PSORIATIC ARTHRITIS

Diagnosing psoriatic arthritis

Psoriatic arthritis can develop slowly with mild symptoms, or it can develop quickly and be severe. Early recognition, diagnosis and treatment of psoriatic arthritis can help prevent or limit extensive joint damage that occurs in later stages of the disease.

Generally, one or more of the following symptoms appears:

Generalized fatigue Tenderness, pain and swelling over tendons Swollen fingers and toes Stiffness, pain, throbbing, swelling and tenderness in one or more joints A reduced range of motion Morning stiffness and tiredness Nail changesfor example, the nail separates from the nail bed and/or becomes pitted and mimics fungus infections Redness and pain of the eye, such as conjunctivitis

The disease can develop in a joint after an injury and may mimic a cartilage tear. The diagnosis of psoriatic arthritis may sometimes be made only after repeated episodes. Muscle or joint pain can occur without joint inflammation (swelling). Tendonitis and bursitis may be prominent features. Swelling of the fingers and toes can suggest a "sausage-like" appearance, known as dactylitis. Psoriatic arthritis usually affects the distal joints (those closest to the nail) in fingers or toes. The lower back, wrists, knees or ankles also may be affected.

In 85 percent of patients, skin disease precedes joint disease. Therefore, it is important to tell your dermatologist if you have any aches and pains. It is important to note that having a severe case of psoriasis does not necessarily mean a person will have a severe case of psoriatic arthritis. A person could have few skin lesions, but have many joints affected by the arthritis.

Tests to confirm the diagnosis

A person with joint aches and pains should talk to a doctor about diagnosis and treatment. Primary-care doctors or dermatologists can treat psoriatic arthritis, but psoriatic arthritis patients should consider seeing a rheumatologist, a doctor who specializes in arthritis.

There is no definitive test for psoriatic arthritis. The diagnosis is made mostly on a clinical basis and by a process of elimination. Medical history, physical examination, blood tests, MRIs and X-rays of the joints that have symptoms may be used to diagnose psoriatic arthritis. It is important to communicate your history of psoriasis to your doctor.

The symptoms of psoriatic arthritis are similar to those of three other arthritic diseases: rheumatoid arthritis, gout and reactive arthritis. Rheumatoid arthritis generally involves joints symmetrically distributed on both sides of the body, and it may produce bumps under the skin that are not present in psoriatic arthritis. However, some forms of psoriatic arthritis look very similar. The simultaneous presence of psoriasis on the skin and nail changes supports a diagnosis of psoriatic arthritis.

A certain antibody, called a rheumatoid factor, is normally present in rheumatoid arthritis. The rheumatoid factor is not usually found in the blood of psoriatic arthritis patients. A blood test for that antibody may help distinguish between the two diseases. A person can have rheumatoid arthritis and psoriatic arthritis, but that is rare. Many of the treatments for psoriatic arthritis and rheumatoid arthritis overlap.

Likewise, it is possible to have gout along with psoriasis and psoriatic arthritis. If you have an excruciatingly painful attack in a joint, particularly in the big toe, you may want to have a test for gout. Fluid drawn from the affected joint is examined to resolve the diagnosis of gout or psoriatic arthritis. Psoriatic arthritis patients are commonly misdiagnosed as having gout, because they often have elevated serum uric acid levels, which also can be caused by taking low-dose aspirin or by increased skin cell turnover. It is important to distinguish between the two forms of arthritis, because they may be treated with different medications.

In the very early stages of the disease, X-rays usually do not reveal signs of arthritis and may not help in making a diagnosis. In the later stages, X-rays may show changes that are characteristic of psoriatic arthritis but not found with other types of arthritis, such as the "pencil in cup" phenomenon where the end of the bone gets whittled down to a sharp point. Changes in the peripheral joints and in the spine support the diagnosis of psoriatic arthritis. However, most of the changes occur in the later stages of the disease.

Treating psoriatic arthritis

Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints working properly and possibly prevent further joint damage. Doctors will recommend treatments based on the type of psoriatic arthritis, its severity and an individuals reaction to treatment.

Early diagnosis and treatment can help slow the disease and preserve function and range of motion. Some early indicators of severe disease include onset at a young age, having many joints involved and spinal involvement. Good control of the skin disease may be valuable in the management of psoriatic arthritis. Some treatments are approved to treat both psoriasis and psoriatic arthritis.

"Localized" mild psoriatic arthritis

Generally, localized psoriatic arthritis is mild and affects only one or two joints. A person may experience long periods with no symptoms. Psoriatic arthritis of this nature generally causes less deformity and long-term disability.

"Generalized" disabling psoriatic arthritis

A portion of people who have three or more affected joints may have a higher risk of joint destruction and disability. When it is not relieved by anti-inflammatory drugs, more potent medications may be required. Some cases may require surgery and rehabilitation.

Types of psoriatic arthritis

There are five types of psoriatic arthritis: symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans.

Symmetric arthritis is much like rheumatoid arthritis but generally milder with less deformity. It usually affects multiple symmetric pairs of joints (occurs in the same joints on both sides of the body) and can be disabling.

Asymmetric arthritis can involve a few or many joints and does not occur in the same joints on both sides of the body. It can affect any joint, such as the knee, hip, ankle or wrist. The hands and feet may have enlarged "sausage" digits. The joints may also be warm, tender and red. Individuals may experience periodic joint pain which is usually responsive to medical therapy. This form is generally mild, although some people might develop disabling disease.

Distal interphalangeal predominant (DIP) although the "classic" type, occurs in only about 5 percent of people with psoriatic arthritis. Primarily, it involves the distal joints of the fingers and toes (the joint closest to the nail). Sometimes it is confused with osteoarthritis, but nail changes are usually prominent.

Spondylitis is inflammation of the spinal column. In about 5 percent of individuals with psoriatic arthritis, spondylitis is the predominant symptom. Inflammation with stiffness of the neck, lower back, sacroiliac or spinal vertebrae are common symptoms in a larger number of patients, making motion painful and difficult. Peripheral disease can be present in the hands, arms, hips, legs and feet.

Arthritis mutilans is a severe, deforming and destructive arthritis that affects fewer than 5 percent of people with psoriatic arthritis. It principally affects the small joints of the hands and feet, though there is frequently associated neck or lower back pain.

Living well with psoriatic arthritis

Due to the outward effects of psoriatic arthritis, the condition can greatly affect a person's emotional and psychological well-being. People with psoriatic arthritis may experience feelings of helplessness and frustration.

The physical and emotional effects of psoriatic arthritis may reduce an affected individual's overall quality of life. For example, some people with psoriatic arthritis may have trouble with daily activities including using their hands, standing for long periods of time and walking. Psoriatic arthritis may also limit job performance, social interactions and intimacy.

As a person living with psoriatic arthritis, its important to pay attention to the impact of your diseasephysical and emotional, and skin and jointsas well as various means to address them.

The Arthritis Foundation offers exercise programs and self-help manuals. Call 800.568.4045 or visit www.arthritis.org. Information on local programs can be obtained by contacting a local Arthritis Foundation chapter.

The U.S. Department of Health and Human Services Small Step program offers practical tips on leading a healthier life. Visit www.smallstep.gov.

Physical activity and psoriatic arthritis

Physical activity plays an important role in overall well-being. If you have psoriatic arthritis, moderate exercise may offer specific benefits, including improved range of motion, reduced joint pain and stiffness, heightened endurance, increased flexibility and weight loss. Following are helpful tips to consider when embarking on an exercise program.

Consult your doctor.

Before beginning any exercise program, it is important to talk to your doctor to determine what is appropriate for you.

Stretch out.
Your workout should include 15 minutes of flexibility exercises. Once you can do 15 continuous minutes of flexibility exercises per workout, you should be able to add strengthening and aerobic exercises to your routine.

Build muscles.
Using weights or resistance helps muscles work harder and become stronger so they can reduce the stress on joints and protect them from injury.

Make a splash.
Water exercises, from swimming to walking in the water, are a no-impact way to build strength and flexibility. Swimming can help strengthen the back, shoulders and hips while providing a good cardiovascular workout.

Walk it off.
Walking is an excellent form of exercise. If your feet, ankles or knees are affected by arthritis, you may need a walking aid or shoe inserts to avoid putting undue stress on your lower joints.

Find a buddy.
Consider exercising in a group or with a friend. Accountability to others will help you stick with your regimen. Plus, you can benefit from their encouragement and support!

Make it fun.
Start slow and focus on activities that you find enjoyable.

Let your body guide you.

Stop any activity that causes extreme pain or discomfort. Ignoring pain is not a good idea and may lead to injury, so always listen to your body. Consult your doctor if you experience pain.

Living a healthy lifestyle with psoriatic arthritis

Ensuring a healthy lifestyle is essential for people with a chronic condition such as psoriatic arthritis. To help manage the disease, it is important to implement a healthy diet, control weight, quit smoking (or never start!) and limit alcohol use.

Eat a variety of foods

It's important that your body gets all the essential nutrients and healthful substances that it needs to function properly. The nutrients we need come from a variety of meats, fruits, vegetables, dairy and grain products, which provide carbohydrates, fats, vitamins and minerals.

Eat regularly
Establish a schedule in which you eat several small meals each day. Steadily fueling your body will keep it functioning properly and help you maintain energy. Eating several small meals can also keep hunger at bay.

Maintain a healthy weight

Maintaining a healthy weight will help you feel good both physically and emotionally, and it can help reduce your risk of developing health problems. Your healthy weight range is dependent upon several factors, including your body composition and body fat distribution. Work with your doctor to determine your healthy weight, and be sure to set reasonable expectations for yourself to ensure long-term success.

Watch food portions

One serving of meat3 ouncesis the size of the palm of your hand. One serving of dairy2 ounces of cheeseis the size of a pair of dominoes.

One serving of vegetables1 cupis the size of your fist.

Add color to your diet

Fruits and vegetables are loaded with vitamins, minerals and fiber. Choose ones in a wide range of colors to ensure you are getting the maximum nutrients, such as fiber and disease-fighting antioxidants.

Use sugar and salt in moderation Limit foods that are high in fat and cholesterol
All of us need a small amount of fat to build, strengthen and repair body tissue. Want to be healthier? Choose lean beef and poultry, fish, low fat dairy and plant-based oils such as soybean, canola or olive, and stay away from fat found in animal foods like red meat; processed meats like bacon; poultry; whole milk dairy foods; and palm and coconut oils.

Avoid foods that can interact with your medications

Talk with your doctor or pharmacist about specific food-drug interactions.

Do not smoke and limit alcohol consumption

Smoking is bad for your health so if you smoke, you may want to consider quitting. Heavy drinking may hinder the potency of certain medications.

Be supplement savvy
Although a healthy diet can help you get the vitamins and minerals you need, supplementing your diet with a multivitamin may also help.

Discuss any changes in diet with your physician Avoid the "splurge"
Carry finger foods and healthy snacks to work or outings to minimize the urge to splurge on "junk" foods. Grapes, carrots, apple slices and nuts are healthy and portable snack options.

Helpful hints for preparing healthy foods:

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When you feel like cooking, prepare extra to freeze for leftovers, so you always have healthy food around to eat on your lower-energy days when you'd rather not cook. Choose frozen entrees and canned soups that are low in sodium. Read the nutrition labels and limit your total daily sodium intake to less than 2,400 milligrams. Purchase a few "arthritis friendly" kitchen gadgets to assist with food preparation. Consider pre-cut vegetables and fruits for healthy snack options.

If meal prep is largely out of the question for you, consider using your local "Meals on Wheels" program.

What Causes Psoriasis to Spread?

1. Introduction
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Psoriasis is a common chronic skin condition that is incurable. This disease alters the skin renewal cycle. Usually the lower level of new skin cells takes about a month to move to the outer layer of the skin. Once on the surface, the skin sloughs off. But with psoriasis the new skin cycle takes only a few days. This accelerated process results in dry, itchy skin with silvery scales. The severity of psoriasis is different for everyone and can vary in intensity with each individual. At times the psoriasis is in remission and at other times it is much worse because it spreads.

Symptoms of Psoriasis
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Psoriasis has a wide variety of symptoms but not every person afflicted has all the symptoms. Some symptoms are just annoying while others are disfiguring. Psoriasis can also appear on any part of the body including the scalp, mouth, genitals, nails and joints. Because the top layer of dead skin cells cannot flake off easily, thickening of the skin develops. Skin is dry and cracked and in some cases the skin bleeds. The skin can also itch or burn. Another common symptom is red patches with silvery scales. These patched can cover small spots or a large area of skin. In rare cases swollen joints are also a symptom.

How Psoriasis Spreads

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Researchers feel that psoriasis is an immune system disorder but also think that genetics and the environment contribute to flare-ups. There are several triggers that can make psoriasis worse. Stress is a culprit for worsening psoriasis as it is for many diseases and conditions. Smoking cigarettes and drinking too much alcohol can also bring about more pronounced symptoms. For some people, cold weather makes the condition worse. Sunburn can also trigger the disease. Even smaller skin injuries like a cut, bruise, scrape or insect bite can cause psoriasis to spread. Viral and bacterial infections can cause psoriasis. Certain medications can also worsen psoriasis. Drugs for hypertension (high blood pressures), bipolar disorder (manic-depression) and malaria are also known triggers.

Treatment of Psoriasis
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While there is no cure for psoriasis, doctors offer a variety of treatments to deal with the symptoms. The first treatments offered are topical creams such as corticosteroids, synthetic Vitamin D or Vitamin A derivatives (retinoid). Moisturizers and coal tar are also recommended. Light therapy using sunlight, ultraviolet light or lasers is another course of treatment. Medication is prescribed for the most severe forms of psoriasis, with delivery methods ranging from pills to intravenous injections.

Stopping the spread of psoriasis

Psoriasis is a disease whose main symptom is gray or silvery flaky patches on the skin which are red and inflamed underneath. In the United States, it affects 2 to 2.6 percent of the population, or between 5.8 and 7.5 million people. But can it be stopped? For the nearly 5 million Americans who suffer from psoriasis, life can be a painful odyssey of pills, creams and even light therapy. Worse yet, the condition can spread beyond large swaths of skin to the joints, leading to debilitating arthritis.To get the word out about this potentially disabling disorder, the National psoriasis Foundation has designated August as psoriasis Awareness Month.Fortunately, knowledge about the condition is increasing and, with it, the stock of available remedies. The most promising are new biologic treatments that work with few side effects, experts say.

"I'd say [psoriasis] is very treatable. It's just not curable," says Dr. Ted Daly, director of paediatric dermatology at Nassau University Medical Centre in East Meadow, N.Y. Psoriasis is immune-mediated, meaning that abnormal immune system responses are somehow involved. "There's no question that the immune system plays a role in the development of the disease," says Dr. Mark Lebwohl, professor and chairman of the department of dermatology at the Mount Sinai School of Medicine in New York City and president of the medical board of the psoriasis Foundation. Other than that, no one is sure what causes the disease, although there does seem to be a genetic component. "We have not identified the psoriasis gene, but [the disease] seems to be a combination of genes and external factors," Lebwohl says. While the precise causes are unclear, some triggers have been identified, including strep throat, cold weather, being out of the sun and even the drug lithium, which is commonly prescribed for bipolar disorder. What is certain, however, is the suffering it can cause. Psoriasis manifests as an uncomfortable itchy, thickening of the skin with red patches and silvery scales. These abnormal patches are really areas of extra skin cells. Inside the body, defective immune systems trigger a series of events that lead to the skin's outer layer growing at a much faster rate than normal. "Instead of being a month, the turnover of cells happens within a week or even less," Daly explains. There's not enough time for the dead cells to slough off, so these build-ups occur. The red comes from the excess blood supply needed by the rapidly growing cells. For some people, the rash is confined to a small part of the body, such as elbows, knees or scalp. Others aren't so lucky. The scaly area can spread to cover a much greater area. "It can go from a patch or two to 100 percent of the body," Daly says. And the disease can strike at any age. "Just because you don't have it now doesn't mean you won't get it in the future," Lebwohl explains. "It can come as early as birth and as late as 100 years of age." Luckily, recent treatment advances are making life easier for many sufferers. Most exciting is the development of biologic treatments. "These drugs target specific receptors on molecules or specific chemicals without affecting the entire immune system," Lebwohl says. That means they have far fewer side effects than conventional treatments. The U.S. Food and Drug Administration (FDA) approved the first biologic treatment for psoriasis in March: alefacept (brand name Amevive). A study published in the June issue of the Archives of Dermatology found that people taking 15 milligrams of the drug had a 75 percent reduction in their psoriasis Area and Severity Index (pASI), a measure of the severity of the condition. Alefacept stops the overproduction of skin cells by destroying the defective immune cells that are responsible for the abnormality. "That's one of at least five new agents that are in development for psoriasis and probably more will be coming after that and probably we haven't even seen the best of them," Lebwohl says. "As time goes on, we're going to see better and better molecules." Embrel, or etanercept, another biologic agent, was approved for psoriatic arthritis in January 2002 and is currently being considered by the FDA for moderate to severe psoriasis. Many patients still rely on the traditional arsenal of treatments, many of which have been around for decades. "Those treatments are still very useful," Lebwohl says. Some, such as cyclosporine, may be more effective than the biologics, but can entail severe side effects. Cyclosporine can damage the kidneys, and methotrexate, a chemotherapy drug, can cause liver damage. Both of these drugs are for more severe forms of the disease, doctors say.

A variety of treatments are available for milder versions of psoriasis, including creams you put directly on your skin (for instance, steroid creams and topical vitamin D). People with larger affected areas might benefit from light therapy, or even a combination of this and topical creams.

Link Between Smoking and Psoriasis

Psoriasis is a skin illness in which red scaly spots appear on the body and lead to itchiness. Psoriasis leads to red spots as a result of psoriatic plaques. Psoriatic plaques might result in inflammation as well as extreme skin turn over. These plaques are generally located on the elbows, scalp, feet, knees, genital as well as palms. Research shows that there might be a link between smoking as well as psoriasis and that smoking may be a trigger.

Psoriasis is an incurable skin disease and its degree may differ from one person to another. A few people might display just a few symptoms localized on a certain body part, whereas certain individuals might have it spread throughout the body. Psoriasis might likewise cause swelling of the joints therefore triggering "Psoriatic Arthritis". No specific reason has still been identified for psoriasis. It can be genetic or hereditary.

Psoriasis patients should not smoke as it has a tendency to worsen the problem. If you're already a cigarette smoker, try to cease this behavior since it would only aggravate the psoriasis even further. It's been noticed that on stopping cigarette smoking the psoriasis lesions have a tendency to go away progressively.

Along with cigarette smoking, alcohol consumption also needs to be checked as alcohol and psoriasis do not go together. Even possessing a small quantity of alcohol can trigger tremendous damage and accentuate the psoriasis.

Research exhibits that the pustular psoriasis on the feet and palms is afflicted by cigarette smoking to a fantastic degree. Stopping smoking completely instantly exhibits results by the reducing of the red psoriasis patches. If you wish to control the flare-ups of psoriasis as well as relieving yourself from agony and pain you have no choice however to get rid off your smoking cigarettes and alcohol consumption.

Psoriasis sufferers experience haphazard symptoms. A few days could be quite bearable while certain might be totally agonizing. There is no definite cure for this severe skin disorder. Scientific improvements have caused many most up-todate treatments for minimizing psoriasis. You can now not simply control psoriasis effectively but likewise manage its spread to a very large degree.

Psoriasis does not have a single cure that would suit all patients. Dermatologists would take into consideration your sex, age, way of life, health situation and also the extent psoriasis has spread in order to offer a proper diagnosis. The correct diagnosis would aid the doctor in prescribing the therapy that would give the best results likely.

Psoriasis is tremendously affected by the state of your mind. Any stress can trigger of a flare-up of your psoriasis. Thus, possessing a good attitude in life is the key to possess a healthy body. Keep all negative factors far away from your mind. If you want to cure psoriasis don't disregard the link between smoking and psoriasis. Stop smoking and keep psoriasis under control substantially. Stay positive and remain healthy.

Phil Mickelson
A few weeks before the 2010 U.S. Open, golf pro Phil Mickelson began to experience severe joint pain. Even his regular practice routine suddenly became difficult to endure. "I didn't think much of it," said Mickelson. "But I didn't know what it was or what it could be." But 40-year-old Mickelson still couldn't shake it. He and his family left for a vacation in Hawaii, where Mickelson's aches and pains became so excruciating that he could barely get out of bed, never mind swing a golf club. "I got really scared," said Mickelson. "I started wondering what it was, and if it was even treatable." Mickelson immediately went to see a rheumatologist, who diagnosed him with psoriatic arthritis, a chronic, inflammatory arthritis caused by an overactive immune system. Symptoms and signs include stiffness, pain and swelling of joints, reduced physical function and reduced quality of life. While athletic injuries can predispose people to early osteoarthritis, a degenerative disease of cartilage, there is no study that suggests sports predispose people to psoriatic arthritis, which usually hits those in their 30s and 40s. Up to 30 percent of people who have psoriatic arthritis have had psoriasis, a common skin disease that causes itchy, dry red patches topped with silvery scales on Mickelson said that he had psoriasis about eight years ago, and a dermatologist had treated him for it. After diagnosis, doctors put Mickelson on an individualized treatment program right away. Today, the golfer, who has won four major championships and 38 PGA titles, is back to his practice regimens and workouts. 'On Course With Phil' And on Wednesday, Mickelson launched 'On Course With Phil,' created in collaboration with Amgen and Pfizer, and the Joint Smart Coalition, which includes the Arthritis Foundation and the National Psoriasis Foundation. The program is meant to educate peopl about chronic inflammatory conditions and encourage people to get checked if they have any symptoms. Early Diagnosis is Key "This is meant to give people who have similar symptoms the tools and resources that will help them get questions of their own answered," said Mickelson. "I was so lucky, because I got on it right away, so I was able to slow or stop any further damage." "It's important to get diagnosed early to slow or prevent long-term damage," said Dr. Christopher Ritchlin, a professor of medicine at the University of Rochester School of Medicine, who serves as a consultant to "On the Course With Phil."

Mickelson and Ritchlin stressed that there are thousands of people who go untreated for the debilitating disease they lack information information. "The severity of the disease and the pace of joint damage are variable, but it is usually progressive," said Dr. Beth Jonas, an assistant professor of rheumatology, allergy and immunology at University of North Carolina at Chapel Hill. "Once joint damage occurs, it is irreversible, so it does not make any sense to wait until things get really bad to seek medical help. If the disease is treated early, damage can be limited or even avoided in some cases." "Psoriatic arthritis is a very variable disease. It tends to involve just a few joints and can wax and wane over time," said Dr. Nortin Hadler, a professor of medicine and microbiology and immunology at Chapel Hill. "Hence, the fashion in which it interferes with function is very individualized." New and Effective Treatments Ritchlin said that treatments for psoriatic arthritis have greatly improved in the last decade. There are now several ways to manage the illness. "We're really stressing this early intervention in order to talk about the effective treatments," said Ritchlin. "Twenty years ago, I couldn't have told you that. There are a lot of variables that go into treatment, but there are a lot of options."

Variety of Treatments
The variety of psoriatic arthritis treatments include nonsteroidal inflammatory drugs, oral system therapies and biologic agents, which act closer to the cause of the disease. "If you have a joint that is painful or swollen you may be considerably limited in your ability to use or stress that joint," said Jonas. "However, since we now have very effective therapies, it is conceivable that people with psoriatic arthritis can participate fully in exercise and athletics and even have a career in competitive sports. Most people whose disease is well-managed can exercise, although some patients remain limited." Dr. Joan Von Feldt, a professor of medicine at University of Pennsylvania, said that Mickelson's early diagnosis was key to his ability to get back to golf. "The medicines are so powerful nowadays that Mr. Mickelson should expect to go back to his normal superstar career, with the help of his rheumatologist," said Von Feldt. "I've always been a fan of Phil Mickelson, and so I was thrilled that he would use his misfortune and turn it into an opportunity to help others." And now, because Mickelson took advantage of those medical breakthroughs, he's back on the green. "I feel much better, and I'm able to do everything that I'm able to do what I can do what I can do," he said. "I'm back to my practice schedule and really excited for the season."