Coping with Psoriatic Arthritis

Lynda is one of the leaders of the support group that I attend locally. Not everyone in the group has PsA, but Lynda is one of the handful of folks who do. I asked her to answer a few questions about her experiences with PsA.

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When did you first start experiencing symptoms of PsA? How old were you?
It manifested when I was 40, although I may have had minor symptoms a few years prior.

How long did it take for you to receive your diagnosis?
It took 12 years.

What do you think delayed the diagnosis?
Idiot doctors is what caused the delay! Granted, this is hard to diagnose. They thought I had MS or Lupus. But when they never had any positive test results, they said fibromyalgia. During this time I saw 2 rheumatologists and the word arthritis never came up - I consider them the idiots!

How has your disease changed or progressed over time?
I had lots of crazy things in the earlier years, like "burned" skin rashes, psoriasis, and weird rashes on my legs. Smells, noises and lights bothered me. It was as if I was already in a sensory overload, so I couldn't add any extra without what I now know as causing a flare. I couldn't walk up stairs without my whole head and neck locking up. At strange times I got diarrhea. I couldn't tolerate any exercise (still can't).

It now seems to have settled in. I think my joints have all been damaged, and the enthesitis is what seems to cause the trouble on my spine. If I push, pull, or over-do it, my spine inflames and then the muscles get crazy nearby. No more skin reactions. I only get diarrhea now when the muscles in my midsection spaz out and tighten up. Of course, I can get a lot of muscles involved and then I'm in bed with hot muscles and no energy and lots of pain: a flare. 

What combination of medications, treatments and tactics has been most successful for you in managing your PsA?
It is just that, a combo that works, not any one thing. Massage and heat, stress reduction, and careful movements (like limiting stairs). NSAIDs, DMARDs, pain and nerve calmers. Plus muscle relaxants and of course the anti-TNFs work for many people! And I keep prednisone to try and stop flares!

Have you ever experienced any periods of remission? If yes, what do you attribute that to, and if no, do you hold out hope that you will have a remission in the future?
I seemed to have a remission at the worst point in my life, after a divorce. I guess I needed to be free from that one. I can't answer about the hope part. I am trying LDN (low dose naltrexone, a medication sometimes used off-label as an alternative treatment for PsA and other autoimmune diseases), so that suggests I am acting on hope, but I just live each day the best I can. I don't hope too much.

Do you expect to see a cure for PsA in your lifetime?
A cure? Maybe, again, I don't live my life on hope, nor do I on a cure.

What is the most important advice you can give to someone who was recently diagnosed with PsA? 
Know that it is a combination of things that help! There is no one miracle! You have to get together a program of all of them to live somewhat normally! That goes back to the heat, massage, dmards, etc. answer. Know that this doesn't kill us. We just have to have a program and adapt our lifestyle.

Thanks Lynda!

Coping With Psoriatic Arthritis from Mary PsA on Vimeo.

The images in this video document the first year of my life after being diagnosed with Psoriatic Arthritis. The tone of the music and images fits with the tone of most of that year. It probably looks very familiar to anyone else who has been through it too. Thankfully it ends on a better note: making moves toward a less painful life via exercise and modern medicine. It may not seem like a much happier turn of events if you've never lived with this disease, but if you've experienced successful treatment with a biologic medicine, you know how life changing it can be. The accomplishment of exercising is no small matter either, even if you're a twenty-something exercising with the elderly. I rock those 3 pound weights, thank you very much.

References:
Sandler, M. (2005, August 23). Music in 5 keys - F. [MP3]. Raleigh, North Carolina: Unsigned. Retrieved from http://archive.org/details/m5k

Like Lynda, who I'll be interviewing later in the week, Claire is one of the leaders of my local support group. All three of us ladies have spondylitis as a component of our psoriatic arthritis. We have varying degrees of peripheral joint involvement too. Claire has had great success with some alternative treatments, so I was interested to ask her a little more about her tricks and tips for coping with this disease!

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When did you first start experiencing symptoms of PsA? How old were you?
Symptoms were a progression from the initial spondylitis diagnosis which mainly affected the SI joints. The symptoms actually began a few weeks after I was in an accident in which I sprained both wrists and both thumbs. The doctor gave me an article that told how psoriatic arthritis can develop following an accident, and I think that is what happened. I was in my 50s.

How long did it take for you to receive your diagnosis? What do you think delayed the diagnosis (if applicable)?
The initial diagnosis of spondylitis took 5 years. The PsA diagnosis came quickly. I had had skin issues since 2002, but the dermatologist I was seeing said it was dandruff. Eventually, his nurse sent me to another dermatologist who diagnosed psoriasis. A few months later I had the above mentioned accident. Then a few weeks later, I had my appointment with my rheumatologist, and he quickly gave me the diagnosis. He told me he was just waiting for me to come up with a skin issue! And he felt the accident triggered the PsA to develop.

How has your disease changed or progressed over time?
My hands and wrists used to hurt so badly that I could hardly use them. They are about normal now.

What combination of medications, treatments and tactics has been most successful for you in managing your PsA?
My miracle medication is low-dose-naltrexone, 2 mg, and I also take 400 mg plaquenil. I take one 75 mg Voltaren about 1 time a week, and use Voltaren gel if I need to, usually once or twice a day several times a week. I also take mega-high doses of fish oil, and high doses of tart cherry extract capsules and broken-cell-wall chlorella, all of which have effectively eliminated most all inflammation. Additionally, I tape with kinesio tape if I have pain and need to play my saxophone. Cold laser or acupuncture have helped in the past and if I get tendonitis in the wrist I use a wrist support wrap.

Have you ever experienced any periods of remission?
I would say I am in remission.

What do you attribute that to?
I attribute it to the above mentioned medications and supplements.

Do you expect to see a cure for PsA in your lifetime?
About the cure, I really don't know. I haven't followed the research on it at all, but I know they have discovered genes associated with it. I don't know what would happen if they figured out a way to "turn off' certain genes. That may have negative implications in other ways.

What is the most important advice you can give to someone who was recently diagnosed with PsA?
Be your own advocate. Read up on it, preferably in medical journals. Try as many "external" treatments as you can such as cold laser therapy, acupuncture, occupational therapy, etc., in an effort to try to keep reliance on medication to a minimum. If you aren't thoroughly happy with one doctor, try another one.

Thanks Claire!

NSAIDs, DMARDs, and biologics: what role do they play in treating psoriatic arthritis? If you're not familiar with these acronyms, I explain them briefly here. I'm going to turn to a great article in the International Journal of Advances in Rheumatology to help me explain the use of these drugs for psoriatic arthritis.

NSAIDs

NSAIDs have been the mainstay of treatment for psoriatic arthritis for decades. NSAIDs are not used to treat skin psoriasis, but taken at anti-inflammatory doses, their symptomatic relief for peripheral arthritis, spondylitis, enthesitis, and dactylitis (components of psoriatic arthritis) make these drugs an important part of many patients' PsA treatment.^[1] NSAIDs' effectiveness is typically modest, but that is sufficient for some patients, and they can also be used in combination with DMARDs and TNF inhibitors. NSAIDs are primarily taken in pill form. Ibuprofen and naproxen, also known as Advil and Aleve, are two popular over-the-counter options, but there are dozens of prescription varieties. A few topical prescription NSAID options also exist.

In years past, there was concern that NSAIDs might worsen skin psoriasis, but thankfully studies have not supported that idea.^[1] Some of the major risks for long term NSAID use are in the gastrointestinal realm. It's important to keep regular labs while on NSAID therapy, and to consult your doctor if you experience GI distress.

DMARDs

If NSAIDs are not sufficient, DMARDs are typically the next step. Sometimes this step is skipped if your disease presentation is primarily axial because DMARDs don't seem to work for axial arthritis as well as for peripheral arthritis.^[1] DMARDs sometimes used in the treatment of PsA include methotrexate, sulfasalazine, leflunomide (Arava), hydroxychloroquine (Plaquenil), azathioprine (Imuran) and cyclosporine.^[2] These drugs are unrelated in all but name, so it's difficult to generalize how they work. Methotrexate and sulfasalazine are the two DMARDs most commonly prescribed for PsA.^[1]

Methotrexate blocks several enzymes that play a role in the immune system.^[3] It is not fully understood how methotrexate decreases the severity of arthritis, but... it just does, for many people. Also used to treat cancer, methotrexate is used in much lower doses for PsA and psoriasis. Many of the worst side effects listed in its prescribing information are mainly a concern at the higher doses intended for cancer, but there are still some side effects to be aware of. Nausea, vomiting, and abnormalities on liver function tests are the most common side effects.^[3] Methotrexate should be discontinued for at least 3 months before attempting to become pregnant - it can cause serious birth defects and pregnancy complications.^[3]
 
Sulfasalazine is a combination of an aspirin-like anti-inflammatory medicine with a sulfa antibiotic. This combination arose at a time when rheumatoid arthritis (the condition it was originally developed for) was believed to be caused by a bacterial infection.^[4] We now know that isn't true, but sulfasalazine works for many RA and PsA patients anyway, for reasons that aren't fully understood. Sulfasalazine is taken orally. Most patients have few side effects to sulfasalazine, but the most common ones are nausea and abdominal discomfort.^[4]

Biologics

The third tier of PsA treatment: TNF inhibitors and other biologic drugs. You've undoubtedly seen TV ads for these high dollar medications, some featuring celebrities who truly have PsA (golfer Phil Mickelson) or psoriasis (model CariDee English), and others with actors pretending to have one of a variety of autoimmune diseases that these drugs treat.

There are currently 4 biologics approved for the treatment of PsA: etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade) and golimumab (Simponi).^[5] All 4 of these drugs are TNF inhibitors, which work by suppressing a very specific portion of the immune system, TNF-alpha, which is involved in triggering inflammation.^[5] Enbrel, Humira, and Simponi are delivered via self-injection under the skin. Remicade is given via infusion in a doctor's office or infusion center. There are a number of other biologics currently under study for the use in PsA including certolizumab pegol (Cimzia), alefacept (Amevive), apremilast, and ustekinumab (Stelara).^[6] We may see these drugs added to our treatment options before too much time goes by!

There are some very serious potential side effects to these drugs, the most common being an increased incidence of serious infections (less common risks include not-so-fun things like lymphoma, drug-induced lupus, new or worsening psoriasis, brain demyelination, and heart failure), but the positive results they can have are dramatic!^[7] It's a difficult choice that each of us must make as we weigh our treatment options. I've personally decided that biologic drugs are worth the risk, but I completely understand when other patients decide against biologics for themselves.

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I have personally tried 8 NSAIDs, 2 DMARDs, and 3 TNF Inhibitors with varying degrees of success and failure. I currently take 1 NSAID, 1 DMARD, and 1 TNF Inhibitor as the core of my PsA treatment. I welcome any private questions about my personal experiences with these medications. Email me at copingwithpsa [at] gmail [dot] com.

References
[1] Ceponis, A., & Kavanaugh, A. (2011, June). Psoriatic arthritis: advances in therapy. International Journal of Advances in Rheumatology, 9(2), 45-55.
[2] Emery, P. & Ash, Z. (2012, September). Psoriatic arthritis. Retrieved from http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/psoriaticarthritis.asp
[3] Cannon, M. (2012, May). Methotrexate. Retrieved from http://www.rheumatology.org/practice/clinical/patients/medications/methotrexate.asp
[4] Cannon, M. (2012, May). Sulfasalazine. Retrieved from http://www.rheumatology.org/practice/clinical/patients/medications/sulfasalazine.asp
[5] National Psoriasis Foundation. (n.d.). Treating psoriatic arthritis with biologic drugs. Retrieved from http://www.psoriasis.org/psoriatic-arthritis/treatments/biologics
[6] Bernstein, S. (2011). Cutting edge of treatments in psoriatic arthritis. Retrieved from http://www.arthritistoday.org/conditions/psoriatic-arthritis/psoriatic-arthritis-treatment-research.php
[7] Abbott Laboratories. (2012, September). Prescribing information. Retrieved from http://www.rxabbott.com/pdf/humira.pdf

Depression is common, underdiagnosed, and undertreated in patients with psoriatic arthritis.^[1] It's a study finding that doesn't surprise me.When chronic pain comes together with a chronic skin condition, it makes a great deal of sense when depression accompanies it. If you don't feel good and you feel like you don't look good either, it's a tough combination. Studies have found depression to be common among multiple forms of inflammatory arthritis, but in one study focusing on rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis, the psoriatic arthritis patients were found to have greater psychosocial problems - namely with mental health, limitations due to emotional health, and social functioning.^[2] The study authors point toward the combination of inflammatory arthritis with inflammatory skin condition as the reason for the greater effect on our mental health.

I was most depressed shortly after my diagnosis. I commonly describe the experience of receiving my diagnosis as something of a "grieving process", and depression definitely preceded acceptance. This is a chronic, painful disease that causes permanent damage. It currently has no cure. The treatments come with varying degrees of terrifying side effects. It can take months and years to find a treatment that works well, and there's no guarantee that any treatment will work indefinitely. The disease forces you to reassess your dreams and goals, sometimes taking them away from you entirely. There's a lot to be depressed about.

With everything we're up against, it makes a lot of sense to work with a mental health professional. Your rheumatologist (or any of your other doctors) can refer you to one. Just ask.

Here are a few other tips from Arthritis Today on warding off depression:

• Spend time with friends or join a support group.
• Do things you enjoy. If your arthritis prevents something, enjoy a modified version instead.
• Try positive thinking: instead of thinking, "This pain will last forever", think, "This pain will come and go."
• Make yourself feel pretty. Even if you don't feel like leaving the house, don't just mope around in sweats. When you look good, you can feel good.
• Don't berate yourself for your depression. It isn't a matter of discipline or character.^[3]

References
1. Jancin, B. (2011, February 15). Depression highly prevalent in psoriatic arthritis. Clinical Psychiatry News. Retrieved from http://www.clinicalpsychiatrynews.com/news/psychosomatic-medicine/single-article/depression-highly-prevalent-in-psoriatic-arthritis/d2d0a3b8c4801f4e0e6cc6f779e7c617.html
2. Salaffi, F., Carotti, M., Gasparini, S., Intorcia, M., Grassi, W. (2009, March 18). The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health and Quality of Life Outcomes, 7(25). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674445/?report=abstract
3. Arthritis Today. (n.d.). Ward off depression. Arthritis Today. Retrieved from http://www.arthritis.org/ward-off-depression.php

I know your rheumatologist is probably hassling you to exercise (mine is too). I know it feels impossible. Between the pain and fatigue, exercising is the very last thing you or I want to do most days. Here's the thing though - you'll feel much better if you exercise daily. Really.

It doesn't have to be for very long. It doesn't have to be very strenuous. Whatever you can find that works for you, just do it. Move those joints. Strengthen those muscles. Improve that range of motion.

Some forms of exercise are well suited for the arthritic body: yoga, tai chi, pilates, and swimming. All of these activities may require some modifications to suit your particular needs, but overall, they're much kinder than running or other high impact exercises!

The best I've ever felt since my PsA kicked into high gear was the two months where I got my act together and exercised everyday. My pain decreased. My energy increased. I had less need for medical intervention. Unfortunately a flare knocked me back and I haven't gotten back on the exercise train since, but I know it's worth it.

I just need to do it, and so do you. Let's stop making excuses.

Whatever your limitations, it's worth a visit to a physical therapist or occupational therapist to learn the safe manner to use exercise equipment! Don't be shy about asking your general practitioner or rheumatologist for a referral.

Hi everyone! My name is Michelle (or Mia – either one!) and I blog over at Desire Higher. Mary let me borrow her blog to talk about how yoga can assist with inflammation caused by psoriatic arthritis.

I must admit that I was not well-informed about psoriatic arthritis before talking to Mary and reading her blog. I did a little bit of research and found that yoga is recommended for many different types of chronic pain, including all types of arthritis. A consistent practice every day of about 15 to 20 minutes can both reduce pain by balancing the body’s muscles and, through focusing on meditative breathing, lessen pain. Kimberly Carson, a yoga therapist interviewed for Psoriasis Advance, says that when the body is in pain, it is almost instinctual to contract your muscles to try and ward it away, which can actually increase pain. Yoga serves as a way to “get movement back” into that contracting area. Sounds good to me!

Yoga has also proven time and time again to offer a myriad of other health benefits, from better sleep to lower blood pressure. If you want to lessen your pain from PsA as well as lower stress levels, yoga might be the right choice for you. First, remember to ask your doctor before beginning any new exercise routine.

If you are interested in trying out yoga, decide if you want to take classes or practice at home. Since you will likely need to modify the poses to better suit your body, a class might be a better starting point, especially if you are completely new to yoga. Search around and try to find an instructor who has taught others with chronic pain. At the very least, be sure to talk with the instructor before the class begins so they can make appropriate modifications for you throughout the class. Remember that you might not click with your first instructor. Don’t give up hope! You may need to try out a few different classes to see which type of yoga, instructor, and style is right for you.

An at-home practice can be used to replace or supplement a studio practice. If you are doing an at-home practice, you can follow online routines, DVDs, or even YouTube videos. Kimberly Carson included a series of arthritis-friendly poses in her article here. However, for safety reasons, Livestrong advises those with arthritis to be extremely careful about any backbend poses – such as camel, wheel and cobra – and hip opening poses, like butterfly and pigeon. If you are having a flare, then avoid poses that will further aggravate that part of your body. Above all, listen to your body. If you are in pain, do not continue a pose.

Overall, research has proven that yoga can be beneficial for those who suffer from any sort of chronic pain. If you are interested, give it a shot! It might be right for you or it might not be, but you never know until you try. At worst, you have tried something new, and at best, it could be an all-new part of your routine that prevents pain.

When you're newly diagnosed with psoriatic arthritis, it's common to feel alone. Forming a strong support system is important!

Family

If you're lucky, family will be an awesome, built-in support system. Thankfully my immediate family has been that way. You will probably have to educate some of your family in order for them to understand your condition, and the need for support that comes with it. You also can't expect them to know exactly what you need. If you need a listening ear, if you need a ride to the doctor, if you need help with your housework or childcare, if you need anything at all, you have to ask. In the early days after your diagnosis, you may have to explain why you need help with things you used to handle yourself with no problem, but after a while, "I'm in a flare" will be all the explanation you need.

Friends & Facebook

You may need to be more selective about the friends you turn to for support. Undoubtedly your very closest friends will be interested in learning more about psoriatic arthritis, and helping you when they can. Be wary of spilling everything to the acquaintances known as "Facebook friends" though! Unfortunately with the little known nature of this disease, it's easiest (and most fun) for folks to label you a hypochondriac and a drama queen, rather than educating themselves and being understanding.

There are facebook groups for Psoriatic Arthritis (here's one), but be aware that most groups are public. That means that regardless of your personal security settings, anyone can see what you post there. With facebook's current news feed set up, your posts and likes in that group can even show up in your "friends'" news feeds, despite them not being members of the same group.

Online Support Groups

Fortunately, there are online support groups that come much closer to anonymity! TalkPsoriasis is a message board sponsored by the National Psoriasis Foundation. Although the site of course serves the needs of psoriasis patients (which most of us with PsA are as well), there's a section specifically for discussing psoriatic arthritis.

If you happen to have spondylitis (inflammation of the spine) as part of your disease presentation, the Spondylitis Association of America's message board is a great option too! Most members have ankylosing spondylitis or undifferentiated spondyloarthropothy, but there are a number of PsA patients who frequent the boards. The AS and USpA patients share many of our experiences, so you don't have to only seek out those with PsA and spondylitis.

There are other privately run PsA forums around the web, but I'm most comfortable with using the forums sponsored by these non-profits.

Local Support Groups

The NPF and SAA also sponsor local support groups. This is an opportunity to meet fellow patients face-to-face, which is strong confirmation that you're not alone in having this disease. See a listing of support group locations for the NPF and SAA.

There are times when a good heating pad or ice pack can be your best friend. A successful medication regimen is my primary coping mechanism for psoriatic arthritis, but there are times when medicine isn't enough, or when you're still working on getting the perfect mix of drugs and lifestyle changes for you. Perhaps you're trying to get by without any medication at all. Whatever the case, heat and ice can both feel good on inflamed joints!

Heating Pads

It's not uncommon to see me walking down the hall at work with a microwaveable heating pad strapped onto my back or hips. I think it's better to make that questionable fashion statement than to skip a day of work! Other folks prefer ice packs for their inflammation, but I find heat works best for me in most cases. This Carex Bed Buddy is my heating pad of choice, but many people prefer ones that plug in. Yes, a microwaveable heating pad like this one loses its heat within about 45 minutes, and it does have a bit of an odor of buckwheat, but I love the moist heat it provides. When it cools down, that just gives me a reason to get up and moving again (as far as the microwave, anyhow), which is probably just as helpful as the heat itself.

Hot Showers

I also begin everyday with a very hot shower to help work out the kinks. After all, with an inflammatory arthritis like psoriatic arthritis, it's normal to feel worst after long periods of rest. Sleeping definitely falls into that category. I'm not particularly human in the mornings before my hot shower and my morning medications! 

Hot Baths

After a long day on my feet, nothing beats a hot bath. I never have time for one in the morning, but once I'm through with my commitments for the day, a bath is just the thing for cranky joints. 

Ice Packs

The one time I do bust out the ice pack is for visible inflammation. When my ankles swell, I elevate those suckers and ice them. When my fingers swell? Ice again! There are fancier methods (some of which I own, including the aforementioned dual purpose Bed Buddy), but my favorite ice pack is just a frozen bag of peas. I can simply hobble to the freezer and grab a package rather than fiddling with ice cubes and bags and other such nonsense. Though in theory any frozen item would work, peas or corn are ideal, since they shape nicely to the area you're trying to ice.    

How do you use ice and heat to help you cope? 

There are a heck of a lot of acronyms that surround Psoriatic Arthritis and its related diseases! With that in mind, here's a running list of the acronyms you're likely to encounter on this blog, or in conversation with your doctor or fellow patients:

• AS - ankylosing spondylitis. This is a related form of arthritis that can cause the spine and sacroiliac joints to fuse.¹
• CRP - C-reactive protein. This is a blood test that measures a form of protein. Elevated levels can indicate inflammation.²
• DDX - differential diagnosis.
• DIP - distal interphalangeal predominate. Distal interphalangeal refers to the last knuckle of the fingers or toes. DIP is the "classic" presentation of psoriatic arthritis, but not the most common.³
• DMARD - disease modifying anti-rheumatic drug. This is a class of treatment for various forms of inflammatory arthritis. They are particularly "disease modifying" for rheumatoid arthritis patients. Methotrexate, sulfasalazine, and plaquenil are a few drugs in this class.
• Dx - diagnosis.
• ESR - erythrocyte sedimentation rate. This is a blood test performed to check for inflammation. It's commonly called the "sed rate".⁴
• FM or FMS - fibromyalgia syndrome. Fibromyalgia is a condition that causes chronic widespread muskuloskeletal pain. It is a common misdiagnosis for psoriatic arthritis, but also occurs alongside psoriatic arthritis and other autoimmune diseases quite frequently.⁵
• GP - general practitioner.
• HLA B27 - human leukocyte antigen B27. This is a blood test for a protein found on the surface of white blood cells. HLA B27 is an indication of ankylosing spondylitis and some other spondyloarthropothies.⁶
• JIA or JRA - juvenile idiopathic arthritis or juvenile rheumatoid arthritis.
• MTX - methotrexate. This is a type of DMARD. Methotrexate is a chemotheraphy drug, but is used in smaller doses for inflammatory arthritis treatment.⁷
• NPF - National Psoriasis Foundation.
• NSAID - non-steroidal anti-inflammatory drug.
• OA - osteoarthritis. Also known as your grandmother's arthritis.
• PCP - primary care provider.
• PsA - psoriatic arthritis.
• RA - rheumatoid arthritis.
• ReA - reactive arthritis.
• RF - rheumatoid factor. An indication of rheumatoid arthritis, this test is rarely positive for psoriatic arthritis patients.
• Rx - prescription.
• SAA - Spondylitis Association of America.
• SIJs - sacroiliac joints.
• SpA - spondyloarthropothy or spondyloarthritis. This is the name of the group of diseases that includes psoriatic arthritis.⁸ 
• SSDI - social security disability insurance.
• SSZ - sulfasalazine, a type of DMARD.
• TB - tuberculosis. Testing for tuberculosis is required before starting TNF inhibitor treatment. Latent infections must be treated to prevent them from becoming active while taking TNF inhibitors.⁹
• TNF and Anti-TNF - tumor necrosis factor. Anti-TNFs or TNF-alpha inhibitors block a portion of the immune system thought to cause inflammation. This is a common treatment for moderate to severe psoriatic arthritis.¹⁰
• USpA - undifferentiated spondyloarthropothy. This is the diagnosis given to patients whose disease has not differentiated itself as psoriatic arthritis, ankylosing spondylitis, or another specific spondyloarthropothy.¹¹

Please let me know if I sneak in any acronyms unexplained!


References
1. Spondylitis Association of America. (n.d.). About ankylosing spondylitis. Retrieved from 
    http://www.spondylitis.org/about/as.aspx
2. Mayo Clinic. (2011, December 16). C-reactive protein test. Retrieved from 
   http://www.mayoclinic.com/health/c-reactive-protein/my01018
3. National Psoriasis Foundation. (n.d.). Types of psoriatic arthritis. Retrieved from 
   http://www.psoriasis.org/psoriatic-arthritis/types
4. Mayo Clinic. (2010, November 19). Sed rate (erythrocyte sedimentation rate). Retrieved from 
   http://www.mayoclinic.com/health/sed-rate/MY00343
5. Buskila, D., & Sarzi-Puttini, P. (2008, January). Fibromyalgia and autoimmune diseases: the pain behind autoimmunity.
    The Israel Medical Association Journal, 10, 77-78. Retrieved from http://www.ima.org.il/imaj/ar08jan-20.pdf?q=antipolymer
6. Dugdale, D.C. (2011, May 23). HLA-B27 antigen. In MedlinePlus Medical Encyclopedia. Retrieved from
    http://www.nlm.nih.gov/medlineplus/ency/article/003551.htm
7. Methotrexate. (2009, April 1). In MedlinePlus Medical Encyclopedia. Retrieved from 
   http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682019.html
8. Spondylitis Association of America. (n.d.). Ankylosing spondylitis & related diseases: an overview. Retrieved from
   http://www.spondylitis.org/about/overview.aspx
9. Solovic, I., Sester, M., Gomez-Reino, J.J., Rieder, H.L., Ehlers, S., Milburn, H.J., . . . Lange, C. (2010, November 1). The risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement. European Respiratory Journal, 36(5), 1185-1206. Retrieved from http://erj.ersjournals.com/content/36/5/1185.full
10. Mayo Clinic. (2010, December 9). Psoriatic arthritis: treatments and drugs. Retrieved from 
   http://www.mayoclinic.com/health/psoriatic-arthritis/DS00476/DSECTION=treatments-and-drugs
11. Spondylitis Association of America. (n.d.). Undifferentiated spondyloarthropothy. Retrieved from 
   http://www.spondylitis.org/about/undif.aspx

If you're like me, you may sometimes head online when you need support for your health problems. Unfortunately, if you're also a Psoriatic Arthritis patient like me, a gap exists in the resources available to us. 

Large non-profit organizations like the Arthritis Foundation, the National Psoriasis Foundation, and the Spondylitis Association of America provide basic information about Psoriatic Arthritis (PsA), but their focus is broad, and PsA doesn't really make top billing. Forums connected with these organizations provide great venues for discussion (Arthritis Foundation Forum, TalkPsoriasis, and Spondylitis Association of America Forum), but patients with PsA are the minority in each of these forums, outnumbered by patients with psoriasis without PsA or those with other rheumatic diseases. 

As for blogs on the subject, there are a handful of diary style blogs written by PsA patients, an advice column style blog written by various doctors and sponsored by the National Psoriasis Foundation, and one informative blog called Understanding Psoriatic Arthritis that has not been updated for over a year, though I hope the author will update again, because I've learned a lot from digging around in the archives! Right now, I can't find any active blogs written by PsA patients to help their fellow patients learn how to live with this disease. 

That's where I come in.

I'm no medical expert. 
I am more of an expert than your doctor on one subject though: what it feels like to have PsA. If your doctor also happens to have PsA then that's another matter, but since less than 3% of the population shares this form of inflammatory arthritis, it's not terribly likely.^[1]

My arthritis has been active to one degree or another since about 2006, and I've picked up a few tricks along the way for coping with this disease. I look forward to sharing those tricks with you. If you have any other tips and tricks to pass along, please do! 



References
1.  Ceponis, A. and Kavanaugh, A. (2011). Psoriatic arthritis: Advances in therapy. Advances in Rheumatology 9(2), 45-55.