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Managing Pain with PsA and Gastrointestinal Issues

Anyone with psoriatic arthritis (PsA) knows how difficult and uncomfortable it can be living with awful joint pain. However, many individuals experience pain a step further, when conditions that can follow PsA cause even more discomfort in often varied places. A very common example of this is seen in individuals with PsA and accompanying gastrointestinal conditions. Most of these gastrointestinal issues are inflammatory in nature, which seems to make sense for anyone familiar with PsA. Since PsA, and commonly accompanying psoriasis, stem from inappropriate immune responses and inflammation, it doesn’t seem too far-fetched to extend those issues past the skin and joints only.

Chronic inflammatory conditions of the gastrointestinal system, such as Crohn’s disease, present with cramping, bowel irregularities, abdominal pain, and appetite changes, which can range from moderate to severe, similar to PsA. There has been an increasing amount of research dedicated to studying and classifying the connection between inflammatory conditions like PsA and Crohn’s and while there is no clear-cut answer, many theories point towards common mutations in the genes controlling inflammation and immune response.

However, while this link is still being considered, individuals with both PsA and gastrointestinal conditions can still be extremely uncomfortable, and experience daily pain. Oftentimes, cycles of symptoms aren’t linked, leading to discomfort frequently. If cycles of flare-ups and remission are linked, this can lead to double the pain during symptomatic times. It really can be a frustrating situation!

So how do we combat this pain? Well, just as research is being performed to isolate the cause of these conditions and why they can come in tandem, there is also a lot of research in the works to determine the effects of different medications on pain levels for individuals with PsA and comorbid gastrointestinal conditions. Due to the ongoing nature of research, we can’t say for sure what works, or doesn’t work, to a fault, but we can talk about the types of medicines being analyzed as potential solutions. These include:

  • Naproxen (Aleve)—Long-term side effects unknown at this time
  • Aspirin and NSAIDs (Nonsteroidal Anti-inflammatory Drugs)—Can control pain and swelling, but could cause stomach, liver, or heart issues with prolonged use. NSAIDs include; ibuprofen, diclofenac, naproxen, and COX-2s (celecoxib)
  • Paracetamol (Acetaminophen)—Can help control pain, but can’t control swelling
  • Opioids—Powerful pain relieving substances, but have psychoactive, addictive, mental fogging, and physical impairment properties. Opiods include; codeine-containing Tylenol, hydromorphone (Dilaudid), oxycodone (Percocet), morphine, and morphine-like tramadol.
  • Neuromodulators—Antidepressants, anticonvulsants, and muscle relaxants fall in this category. Although the primary purpose for these drugs aren’t pain relief, they do have pain-relieving properties. Long-term effects still need to be considered.

Ultimately, the issue of relieving pain in individuals with both PsA and other comorbid conditions, especially gastrointestinal issues, is a complex one. Hopefully, more research on the long-term effects and effectiveness of some of the medications listed will be completed or released soon, and can give us a better picture of what pain management strategies could lead to the most relief. Let us know how you manage you pain on a daily basis, especially if it comes from more than one comorbid condition.

  1. Orenstein, Beth. “Psoriasis, Psoriatic Arthritis Connected to Crohn’s.” Psoriasis.org. 6 May 2015. Available from: https://www.psoriasis.org/advance/psoriasis-psoriatic-arthritis-connected-to-crohns
  2. Radner H, et al. “Pain management for inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and other spondyloarthritis) and gastrointestinal or liver comorbidity.” The Cochrane Library. 18 Jan 2012. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008951.pub2/full

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