Psoriatic arthritis (PsA) is a complex and chronic form of arthritis that goes well beyond normal arthritis pains. In fact, PsA affects the skin, causing red, scaly patches all over. Different from other forms like osteoarthritis or rheumatoid arthritis, PsA often impacts the nails and joints as well.
In Black populations, PsA presentation is especially unique.
In fact, variations in joint damage, diagnosis, and symptom profiles are especially pronounced among Black sufferers. These symptoms also carry with them a higher risk of other diseases and disorders, such as hypertension and diabetes.
So let’s get into it.
In this article, we’ll discuss the distinct traits of PsA in Black patients, and the various environmental and genetic factors at play. Hopefully, by better understanding these differentiations, Black patients and doctors can better manage their condition and improve their overall health.
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Joint Damage in Black Folks With PsA
Joint damage from PsA in Black patients is a problem for various reasons. Firstly, it causes something called enthesitis, which is the inflammation of the tendons and ligaments attached to the bones. This is a distinct form of arthritis, and primarily affects joint surfaces. Unfortunately for Black patients, enthesitis is usually more severe and may contribute to painful, swollen, and less mobile joints.
In particular, studies show that Black patients with PsA often experience greater damage in their smaller joints, such as the fingers and toes. Over time, this may cause dactylitis, which changes the appearance of appendages, giving them a sausage-like look.
When this happens, Black sufferers may struggle to perform daily activities. This is why timely and proper diagnosis is so critical.
Unfortunately, proper diagnosis is often hard to achieve. Many people with PsA, especially Black patients, are misdiagnosed with other dermatological conditions. Many Black patients don’t even receive the right referrals to rheumatologists, meaning they may never actually see specialists in this area.
Then there is the issue of unique presentation. On darker skin, psoriasis is usually not red like it is on lighter skin. This further complicates a correct diagnosis, occasionally leading to irreversible impacts on quality of life.
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Other Unique Presentations in Black Patients
Many Black patients with PsA cite symptoms that are different from those of other arthritis forms. Whereas rheumatoid arthritis impacts joints symmetrically (same on both sides of the body), PsA does not. It is asymmetric, and often more severely asymmetric in Black sufferers. This makes it harder for doctors to readily diagnose, given the lack of predictable patterns.
Black patients also more often have axial symptoms, in which the spine and pelvis are affected, contributing to lower back aches and stiffness. If these PsA symptoms are left untreated, they can lead to intense pain, and in some cases crippling consequences.
It’s important to note that Black patients also have higher risks of comorbidities commonly associated with PsA, such as high blood pressure, diabetes, and other cardiovascular conditions. The reason for this is complex. Genetics, environmental factors, and socioeconomic struggles are all part of this problem.
In many cases, the inflammation from PsA can also make preexisting conditions worse. For instance, it may lead to arterial stiffness and plaque, which raises one’s risk of heart disease. Over time, inflammation can also contribute to numerous other diseases and disorders, making PsA more than just an arthritic disease.
And unfortunately, thanks to genetic variants in Black patients, the body may struggle to manage inflammatory responses. In other words, not only are Black patients with PsA at higher risk of inflammatory issues, but they’re also often unable to regulate that inflammation.
Fortunately, there are ways to manage these problems.
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Managing and Treating PsA in Black Patients
Turns out, healthcare providers can tailor many treatment protocols specifically to Black patients. However, this first requires an understanding of the science behind disease progression in the Black population. With PsA, it’s all about managing both the physical and social factors influencing how the condition develops.
Consider the following:
- Accurate Diagnosis: The best diagnosis is both accurate and early. Because PsA presents uniquely in the Black body, conditions such as enthesitis, dactylitis, and spinal impacts are all indicators of a problem. This can help medical professionals recognize the disease early and begin proper treatment right away.
- Personalized Plans: The two main classes of disease treatment are disease-modifying anti-rheumatic drugs (DMARDs) and biologics. These types of medications help with the severe inflammation often seen in Black patients, targeting particular inflammatory markers of the disease. By honing in on these specific bodily symptoms, DMARDs and biologics can treat the precise problem without needlessly affecting other systems of the body.
- Comorbidity Help: Given that PsA affects other areas of health, it’s important to get regular screening. Checkups for high blood pressure, diabetes, and cardiovascular disease are all critical, in that they allow healthcare providers to integrate comprehensive treatment protocols. Lifestyle adjustments can further help Black patients with PsA manage both their psoriasis and any related conditions.
- Diet and Lifestyle Interventions: Speaking of lifestyle adjustments, one way to help manage PsA is through anti-inflammatory foods. Diets that contain omega-3 fatty acids, fiber, and antioxidants are particularly useful. But diet is just a part of it. You can also engage in exercise routines such as low-impact activities, whether swimming, walking, or practicing yoga. The trick is to find an exercise that does not put undue pressure on the joints, while still promoting overall health.
- Mental Health Support: Last but not least is mental health support. Mental health support is vital because PsA can certainly take its toll! Managing chronic pain is rarely easy, so keeping your mental health in check is very important. One way to do this is through counseling and support groups, which can bring like-minded individuals together while fostering a more positive outlook. This can be anything from a one-on-one with a therapist to a group meeting with other PsA sufferers.
At the end of the day, managing PsA can be challenging. For Black patients, who face distinct and more severe disease progression, these challenges may be particularly severe. Fortunately, there are many resources out there to help.
Consult your healthcare provider and speak to others who are living with the condition as well. By increasing awareness, pushing for early diagnosis, and catering personalized treatment plans, Black patients with PsA can live the wholesome, fulfilling lives they deserve.
