Chronic Lyme arthritis: A mystery solved?
Psoriatic Arthritis
Psoriatic arthritis (PsA) is a form of inflammatory arthritis. It affects about 1.5 million people in the U.S., or 30% of people who have psoriasis. Psoriasis is a skin disease that causes a red, scaly rash, most often on your elbows, knees, ankles, feet, and hands.
Psoriatic arthritis is a form of inflammatory arthritis that primarily affects people who have psoriasis. While there's no cure, there are ways to treat and manage the condition. (Photo Credit: E+/Getty Images)
PsA is an autoimmune condition. It happens when your body's immune system attacks healthy tissue by mistake. PsA most often affects your skin and your joints, which can become swollen, stiff, and painful. Over time, if you don't treat it, the inflammation can damage joints and tissues.
The symptoms of psoriatic arthritis include:
Where can psoriatic arthritis affect your body?
This condition can involve different body parts.
Spondylitis affects your spine and may cause inflammation and stiffness in your neck, lower back, spinal vertebrae, or sacroiliac region (pelvic area), which can make it hard to move. Spondylitis also can attack connective tissue, such as ligaments, or cause arthritis in the joints of your arms, hips, legs, or feet.
Enthesitis is inflammation of the entheses, the areas where ligaments or tendons insert into your bones. You're likely to get it on the bottoms of your feet, your Achilles tendons, and the places where ligaments attach to your ribs, spine, and pelvis. It affects only people with PsA, not those with other types of arthritis such as rheumatoid arthritis or osteoarthritis. Over time, enthesitis can make tissues in the affected area ropey (your doctor will call this fibrosis) or solid (the doctor might refer to this as ossification or calcification).
Dactylitis, or "sausage digits," is inflammation that affects an entire finger or toe. It happens when small joints and entheses of the surrounding tendons get inflamed. Dactylitis is another hallmark of psoriatic arthritis. It usually involves a few fingers or toes, but not in a symmetrical pattern. Unlike other types of arthritis, PsA can affect different toes and fingers on different sides of your body.
What are the early warning signs of psoriatic arthritis?
Most people may have already had psoriasis for 10-20 years before developing psoriatic arthritis. But for some people, joint pain can start at the same time as skin problems, or even before psoriasis appears. At the beginning stages of the disease, it can be normal to have periods when symptoms feel worse, and then periods when symptoms seem to improve.
Early warning signs of psoriatic arthritis may include:
Psoriatic arthritis nails
Up to 80% of people with psoriatic arthritis see changes to their fingernails and toenails. This is known as a separate condition, called nail psoriasis. Nails can experience many types of changes due to psoriatic arthritis. Some of these include:
Nail pitting. These are small dents in the nail plate. It's the most common symptom of nail psoriasis.
Nail crumbling. Nails might also become thin or brittle.
Beau's lines. These are horizontal lines and grooves that run across the nail plate.
Discoloration. Parts of the skin underneath your nails could change to colors such as yellow, brown, pink, or red. These are called oil drop spots or salmon patches.
Splinter hemorrhages. Small lines of blood can appear under the nail.
Onycholysis. This is when the nail separates from the nail bed.
Subungual hyperkeratosis. This is a thickening of the nail bed.
Infection. Your nails might become infected with a fungus.
Psoriatic arthritis rash
If you have psoriatic arthritis, you may also have the rash that comes with having psoriasis. This rash usually looks like scaly patches, and it can be itchy. The rash is most commonly found on the knees, elbows, torso, and scalp, but it can be found on other parts of the body as well. There are several different types of psoriasis, each with different rashes:
Plaque psoriasis. This is the most common type of psoriasis, and it causes scaly, raised skin patches.
Guttate psoriasis. You may see small, red dots on your torso or limbs after an infection, like strep throat. It's more common in children and young adults.
Pustular psoriasis. It causes pus-filled bumps, surrounded by red skin.
Inverse psoriasis. You may have smooth, red patches in between folds of skin, like beneath your breasts.
Erythrodermic psoriasis. In this rare and serious type of psoriasis, a red, scaly rash covers most of your body.
Like other types of arthritis, psoriatic arthritis can be more or less severe. Some doctors group psoriatic arthritis based on what joints it affects or what side of your body experiences symptoms. Based on this, there are five types of psoriatic arthritis:
Distal interphalangeal predominant psoriatic arthritis. This type affects the joints near your fingers and toes. It's the type most likely to have nail psoriasis.
Symmetric polyarthritis. This is when more than five joints are affected, and the same joints on both sides of your body are impacted. For example, both of your ankles, shoulders, and elbows.
Asymmetric oligoarticular psoriatic arthritis. This is when two to four joints on both sides of your body are affected. For example, one ankle and one shoulder.
Spondylitis. This is when the joints between your spine's vertebrae (back bones) are affected. It can also affect your lower back.
Arthritis mutilans. It's the rarest type of psoriatic arthritis that causes severe inflammation in your hands and feet. It also causes bone loss and deforms your joints.
Doctors aren't sure what causes psoriatic arthritis, but these things may play a role:
Genes. Having a parent with psoriasis increases your chance of getting psoriasis and makes you more likely to have psoriatic arthritis. Scientists have identified some genes that they believe play a role in psoriatic arthritis.
Infection. An infection that sets off your immune system could be to blame. Psoriasis, for example, is often triggered by strep throat.
Physical trauma. Studies show that some people who already have psoriasis and experience trauma to their bone or joint may be more likely to develop psoriatic arthritis.
Psoriasis. Up to 30% of people with psoriasis get psoriatic arthritis. People who have more severe psoriasis may be more likely to get psoriatic arthritis, but this isn't always the case and needs further research. It affects men and women equally.
Age. You can get PsA at any age, but it usually affects people between 30 and 50.
Family history. As many as 40% of people with psoriatic arthritis have a family history of skin or joint disease.
Obesity. Studies show that obesity is a risk factor for both psoriasis and psoriatic arthritis.
To diagnose PsA, your doctor will ask about your symptoms and whether any of your relatives have psoriasis, psoriatic arthritis, or another autoimmune disease. They'll also check how well your joints move and whether you have pain, tenderness, swelling, or warmth. You may have tests including:
Psoriatic arthritis vs. Rheumatoid arthritis
Psoriatic arthritis shares some symptoms with rheumatoid arthritis (RA), such as joint pain and swelling. But RA usually affects joints on both sides of your body, while this is not always the case with psoriatic arthritis. Psoriatic arthritis also typically affects fewer joints than RA.
People with RA may have bumps under their skin close to their joints, called rheumatoid nodules. This doesn't tend to happen with psoriatic arthritis. But other skin and nail changes are more likely with psoriatic arthritis than with RA.
Finally, people with psoriatic arthritis won't have the common antibodies that many people with RA have.
Psoriatic arthritis radiology
Your doctor may want to do radiology tests, such as an MRI, CT scan, ultrasound, or X-ray, to help diagnose psoriatic arthritis. Sometimes, it can be hard to see evidence of psoriatic arthritis on these images if you are still in the early stages of the disease. In later stages of the disease, radiographic findings of PsA may include:
Medical treatments for psoriatic arthritis include:
Nonsteroidal anti-inflammatory drugs (NSAIDs). These are over-the-counter medications such as ibuprofen and naproxen.
Disease-modifying antirheumatic drugs (DMARDs). These can slow or stop pain, swelling, and joint and tissue damage. If NSAIDs don't work, your doctor will try DMARDs. They may take longer to work.
Immunosuppressants. If you can't take a DMARD, you might get a type of drug called an immunosuppressant. These drugs curb your immune system, which is what's causing the problem in an autoimmune condition such as PsA. But they can also make it more likely that you'll get an infection.
Biologics. If immune suppression doesn't work, your doctor may prescribe a biologic. These are a newer type of DMARD. Instead of weakening your entire immune system, these medications block a protein that causes inflammation.
Enzyme inhibitor. This works by blocking a certain enzyme, a kind of protein, called PDE-4. That helps slow other reactions that lead to inflammation.
Steroids. These can help control inflammation, but doctors don't use them often for PsA. That's because they can make your skin rash worse. Doctors prescribe steroids only when you really need them. If you use them for a long time, you could have serious side effects such as brittle bones, weight gain, hypertension, and diabetes.
Surgery. A severely damaged joint can be replaced with a new one made from metal and plastic.
You can ease some psoriatic arthritis symptoms on your own. Try to:
Keep a healthy weight. Carrying extra pounds puts more stress on your joints. It may also affect how well your medications work.
Stop smoking. This is one of the best things you can do for your overall health.
Limit alcohol. It can also affect how your treatments work.
Exercise. It's a great way to protect your joints and keep your weight in check. Stronger muscles can also support your joints. Low-impact exercises, such as swimming or walking, are easier on them. Ask your doctor about an exercise plan.
Use physical or occupational therapy. Your doctor might recommend that you see a specialist who can help you learn to manage your symptoms. This can involve exercises, body adjustments, hot and cold therapy, and tips for changing the way you do certain things. A physical or occupational therapist can also help you pick assistive devices such as braces or splints to support your joints.
Use acupuncture or massage therapy. These treatments are natural ways to ease pain and stiffness.
Use hot and cold therapy. Heating pads or sitting in a hot bath can help painful joints. An ice pack can help ease inflammation and pain. You may want to switch between heat and cold therapy depending on how you feel.
Take vitamins. Some vitamins and minerals, such as calcium and Vitamin D, may help slow bone deformation.
Use tools that help your joints. Tools are available to help open cans, pick up heavy objects, lift objects off the ground, and more. Using these tools when needed can help protect your joints from unnecessary stress.
Rest when needed. Living with a chronic illness such as psoriatic arthritis can be painful and exhausting. Make sure you take enough time to rest throughout the day.
Psoriatic arthritis diet
There's no one specific diet recommended for people with psoriatic arthritis. The best diet to eat is one that will help you eat nutritious food and keep you at a healthy weight. To reduce the chances of a flare-up, you may also want to eat anti-inflammatory foods, such as:
You may want to avoid foods that can commonly trigger inflammation. These include:
Is psoriatic arthritis a disability?
Depending on severity, psoriatic arthritis can be a disabling disease. Psoriatic arthritis is one of the conditions named under the Listing of Impairments according to the Social Security Administration. You could qualify for Social Security benefits if you apply for them and are deemed disabled.
Just like all people with disabilities, people who are disabled from psoriatic arthritis are also protected under the Americans with Disabilities Act, or ADA. The ADA prevents discrimination against people with disabilities in areas including transportation, public accommodations, schools, government services, and employment.
If your psoriatic arthritis makes it difficult to work, you can request reasonable accommodations from your employer or your school under the ADA. Some of these accommodations could include:
PsA can make you more likely to have:
Certain things could trigger psoriatic arthritis, including:
Psoriatic arthritis is a form of inflammatory arthritis that primarily affects people who have psoriasis. It can cause painful joint swelling and stiffness, along with nail damage and a psoriasis rash. There's no cure, but treatment with medication and lifestyle changes such as diet modification and exercise can ease your symptoms. Sometimes symptoms may go away completely -- known as remission -- and these periods can last years at a time.
What are the first signs of psoriatic arthritis?
The first signs usually include joint pain and swelling, joint stiffness, fatigue, and changes to your fingernails. You may also notice patches of a psoriasis rash on your body if you weren't already aware of having psoriasis.
Does psoriatic arthritis go away?
There is no cure for psoriatic arthritis, and it's a lifelong condition. However, it can go into remission, meaning that all your symptoms can go away for a period. This period can last days, weeks, months, or years.
What is the best cure for psoriatic arthritis?
There is no cure for psoriatic arthritis, but there are many different treatments that can help you manage the condition. You may have to try several different treatments before you find the best one for you. Some of the most effective treatments include disease-modifying antirheumatic drugs (DMARDs) and biologics.
CBD For Inflammation: What To Know And Best Products For 2024
Cannabidiol (CBD) may be beneficial for treating pain and inflammation. CBD is a compound from the cannabis plant and comes in both topical and edible forms.
A quick look at the best CBD products for inflammationCannabis is a plant that has been in use for more than 4,000 years. There are a few different kinds of cannabis, including Cannabis sativa.
Although research on CBD is still in its early stages, people are increasingly using it as an alternative treatment for various health conditions, including inflammation.
Is CBD legal?The 2018 Farm Bill removed hemp from the legal definition of marijuana in the Controlled Substances Act. This made some hemp-derived CBD products with less than 0.3% THC federally legal. However, CBD products containing more than 0.3% THC still fall under the legal definition of marijuana, making them federally illegal but legal under some state laws. Be sure to check state laws, especially when traveling. Also, keep in mind that the FDA has not approved nonprescription CBD products, and some products may be inaccurately labeled.
How we chose CBD products Does CBD reduce inflammation?Some research suggests that CBD can ease inflammation and results show CBD as a promising anti-inflammatory treatment.
Cannabis sativa contains more than 400 different chemical compounds. Two of the best-known are THC and CBD. THC is the cannabinoid that leads to the "high" feeling many people associate with cannabis. CBD does not provide these same effects.
Learn more about CBD and THC.
Research suggests that CBD's anti-inflammatory properties may be beneficial for rheumatoid arthritis, as it affects certain cell viability. It may also have a synergetic effect on rheumatoid arthritis medication.
A 2020 research review suggests CBD's properties can provide antioxidative effects because of CBD's specific molecular structure. Therefore, it may have anti-inflammatory benefits for conditions that can result from oxidative stress.
A 2023 study concludes that CBD can reduce inflammation following intense physical exercise in comparison to a placebo.
Most studies have not reviewed the long-term effects of CBD, and researchers need to conduct more studies with human participants. However, experts believe the research results may have therapeutic implications.
One 2020 study found that CBD's anti-inflammatory properties may help with the following conditions:
How to use CBD for inflammationCBD comes in many forms. Some people may find that edible CBD products, such as gummies and oral oils, work better for them. Others may find topical CBD, such as creams and massage oils, easier to use.
How individuals take or apply CBD will depend on its form.
CBD oilManufacturers of CBD oil often include a dropper with their product. This means a person can easily measure out the appropriate dose.
A person uses this dropper to place a few drops under the tongue. They should aim to hold these drops under the tongue for around 30–60 seconds. This method of ingesting CBD oil is known as sublingual consumption.
Research from 2021 into sublingual CBD oils in the United Kingdom states that they can reduce pain and improve sleep quality.
CBD topical productsTopical CBD products can help provide more targeted pain relief to specific areas of the body. They come in many forms, including creams, roll-ons, oils, and gels.
A person applies a small amount of the product to the painful area and massages it in. How much someone should apply will vary between products, and they need to follow the guidance on the product label.
A 2022 review concludes that topical CBD products can have anti-inflammatory effects.
CBD gummiesMost CBD gummy manufacturers recommend taking 1–2 gummies daily. However, a person needs to take guidance from the product label as recommended doses vary.
There is limited research into CBD gummies and their effects on pain or inflammation. However, people may find gummies to be a convenient and more subtle way of taking CBD.
CBD capsulesA person takes CBD capsules by swallowing them whole with water. They need to refer to the product label for dosage instructions. Additionally, they need to pay attention to whether the manufacturer recommends taking the capsules with or without food.
There is limited research into CBD capsules and their effects on pain and inflammation.
The best CBD products for inflammationBelow, we look at the best CBD products to consider for inflammation.
Best broad-spectrum gummiesUse code "HEALTHLINE" for 20% off.
MNT's reviewThese broad-spectrum gummies are solvent-free, which means the manufacturers extract CBD without using chemicals such as propane and butane.
The gummies contain organic hemp, tapioca syrup, and cane sugar. It is also cruelty-free and vegan, and CBDfx states it makes this product in the United States.
Each serving of two gummies contains 50–100 milligrams (mg) of CBD, depending on whether a person chooses the 1,500 mg or 3,000 mg bottle.
These gummies may provide a convenient pain-relief option. Taking gummies for pain means a person can control when to take them, and they can do this subtly if they wish.
Read our CBDfx review and discover other best CBD gummies.
Subscriptions and savings
CBDfx does not currently offer a subscribe and save feature.
However, it does offer free shipping on orders of $75 and over. People can also use third-party companies such as Sezzle and Klarna to spread the cost of eligible purchases.
Pros & consThis high potency oral oil contains full-spectrum CBD. It comes in various bottle sizes and contains 50 mg of CBD per milliliter (mL) of oil.
It also contains coconut. If a person has an allergy to coconut or if a doctor has stated that they cannot eat grapefruit, an individual needs to check with a doctor before using this product.
This product is vegan and free of genetically modified organisms (GMOs). The company sources all ingredients from the United States.
Full-spectrum products contain up to 0.3% THC. While it is unlikely that will make people fail a drug test, it is possible, so this product may be unsuitable for those who undergo regular drug testing.
Lazarus Naturals recommends that people take 1 mL (50 mg) as needed or as a healthcare professional directs. The company states that the product takes up to 2 hours to take effect, and some people may need to adjust their dose accordingly.
Lazarus Naturals does not specify that the product is for pain relief. However, various customer reviews mention experiencing relief from arthritis and headache pain after taking the project.
Read our review of Lazarus Naturals and discover other best full-spectrum CBD oils.
Subscriptions and savings
All of Lazarus Natural's products over $25 are eligible for payment with Sezzle, which allows people to split the cost over several interest-free payments.
Additionally, the company offers up to 60% off each product for veterans, people on long-term disability, and low income households. To access this assistance program, people will need to log in to their account and apply by filling out a form.
Pros & consUse code "HEALTH40" for 40% off.
MNT's reviewThis roll-on contains broad-spectrum CBD, cooling menthol, and a mint scent. It is free from THC.
It is a hands-free massaging roller that may suit people who have a busy schedule and are always on the go. It can also provide targeted pain relief to specific areas of the body.
According to the company, it does not leave a messy residue and absorbs quickly.
Subscriptions and savings
People can opt to subscribe and save to gain up to 35% off each purchase. People can choose to receive this product every 1, 2, or 3 months.
Pros & consEach of these soft gels contains 30 mg of broad-spectrum CBD. They are flavor-free and use organic ingredients, including hemp extract and MCT from coconut.
The company recommends taking 1–2 soft gels per day with food. R&R states that this product may aid relaxation and comfort as well as heal pain.
A person takes these soft gels orally, meaning this may help with pain in multiple areas as the positive effects will travel around the body.
Each batch of this product is third-party tested, and the company uses a Food and Drug Administration (FDA)-registered facility.
Subscriptions and savings
R&R offers free shipping on orders over $60.
Alternatively, people can opt to subscribe and save. People can choose to have delivery every 30, 60, or 90 days. Choosing this option provides free shipping and 20% off the price of each product.
Pros & consThe following table compares the products in this article on form, type, potency, and more.
What to look for in CBD products for inflammationPeople may wish to consider the following before purchasing:
A 2020 research review suggests that most people can tolerate CBD. However, this depends on the concentration of CBD in a product.
Possible risks and side effects of CBD use include:
If a person uses CBD alongside other medications, it may affect how those medications work. For instance, a 2019 study found that CBD reduced the effectiveness of steroids in treating inflammation. However, this study was in vitro, meaning it did not take place in a living organism such as humans or animals, and it is not clear how CBD and steroids may work together in humans.
People should discuss CBD with a healthcare professional, especially if they take medications.
Frequently asked questions about CBD for inflammation Is CBD the best anti-inflammatory?While CBD can help reduce inflammation, people should not use it instead of any anti-inflammatories a healthcare professional recommends.
While CBD can help reduce inflammation, people should not use it instead of any anti-inflammatories a healthcare professional recommends.
Is CBD good for inflammation?Yes, evidence suggests that CBD can help reduce inflammation and joint pain. However, not enough studies have investigated CBD’s long-term effects on this condition yet.
An older research review from 2018 suggests that a full-spectrum CBD product may be more effective than other types in treating inflammation and joint pain.
However, if a person does not want to use a product that contains THC, they may prefer to purchase broad-spectrum or CBD isolate products.
It is important to note that researchers have not yet discovered the optimal dosing or length of time to take CBD to see its anti-inflammatory effects. More research is necessary.
Yes, evidence suggests that CBD can help reduce inflammation and joint pain. However, not enough studies have investigated CBD’s long-term effects on this condition yet.
An older research review from 2018 suggests that a full-spectrum CBD product may be more effective than other types in treating inflammation and joint pain.
However, if a person does not want to use a product that contains THC, they may prefer to purchase broad-spectrum or CBD isolate products.
It is important to note that researchers have not yet discovered the optimal dosing or length of time to take CBD to see its anti-inflammatory effects. More research is necessary.
Is CBD better than ibuprofen?CBD has anti-inflammatory and pain-relieving properties and starts working within 45 minutes. Ibuprofen, which has the same effects, starts working within 20–30 minutes.
It is important to note that there have been more studies on the effectiveness, short- and long-term side effects, and toxicity of ibuprofen than CBD for inflammation.
CBD has anti-inflammatory and pain-relieving properties and starts working within 45 minutes. Ibuprofen, which has the same effects, starts working within 20–30 minutes.
It is important to note that there have been more studies on the effectiveness, short- and long-term side effects, and toxicity of ibuprofen than CBD for inflammation.
What is the downside of CBD oil?It may be more difficult to accurately dose CBD oil, especially if the dropper does not have clear markings. Stronger CBD oils may taste bitter if they do not have any flavorings, and they are not as easy to consume on the go as gummies.
It may be more difficult to accurately dose CBD oil, especially if the dropper does not have clear markings. Stronger CBD oils may taste bitter if they do not have any flavorings, and they are not as easy to consume on the go as gummies.
What type of inflammation does CBD help?Studies have found that CBD may help with inflammation relating to joint pain and arthritis.
Studies have found that CBD may help with inflammation relating to joint pain and arthritis.
SummaryCBD is a compound from the cannabis plant that may have various health benefits, including fighting inflammation.
Researchers have not yet conducted many long-term studies on how CBD affects human inflammation. However, anecdotal evidence suggests that the results may be promising.
Brands such as Lazarus Naturals, R&R Medicinals, and Level Select offer CBD products that may help people manage inflammation.
Gut Bacteria And Inflammatory Bowel Disease: A New Frontier In Treatment
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Inflammatory bowel disease (IBD) depletes the microbial ecosystem within the gastrointestinal tract leading to inflammation and metabolic dysfunction. Prebiotics have been shown to alleviate these symptoms by serving as an energy and food source for gut microbes, restoring the microbiome and alleviating IBD symptomology.
view moreCredit: By Ariaee A, Koentgen S, Wardill HR, et al.
A growing body of research suggests that manipulating gut bacteria may offer a promising approach to managing inflammatory bowel disease (IBD), a chronic and debilitating condition affecting millions of people worldwide.
IBD, encompassing Crohn's disease, ulcerative colitis, and unclassified IBD, is characterized by chronic inflammation of the digestive tract. Conventional treatments aim to control symptoms and prevent complications. However, they often have limited effectiveness and can come with side effects.
This new research explores the potential of prebiotics, dietary fibers that nourish beneficial gut bacteria, as a therapeutic strategy for IBD. Studies have shown that a healthy gut microbiome plays a crucial role in maintaining gut health, and alterations in this bacterial community are associated with IBD.
Researchers believe that promoting the growth of beneficial bacteria through prebiotics may restore balance in the gut and alleviate IBD symptoms. This hypothesis has been evaluated in a number of clinical studies. More research on humans is needed to fully understand the personalized responses that occur in these IBD patients before clinical recommendations can safely be made.
The review highlights the therapeutic potential of various prebiotics derived from different food sources, including:
Preclinical studies in animal models of colitis have shown promise for select prebiotics in reducing inflammation, improving gut barrier function, and promoting the growth of beneficial bacteria. However, it is important to note that these animal models demonstrate production of fibre-fermentation byproducts such as short chain fatty acids (SCFA) is typically associated with these beneficial effects and SCFA are typically reduced in IBD patients.
Thus, while some clinical studies have yielded positive results, several significant studies have recently highlighted detrimental effects in select patients, especially those whose gut microbiota are altered and unable to properly utilize these prebiotic fibres. These studies highlight the personalized responses to different prebiotics and demonstrate a need for more research to determine the most effective prebiotics and their optimal dosages for managing IBD in humans.
This approach holds significant promise for improving the lives of patients with IBD. By harnessing the power of gut bacteria, researchers are paving the way for a new generation of treatments that target the root cause of the disease.
See the article:
Ariaee A, Koentgen S, Wardill HR, et al. Prebiotic selection influencing inflammatory bowel disease treatment outcomes: a review of the preclinical and clinical evidence. EGastroenterology 2024;2:e100055. Doi:10.1136/egastro-2023-100055
About the eGastroenterology
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JournaleGastroenterology
Article TitlePrebiotic selection influencing inflammatory bowel disease treatment outcomes: a review of the preclinical and clinical evidence
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