old when they find out they have it.  So that can be a long time for the disease to be active in your body.

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

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