Infrequently asked questions

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The following are a selection of infrequently asked questions:

Please note:
The answers given in this section may not apply in your circumstances.
Always seek advice from your healthcare provider.


Q. I wonder if you can help me, I work in a care home and a female client has psoriasis. She sees a dermatologist every 3-months.  My question is; can you tell me what the ideal bath water temperature is for an older person with severe psoriasis? (May 2013)

A . I think the temperature for bathing is a difficult question for people with psoriasis, and I don’t think there is any guideline on this. All I can offer is a personal opinion based on my own psoriasis.

When my psoriasis is flaring any heat on the affected areas can be painful as the the blood vessels close to the surface of the skin are very dilated. For those without psoriasis the best way to describe this is to compare it with the sensation a hot bath has on sunburnt skin, in those instances many people will opt for a lukewarm cooler bath for relieve, the same helps with inflamed psoriasis. Cooler bath soothes.

I find that even when the water is pleasant to a hand it can still be painful to areas of psoriasis, therefore I tend to start off with a very cool bath and then add hot water once immersed to bring the temperature up.

Q. [response] Thank you so much again. You help is appreciated. I also support someone with a severe learning disability and sensory impairment who cannot always tell us what is a comfortable temperature for her. I was hoping to find a known ‘range’ of temperatures, which is both soothing and that does not trigger pain or a ‘flare-up’ of her psoriasis. However, your experience is very useful and I will advise her support workers to continue with cool to luke-warm baths.

Q. Has anyone that has been diagnosed with PsA been tested for the HLA B27 antigen and been found to be positive?  Also, I have been reading that although one may have a negative blood test for RA it can change to positive at a later date.  Would this mean that you could be misdiagnosed with PsA when you actually have RA. (Jan 2012)

A. B27 occurs in 40% of people with PsA.  The answer to the other question is yes but it is much more complicated than that.  There is no definitive blood test for PsA nor RA  

Q. I’m on methotrexate for PsA the drug isn’t suiting me and I have had the dose halved.  When I was first prescribed the drug I was told I couldn’t take leflunomide instead, as I had breast cancer in the year 2000.  My rheumatologist has said that as it was 11 years ago she feels it is now irrelevant and carries no risk so I could now be given leflunomide.  I’m now being given conflicting views so would I like to do some research on the drug to help come to a decision as to whether the drug would increase my risk of the breast cancer reoccurring.  (July 2011)

A. I am not aware that leflunomide increases breast cancer risk.  There are other drugs of course.  It depends a lot on the patient and their disease.

Q. I wonder if you can help answer a query. I have been investigated for rheumatoid arthritis but my rheumatologist is saying I have psoriatic arthritis not rheumatoid.  I am now on sulfasalasine. I had submitted a critical illness claim for rheumatoid arthritis to my insurers as that was what I was initially led to believe it was, my insurers have rejected my claim saying psoriatic arthritis is not classed a chronic disease.  It has been suggested to me to complain to the financial ombudsman, but I wanted to know if both arthritis’ are chronic.  I will of course ask my consultant but unfortunately I will not be seeing him for another 3 months and any appeal to the financial ombudsman has a very tight timescale. (May 2011)

A. This is an absolute outrage!  There is published evidence on chronicity and that it can be just as disabling as rheumatoid.

Q. I have a broken metatarsal in foot, which has PsA in that joint;  will a procedure to plate and screw the break have any effect on PsA in the associated joint.  (March 2011)

A. There are a number of potential risks. Firstly, if the fracture is adjacent to the joint the arthritis is likely to deteriorate faster than it would have done.  Secondly, if steroids have been used, it may not heal as well, and the patient should probably take something to strengthen bones.  Thirdly, psoriasis may develop in the scar after the operation.