Psoriatic arthritis patient with large knee effusion
5 Top Psoriatic Arthritis Triggers
From injury to certain drugs, you may be surprised by some of the things that can set off a flare.
By Jennifer Warner
Medically Reviewed by Sanjai Sinha, MD
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Nearly a third of people with the autoimmune disease psoriasis develop psoriatic arthritis. A disease that affects the joints, psoriatic arthritis can be painful and debilitating, and its symptoms can be triggered or worsened by a variety of things.
What causes someone to develop either psoriasis or psoriatic arthritis isn't clear. Genes seem to play a role, with about 10 percent of people inheriting genes that predispose them to psoriasis, according to the National Psoriasis Foundation, though only 2 to 3 percent actually develop the disease.
It's also likely that the development of psoriatic arthritis stems from a combination of genes and exposure to a complex mix of external triggers. These triggers vary dramatically from one person to the next, and only a few have been backed up by scientific studies.
Even so, it makes sense to do your best to avoid these known psoriatic arthritis triggers.
Stress is the big one—the top factor implicated both in causing psoriatic arthritis to emerge for the first time and in triggering flares of existing disease.
"The number one thing patients tell me is that when stress levels go up, they have inflammation and a flare and more pain," says Alexis Ogdie-Beatty, MD, rheumatologist at thePerelman Center for Advanced Medicineand assistant professor of medicine at the Hospital of the University of Pennsylvania in Philadelphia.
"Along with stress goes lack of sleep," says Dr. Ogdie-Beatty. When you get less sleep, your pain is likely to seem worse.
2. Injuries to the Skin
Ogdie-Beatty says that another big psoriatic arthritis trigger for flares is any type of injury to the skin, such as a cut, sunburn, or surgery. This is known as the Koebner phenomenon.
"It's the idea that when you have trauma, say a cut on your leg, you can get more psoriatic arthritis in that part of the body," she says.
Ogdie-Beatty says the link between injury and flares of psoriatic arthritis probably all goes back to the abnormal inflammatory response. People with psoriatic arthritis have unusually high levels of systemic inflammation in their body as a result of the disease. An increase in inflammation related to injury may trigger inflammation elsewhere, such as the joints.
3. Adverse Effects of Drugs
Several drugs that are commonly taken to treat other medical conditions may also be psoriatic arthritis triggers, although the link to psoriatic arthritis isn't as clear, says Ogdie-Beatty.
Lithium, for instance, which is used to treat psychiatric disorders, aggravates psoriasis in about half of those with psoriasis who take it. Anti-malaria drugs, including chloroquine and hydroxychloroquine, which may be prescribed for rheumatoid arthritis, may also trigger a bout of psoriasis a couple weeks after taking the drugs.
Inderal (propranolol), a beta-blocker used to treat high blood pressure and other conditions, such as tremors and anxiety, can worsen psoriasis in up to 30 percent of people. Quinidine, a heart medicine, has been reported to trigger some cases of psoriasis.
Also be very careful about using the steroid medication prednisone, warns Ogdie-Beatty, because "when patients come off it, it can cause a bad flare."
4. Alcohol and Inflammation
Jerry Bagel, MD, dermatologist and director of the Psoriasis Treatment Center of Central New Jersey in East Windsor, says that alcohol can exert a pro-inflammatory effect that could trigger psoriasis and psoriatic arthritis.
A study published in November 2011 in theInternational Journal of Dermatologynoted that evidence of the link between alcohol and psoriasis has been building in recent years. Although it's still unclear whether alcohol use is a true risk factor for the disease, data suggests that drinking can exacerbate existing cases of psoriasis.
5. Diet — It Can Help and Hurt
Ogdie-Beatty says that many of her patients tell her that individual foods act as psoriatic triggers.
"It's really an individual thing," she says. "Some people say tomatoes, some say gluten, or sugar."
No particular diet or food has been conclusively proven to trigger psoriatic arthritis. It's difficult to study, in part, because of people’s inability to recall exactly what they ate. "It's hard to pin down a particular nutrient," says Ogdie-Beatty.
There is also growing evidence that certain foods and nutrients may help prevent flares of psoriatic arthritis by fighting inflammation in the body.
Anti-inflammatory foods include omega-3 fatty acids found in some fish, flaxseed, olive oil, and walnuts. Colorful fruits and vegetables that contain high levels of antioxidants, like carrots, spinach, kale, broccoli, blueberries, and strawberries, also may have an anti-inflammatory effect.
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