Psoriasis and psoriatic arthritis are distinct conditions, but they are connected. Psoriasis is an inflammatory condition of the skin. At the same time, psoriatic arthritis also includes inflammation of the joints and etheses (places where a tendon or ligament attaches to the bone), called enthesitis. Psoriatic arthritis can complicate psoriasis, and is reported to occur in 7-26 percent of psoriasis sufferers.

Symptoms can vary from person to person depending on the type and severity of psoriasis or psoriatic arthritis. Psoriasis is most often associated with raised red, itchy, flaky skin patches, usually found on the knees and elbows. Psoriasis plaques may have a silver scale or crust on top, and some patients with psoriasis may notice thick, pitted fingernails. Those with fingernail changes are at higher risk for psoriatic arthritis. In skin of color, especially in deeper shades, the inflammation patches or scales can take a purplish brown color.

PsA is different than psoriasis alone in that it includes joint pain and swelling, and entheseal signs and symptoms. Patients with psoriasis and psoriatic arthritis often have other associated medical conditions, or comorbidities, such as metabolic syndrome, osteoporosis, or cardiovascular disease. Both the chronic inflammation of untreated psoriasis, and psoriasis risk factors, such as alcoholism and smoking, can increase the risk of early heart disease. Due to healthcare disparities and structural racism, BIPOC patients suffer disproportionately from both psoriasis risk factors and associated comorbidities.

We spoke with various BIPOC patients regarding their experience living with psoriatic disease and how it affects their daily life, including going to the doctor and engaging with their community. Research has long shown these health care disparities – delayed diagnosis and treatment, a lack of representation and culturally competent care, and the challenges accessing affordable, timely care. We spoke to patients to put a face to the facts. This video series features the perspective of other patients. This is not medical advice and should not take the place of professional medical care.

PsO and PsA require regular care by a specialist, so finding the right rheumatologist and dermatologist is key to managing your condition. A rheumatologist is a doctor who treats conditions related to the bones, joints, muscles, and immune system. A dermatologist is a doctor who treats conditions related to the skin, nails, and hair.

The doctor-patient relationship has a significant impact on your well-being. It’s important to feel comfortable and safe to talk about what’s bothering you. This is your health, your life, and your future.

Health inequities exist and affect both the health care system and those trying to receive care and treatment. Having health care providers that can provide culturally competent care is essential in helping address disparities in health care.

Cultural competence in health care refers to the “ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring of health care delivery to meet patients’ social, cultural, and linguistic needs.” A lack of cultural competence in health care can have negative effects on patient safety such as “diagnostics errors, missed screenings, and harmful treatment interactions.”

Unfortunately, finding a culturally competent physician can be a particular challenge for BIPOC patients. In the United States, BIPOC physicians are underrepresented with less than 5% of physicians self-reporting as Hispanic/Latinx or African American, and less than 1% reporting as Indigenous American.

An estimated 45 to 56 percent of people living with psoriasis also live with scalp psoriasis. Symptoms may include fine scaling that looks like dandruff, or thick, crusted plaques that cover the entire scalp. This can affect how people care for their hair. There may be cultural differences in hair care, or differences based on hair texture and styling. Black people, who are more likely to have traditionally stigmatized hair textures, may be particularly vulnerable to scalp disease-related distress. Further, the cadence and type of hair styling may vary by cultural background. It’s important that doctors be aware of this when recommending scalp and skin psoriasis treatments. This awareness may help in establishing a trusting therapeutic alliance between doctor and psoriasis patients.

The 50-State Network is the grassroots advocacy arm of the Global Health Living Foundation and CreakyJoints. Through the 50-State Network, we train and help patients living with chronic illnesses to amplify their voice and add their personal perspective to health policy discussions. Join the 50-State Network to share your story about access to treatment, quality of care, and the need to prioritize the physician-patient relationship. Learn more and sign up here.

Many studies on psoriatic disease have shown that the experience of having psoriatic disease in patients of color can be vastly different than white patients for a variety of socio-economic and cultural reasons. But there is still a lack of diversity in research, and a lack of research on the experience of psoriatic disease in BIPOC patients. Getting involved in research and sharing your experience helps impact future patients and ongoing treatment innovation.

If you are diagnosed with arthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.

Dr. Ashira Blazer is an Assistant Professor of Rheumatology at Hospital for Special Surgery, who studies the biologic and genetic determinants of lupus severity in patients of African ancestry. She has forged multiple international collaborations with rheumatology programs in West Africa, spearheading the development of unique bio registries in Accra, Ghana, and Lagos, Nigeria. Dr. Blazer has received several funded grants through the Rheumatology Research Foundation, International League of Associations for Rheumatology (ILAR), Lupus Research Alliance, and the National Institutes of Health. She was most recently awarded a K23 research development award from NIAID to continue her work on APOL1 regulation and expression in lupus at HSS. Furthermore, Dr. Blazer is committed to mentorship and education and is working to advance diversity, equity, and inclusion in the field of Rheumatology in part through her role as the co-chair and inaugural member of the American College of Rheumatology DEI subcommittee. In recognition of her work as a thought leader in reducing health disparities, she was appointed as a 2020 National Minority Quality Forum 40 under 40 leader in Minority Health.