by Dr Valerie Milne

The interaction of inflammatory arthritis (such as rheumatoid arthritis, psoriatic arthritis and other forms of spondyloarthritis), medications to control arthritis and sun sensitivity is not always clear, and the reactions between medications and sun vary;

• NSAIDs, such as Naproxen and diclofenac, can make you more sun sensitive as can Sulfasalazine/ Salazopyrin. Hydroxychloroquine can increase light sensitivity and vision changes.
• COX-2 inhibitors like Celecoxib can cause irritation, with a breakout in rashes, but there is some trial evidence they may slightly reduce the risk of non-melanoma skin cancers (however, other serious side effects need to be considered before any use of COX-2 inhibitors for sun protection).
• There is an increased risk of non-melanoma skin cancers (NMSC) for people being treated with DMARDs such as methotrexate and some biologic therapies. These medications also increase the risk of NMSC recurrence.
• Methotrexate can irritate the skin where sunburn has occurred previously (and let’s face it, that’s highly likely for many, especially older New Zealanders).
• Long-term corticosteroids thins the skin, making it more likely to burn, and more susceptible to wrinkling and thinning of the skin (skin atrophy).

It’s not news to most New Zealanders that our UV rays are higher than other countries at similar latitudes. To make matters worse, this year UV levels are 5-10% higher than usual. Maximum levels are now 11+ and at this level the UV Index recommendation is to seek shade between 10 am and 6 pm, wear sun-protective clothing, use a high-protection sunscreen and reapply regularly to prevent burning.

Damage to unprotected fair skin can occur in less than 15 minutes when the UV Index is 12, and within approximately 60 minutes when UVI is 3. But fair-skinned people are not the only ones at risk of sun damage that can cause skin damage. Other skin types may have a little more time before damage occurs, but few people are exempt from risk, and it’s easy to forget that the long, sunny summer days can play havoc with the skin of people living with arthritis who are taking medications to control their disease.

If you are at high risk, or otherwise concerned about the risk of sun sensitivity, discuss this with your rheumatologist.

For people taking medications for arthritis, especially disease-modifying drugs to suppress inflammatory arthritis conditions, it is more important than ever to check your skin regularly for changes to moles or freckles. Even if your spot doesn’t seem to be very much, you don’t know what is going on underneath that top layer of skin. See your doctor if you notice any changes or if you are at high risk of skin damage; add a dermatologist to your healthcare team for regular checks. Early detection, topical treatments and removal are the best and least invasive approaches for treating these skin lesions. See Skin cancer | Healthify for more information.

Prevention is the obvious choice for sun sensitivity and reactions to the sunlight. Please do follow the SunSmart guides, check your weather app and reduce sun exposure when UV is high and in town, at the beach or on the farm or anywhere else where you’re working, playing or just relaxing in our great outdoors – cover-up, be a shade-seeker, slop on sunscreen (replacing regularly), slap on a hat and wrap on some sunglasses.

Note: Overseas websites may advise using sunscreens with lower UV protection than is advised in New Zealand – check the SunSmart website for recommendations.