Page 33 - Waterfall Issue 10 2021
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Above: Skin psoriasis.
Left: Psoriatic nail disease.
The nail is often
involved, particularly HoW DoES oNE DIAgNoSE psA?
the crumbling of the There is no single blood test or investigation to diagnose
nail plate and the PsA. Instead, a doctor makes a diagnosis considering
separation of the nail the clinical presentation, the family history of psoriasis,
from the nail bed. the blood test results, and the x-ray findings.
HoW DoES oNE mANAgE psA?
Therapy of PsA needs to be individualised, considering all
the areas that could be affected (peripheral joints, axial
disease, dactylitis, enthesitis, psoriasis, and nail disease), the
nail involvement, or bowel, ocular, cardiovascular, co-morbidities, patient preference, disease activity, structural
urogenital and pulmonary involvement. damage and previous therapy. Medication may be advised.
Approximately 20% of the patients with PsA develop Non-pharmacological therapies include giving up
arthritis before the onset of psoriasis. Sometimes, smoking, low impact exercise, physical therapy,
psoriasis is not obvious, and the ‘hidden’ area needs occupational therapy, weight loss in overweight
to be closely examined, particularly in the groin, patients, massage and acupuncture.
umbilicus, hairline, behind the ears, and the anus.
PsA is a complex disease due to its diverse manifestations
WHAT CoNDITIoNS ARE ASSoCIATED and multiple co-morbidities. Delayed diagnosis and
WITH psA? treatment – even by as little as six months – have
PsA is associated with several co-morbidities, been associated with worse outcomes. Therefore, it
including metabolic syndrome and cardiovascular is best managed via a multi-disciplinary approach
disease, fibromyalgia, mood disorder, malignancy that includes a rheumatologist, dermatologist,
and human immunodeficiency virus infection. gastroenterologist and ophthalmologist.
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