All About Telehealth for Psoriatic Arthritis Telehealth allows doctors to care for people virtually over a phone call, text message, or most commonly, video chat. Although some situations require an in-person visit, telehealth is a great option when you can't get to the doctor's office for your psoriatic arthritis. If you're new to telehealth, here's what you need to know. Medicare will cover telehealth visits just like in-person visits, but state Medicaid programs and private insurers vary, so confirm your coverage in advance. With telehealth, even though you're not in the doctor's office, your private health information is still covered by HIPAA, so it will remain confidential and secure. Although your rheumatologist can't give you a physical exam via telehealth, they can write prescriptions and offer quality care, especially if you prepare in advance. Before your telehealth appointment:- List any psoriatic arthritis symptoms (including dates and severity), like swollen fingers and toes, foot pain, and lower back pain- Document any side effects from your psoriatic arthritis treatments, such as stomach upset, breathing problems, or signs of infection- Record your vital signs if you own a thermometer, blood pressure monitor, or another device- Compile a list of your health conditions and medications- Write down questions you have for your rheumatologist- Have any past x-rays and test results handy- Charge your computer or phone- Make sure your internet is reliable- Download any telehealth apps your specific provider may require- Find a quiet, private space to conduct the call- Be prepared with pen and paper or a note-taking app Turn to Healthgrades to connect with the right rheumatologist to treat psoriatic arthritis via telehealth. And share this video to spread the word!

Jenny:I'm Jenny. I have psoriatic arthritis and this is a day in my life. I had horrible pain and I didn't understand where it was coming from because I didn't have any injuries. And then, I had a cut on the bottom of my foot, but the cut wasn't healing, so I started to go to a dermatologist. She gave me some creams and the cream just made things better for a day and it would flare up worse. The hardest part is to find the right doctor. Once I found the right doctor, within two seconds, he said, "You have psoriatic arthritis." When I try and get out of bed in the morning, the reason it takes me so long is because when I haven't moved, all of my joints get stiff. I feel everything just creaking. It's the pain that happens as those joints are opening up. It's hard to motivate to get moving, but at the same time, not moving is the worst thing you can do for this disease. And psoriasis on my foot makes walking difficult. It's a very counterintuitive thing. Because all of my joints hurt, including my jaw, I'm mostly on a liquid diet. I'm very embarrassed of the lifestyle changes I had to make to accommodate the psoriatic arthritis and especially because it is this invisible disease. People look at me and they say, "You look fine." It's frustrating and scary. Mentally preparing myself to do this part of my morning, which is the showering and teeth brushing. Showering, it's a chore. It's that getting in the shower means bending down and turning on that faucet, stepping in, holding my arms up. The water goes on. It's like I'm being punched in the back. When a doctor asks me, "When were you first diagnosed with arthritis?" I have to pull out this binder, which is just my medical history from age 15 to 22. Just managing my psoriatic arthritis is such a full time job. I'm just realizing that it's time to fill this thing up again. And then before I know it, these bottles are empty and then I have to get back on the phone with all these doctor's offices. It's just this cycle where you're chasing your tail. Norman Marcus, MD:Hi, Jenny. Jenny:How are you? Norman Marcus, MD:How are you doing? Jenny:Well, what happens is a tooth cracks and then the psoriasis flares on my hands and on my foot. Norman Marcus, MD:This is a histamine response. The pain and the stress have sort of stimulated everything in your body. Jenny:Walking becomes really painful because one step and this thing cracks open. It's fleeting, so I was only using the front part of my foot. I've had two stress fractures because I can't use the back of my foot. Norman Marcus, MD:Let me talk to your rheumatologist and then we'll be in touch to figure out what our next steps are. Hope:Hey, mom. Jenny:Hi. Hope:Hi. Jenny:How was your day? Hope:It was good. Jenny:The first time I took the injection I was horrified. My daughter got involved. She was like, "Okay. You can do it." Hope:I never want her to feel like she's lonely. 1, 2, 3, 4... Jenny:It made the pain so much less of an issue. Hope:9, 10. I always think, "Is Mom going to be okay?" I always think the worst is going to happen while I'm gone. So I don't like leaving because I like staying with her to make sure she's okay. Jenny:The doctor was saying it runs in families. Knowing that she could potentially have this, I need to be an example for her that it's going to be okay.

5 Tips For People With Psoriatic Arthritis From People With Psoriatic Arthritis Eat lots of fruits, veggies, and protein. You’ll feel better and have more energy! - Jodi L. Self-care is key. Stress can cause flare-ups, so it’s about your physical and mental health. - Summer S. Be honest with loved ones when you need to take it slow. - Noah I. Seek out a support group. It’s crucial to learn from others and it feels good to share what you’ve learned. - Summer S. Don’t forget: there will be bad days, but there will also be good days! - Andrea N. Turn to Healthgrades to connect with the right rheumatologist for your psoriatic arthritis.

Andrea: Every day is different for me and that's how I have to play it and I can't play it any other way. Jodi: My pain comes and goes. Noah: If anyone's ever run a race or played a basketball game or something, and you do that for a long time and then you kind of feel it in your body, you get very exhausted and then you kind of feel the aching--the flareup is exactly like that, 100 times worse, for an extended amount of time. Jodi: Lifestyle really helps to manage my pain. Dr. Faller: Lifestyle is important in psoriatic arthritis, because there's probably an element of stress that has to do with the development of an autoimmune condition. Eat well, get a good night's sleep, exercise regularly. Dr. Wu: Stopping smoking is a huge part of it. Avoidance of excessive alcohol use. Dr. Teitel: Weight loss is the key. I mean, it's definitely been shown that obesity is definitely correlated with this disease. Jodi: I eat all vegetables, fruits, and protein. Noah: I try to walk as much as possible. Jodi: I do yoga, I do mild Pilates, I swim once a week. Noah: Making sure that I am calm and collected. Jodi: I meditate, take a nap when need be. Noah: Make it very clear to whoever you're with, that you can do certain things, you can't do certain things. You'll feel more comfortable, others around you will also start understanding and feel more comfortable around you. Jodi: My husband and my daughter, they know, if they want me at my best, I need my time to myself throughout the day. Dr. Faller: Certainly, I think the greatest challenge someone faces is accepting the diagnosis. Andrea: I personally, always have deflected with humor, you know, comedy/tragedy, it's true. Noah: I've learned to deal with it and it's a part of my identity, so it's not something I'm necessarily ashamed of or upset about. There are times when it does get a little more difficult, but you learn to live with what you have.

Andrea: My name is Andrea, and I'm living with psoriatic arthritis. It was a really long, stressful job, and I wasn't paying attention to my body, and that I was getting sick. And then I went away on vacation, really got sick, and lost 15 pounds in two weeks. I came home, and went to my doctor, guns out, and she sent me to a spine guy, the spine guy sent me to a rheumatologist, and now I'm getting a diagnosis of psoriatic arthritis. Noah: About six and a half years ago, I started noticing some pain in my knees, went to the rheumatologist, and figured out that I had arthritis. Jodi: I have a lot of pain in my hands, specifically, so I went to the doctor, and they ran various tests, and they finally pinpointed it to psoriatic arthritis. Noah: I was having more fatigue, and I wasn't getting as much swelling in my joints, but they were affecting smaller joints, and the rheumatologist that I saw, the new one, he switched the diagnosis from rheumatoid to psoriatic. Andrea: I define psoriatic arthritis in my own words as psoriasis of the connective tissue. Jodi: I had psoriasis for probably 20 years. I would go to the doctors complaining of joint pain, but I never tied psoriasis and psoriatic arthritis together. Once I started reading about autoimmunity disease, all the pieces started falling together. Noah: Emotionally, it's pretty draining, having to explain why once a month I have to either, I can't hang out with my friends, and it kinda takes up a weekend, 'cause you have side effects of having the medication. Andrea: I realized it's a managed thing, it's not something you're gonna cure. Jodi: You just have to manage your life, and take it down a few notches. You know, you may not have the same energy level as your peers, but that's okay. Andrea: Every day is different for me, and that's how I have to play it. Jodi: Just taking it easy, knowing my limits. Noah: If you do surround yourself with good enough friends, they'll be pretty accommodating, and pretty understanding. Jodi: I have good and bad days. Luckily, today is a good day. Andrea: And I'm gonna be okay.

Dr. Faller: Psoriatic arthritis is a form of arthritis that can occur in individuals who have a skin condition called psoriasis. We have so many treatments available that the odds are strongly that we will get their disease under control, and they will be able to live a relatively normal, healthy life. Dr. Wu: The treatment options will depend on a variety of factors. First of all, the severity of the disease: whether the patient has mild, moderate, or severe symptoms. If the patient has relatively mild symptoms, they're functioning okay, but they're in a little bit of discomfort, we'll offer anti-inflammatories. And if they have severe disease then we definitely will offer them a biologic, which is a medication that is developed to target specific inflammatory markers or cytokines that we know drive the disease. Dr. Teitel: In many of these inflammatory conditions, the level of TNF can be elevated in the blood and possibly the skin and the joints, and so if you block it by using these new targeted biological treatments that reduce that TNF level, then that has a beneficial downstream effect of decreasing inflammation. Dr. Wu: Biologics definitely are life-changing for many patients, and are very effective at treating both the arthritic complaints, and oftentimes the skin disease. Dr. Teitel: Usually, you put someone on, it's pretty dramatic, the skin clears maybe almost completely, the joints are great, they feel fantastic. And then sometimes, like a year or two later, it looks like it's failing, and time to switch to another one. Dr. Wu: Typically, if you're switching medication, the patient isn't doing well clinically, so we have to also figure out how to best manage their ongoing symptoms while we transition them to their new medication. Dr. Faller: The best way to figure out whether or not they want to take a medication is to try it. Take it for a month or two, compare how you feel, and then decide whether it's something you want to take the risk of staying on long term. Dr. Wu: I think the most important thing to remember is, is that, with the appropriate treatment, patients can live a very functional and pain-free life for the most part. Dr. Faller: We can do so much to make arthritis patients better that it's almost miraculous.

Lorenzo: Well, whenever I was diagnosed with the psoriasis, of course, the next step is, "Okay, what are we going to do about this?" "What medications am I going to take?" Or, "What medications aren't I going to take?" Dr. Ahluwalia: Usually, it's a discussion between myself and the patient. Lorenzo: So he started me, which thank goodness he did, with something topical. It was just an ointment. Dr. Sejal Shah: Typically, first line therapy is topical treatment. Lorenzo: -which helped. It just didn't help enough. Dr. Sejal Shah: Often, for moderate to severe psoriasis, we look at more aggressive options like phototherapy, oral medications, and injectable biologic treatments. Lorenzo: He needed to take these steps to find out what's going to work for me. Dr. Evan Rieder: Phototherapy is giving people controlled exposure to a very narrow band of ultraviolet light- Dr. Sejal Shah: This is generally done in a very, very controlled environment. Dr. Evan Rieder: -that people get exposed to for about three times a week for just a couple minutes a time. Lorenzo: When we progress through the diagnosis and me trying different options, topical to oral, eventually my case, I did have to take a biologic. Dr. Ahluwalia: A biologic is a protein-derived drug that's made from living cells. Dr. Sejal Shah: And they interrupt the immune process involved in psoriasis. Tiffany: It really has cut my psoriasis down significantly. Lorenzo: It did take a while. I probably didn't see actual results for at least a month, a month and a half. Dr. Evan Rieder: Often, there is some trial and error that goes into finding the perfect treatment regimen for someone. Lorenzo: Everybody has to go through the steps of investigation. Tiffany: Try all of the options first before you go to an injectable. Lorenzo: You need to find out what works for you, but it's manageable.

Dr. Jaber: Biologics are a new class of psoriasis medications that are really wonder drugs, and they can be life-changing for our patients. They're immune medications, and there's many different types, and they all affect the immune system in different ways. They can take patients that are totally covered in psoriasis and clear them. Some are oral and some are injectable. Some are injected by the doctor, some are injected by each patient. For some patients, one biologic drug might be extremely effective, but, for somebody else, you might want to switch to a different biologic drug. Dr. Shah: Psoriasis medications are commonly switched, and this is because either people are not getting an appropriate treatment response or they're experiencing side effects. Wendy: What ends up happening, unfortunately, for most patients is, after a few years, their biologic will stop working for them, and then they will need to try a new one. Dr. Goldberg: Another reason is some of the newer drugs are simply more effective. Instead of 75 or 50% clear, they can get them 90% clear. There are certain medications now that you only have to do one injection every three months, as opposed to doing it once a week. Dr. Shah: We've been able to tailor the newer biologics to specifically target the immune system aspects that are active in psoriasis. When it comes to switching medications, I think some of the biggest myths are that people sometimes think that they need to stop their current medication, and that creates a little bit of fear. Sometimes we can transition them without a break at all. The other myth is, again, that sometimes the medication is stronger, so they may have more side effects, or they may have more immunosuppression. That's also not always the case, as we may be switching them from a more broad biologic to one that's more specific to psoriasis. Dr. Jaber: Some people are worried that, "Oh, I'm on one drug, I can't switch to another good drug." That's not true. Dr. Strachan: There are so many more options to treat psoriasis now. It's important for patients to be optimistic, if something's not working, to explore what the other options are. Wendy: We're so lucky that there are these new biologics out right now. It's given people a new lease on life.

Lorenzo: Why me? It hurts. I don't get it. I thought I was healthy. What am I going to do? I didn't know anything at the time, so it was scary. Brittany: It was really stressful, and it was really aggravating, and it was really depressing. Lorenzo: Uncomfortable feeling in your own skin, literally. In my mind, I keep hearing ashamed, because I hid a lot, I didn't want to be anywhere. Wendy: It's irritating, it's red, which then is more visible to other people. Vanetta: I am so embarrassed to wear short-sleeved shirts. Brittany: I had to cover up in the summer, I had to wear long sleeves and pants. And you could still see it in certain places, on my hands. Vanetta: And I'm uncomfortable to be around other people because I have a lot of skin irritations on my arm. Brittany: People avoided me, out and out. They didn't want to ask any questions, they didn't want to be near me. I was mad at first, but they didn't understand. If you didn't understand it and you saw somebody who was covered in these spots, you'd be petrified, you'd be like, "I don't want to be near this person." Lorenzo: It's frightening, especially when you don't know anything about it. Brittany: They just don't know, people are afraid of what they don't know. Lorenzo: I just needed to relax and just say, "Okay, what the heck am I going to do?" Brittany: It was a huge weight lifted off my shoulders when I spoke to other people in my community and they told me that even though there isn't a cure, there are ways to manage my psoriasis. Lorenzo: I wrote a journal, it keeps me in check. I know what I'm eating, I know what I'm feeling, I know how to handle it. I know how to keep it at bay. Brittany: I focus on my body, I focus on my mental health. Lorenzo: We can actually live our lives. Brittany: The main thing that helped me was UV light therapy. Lorenzo: I do the biologic. Four months into it, started clearing up, clearing up, and this is me. Wendy: I feel that psoriasis, in a way, has given me just a different outlook on life and a larger voice that I can help other people that don't feel as empowered as I do. Brittany: So if I can help other people, that's the most important thing to me. Lorenzo: Be open to it, it actually feels good if you get to help somebody. I mean, if one little tip that I just said helps somebody, we're all winning, right?

Inflammation has been linked to many chronic diseases like rheumatoid arthritis, psoriatic arthritis, heart disease, and depression. Medication is crucial to treat these conditions, but you can also turn to your fridge to ease inflammation. Here's what to add to your grocery list. 1. Cold-water fish. One of the main elements of an anti-inflammatory diet is cold-water fish, rich in inflammation-fighting Omega-3 fatty acids. To catch these benefits, add salmon, mackerel, tuna, sardines, or anchovies to your meals twice a week. 2. Nuts. Next, go nuts. Walnuts, almonds, and pistachios have been associated with reduced inflammation. They can even lower your risk of heart disease and diabetes. 3. Add colorful fruits to your diet, strawberries, blueberries, oranges, and cherries can reduce inflammation and they're delicious. 4. Get plenty of leafy greens. Spinach, kale, and collards are not only anti-inflammatory but are rich in vitamins and antioxidants that can prevent against cancer. 5. Olive oil. Finally, enjoy plenty of olive oil. Extra virgin olive oil can prevent inflammation from developing using the same mechanism as ibuprofen. Reducing inflammation through food is an easy way to keep pain at bay. Keep these five elements stocked in your kitchen and you'll be on the right track to better health.

What Not to Say to Someone With Psoriasis #1. “What’s wrong with your skin?”#2. “That looks contagious”#3. “Maybe you just need to moisturize more”$4. “Try this diet my cousin’s friend swears by”#5. “You’re lucky it’s just a skin disease” Turn to Healthgrades to find a doctor who knows just what to say.