Inflammatory pain that wakes you up at night, joint stiffness in the morning: these are signs that should alert you, especially when you already suffer from psoriasis. It may indeed be psoriatic arthritis, and the earlier the diagnosis and treatment, the better the chances of avoiding devastating consequences.
This is the message broadcast on the occasion of a patient information day (read elsewhere) recently organized at the Sainte Anne Army Training Hospital in Toulon by the France Psoriasis association (1).
Often overlooked pain
“Psoriasis is a chronic inflammatory dermatosis and/or a chronic inflammatory rheumatism which evolves in flare-ups, the inflammation being caused by the presence in the skin or in the joints of excess pro-inflammatory substances, the cytokines”, recalls Dr. Thierry (2), dermatologist. “It is for this reason that the management of psoriatic arthritis is multidisciplinary, combining dermatology and rheumatology”continues Dr. Élodie (2), a rheumatologist internist.
Of the 2-3% of the population who suffer from psoriasis, 20-30% will suffer from psoriatic arthritis. “Some from the start, specify the two doctors, but most often after about ten years.
The problem is that too many patients ignore the symptoms of this rheumatism and interpret them as “daily pains that are not pain”without associating them with their psoriasis.
“Or, insists Dr Élodie, they must be detected as soon as possible. Psoriatic arthritis has a significant impact on quality of life. Neglected, it can cause destructive damage and be responsible for limitations in joint mobility.
If he touches his hands, for example, the patient may have difficulty opening a bottle. It can just as well make it difficult to walk or cause intense neck pain. “However, fortunately not all patients experience destructive attacks of this type” reassure doctors.
A diagnostic complex
Early diagnosis is therefore essential, but not so easy, since the symptoms are those of other inflammatory pathologies. “Psoriatic arthritis is expressed by peripheral (on the limbs), axial (on the spine or cervical) or enthesitis (at the tendinous insertions, for example on the Achilles tendon)” lists Dr. Thierry.
The distinction between the different forms of rheumatism, to identify psoriatic arthritis, is essential to ensure the proper care of the patient. “The French Society of Rheumatology has proposed well-known diagnostic criteria for both specialties, dermatologists and rheumatologists”, indicate the two military doctors.
“A la carte” treatments
“For people who already suffer from psoriasis, it can be pointed out that the signs most often associated with rheumatism psoriatic are attacks on the scalp, the nails, the intergluteal fold and the genital sphere. These psoriatic topographies predispose to psoriatic arthritis and should alert in case of pain”, summarizes Dr. Thierry.
Once diagnosed, the patient can benefit from many available treatments targeting the famous cytokines and inflammatory factors. “We have experienced a real revolution in recent years, hence the importance of collaboration between the two specialties to adapt the treatment to the specificities of each patient. We can offer tailor-made solutions”, points out Dr. Élodie.
To facilitate the choice of treatment, the French Society of Rheumatology (and its European counterpart EULAR) and the French Society of Dermatology have recently published recommendations with a therapeutic decision tree.
It remains to inform patients so that they report these pains as soon as possible, which should alert them. This was the role, among other things, of a fun and educational escape game (Citizen Pso and Rhum’ Pso) offered as part of this awareness day on board a bus parked just in front of the hospital entrance. .
1. Day organized with the scientific support of teams from the dermatology and internal medicine departments of the HIA, a dermatology referral establishment in the Toulon area.
2. For security reasons, the names of the soldiers are not communicated.
On board the Citizen pso and Rhum’ pso bus
“Challenges, puzzles to solve on the theme of psoriasis and psoriatic arthritis: the Citizen pso bus and Rhum’ pso is an educational tool in the form of an escape gameexplains Nathalie Fossati, regional delegate of the France Psoriasis association. It sheds light on a little-known disease and changes the public’s view of psoriasis, by fighting taboos. Psoriasis is neither contagious nor psychological!”
Created 40 years ago, the France Psoriasis association informs patients with regular publications and popularization work on medical advances. She also has a listening and support role, as the disease sometimes has a strong impact on the lives of patients. Finally, it carries out awareness-raising actions for the public authorities.