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When most people hear the word “arthritis,” they think of a single disease that mostly affects older people. So it would probably surprise them to know that arthritis does not just describe one single problem, but over 100 different conditions affecting the joints. This can be any type of rheumatologic diseases that causes joint inflammation. While it is usually associated with aging, there are several forms that affect younger people, and can be just as devastating – if not more so.
One of these lesser-known forms of arthritis is actually associated with the skin condition, psoriasis. Known as psoriatic arthritis, it was only identified as a separate form of the disease some three decades ago.
Psoriasis itself is a skin condition in which skin cells multiply far beyond their normal rate, usually on the knees, elbows, and scalp, but also on ankles, toes, knuckles, and other parts of the body. As this occurs, large white patches of raised skin appear in these locations. While the appearance of these patches can be alarming, they are also not, in and of themselves, dangerous. While there is no cure for the condition, the skin can often be treated with creams or drugs, causing the patches to temporarily disappear. In some cases they may come back as soon as treatment is stopped – and in fact may become worse once steroid medication is stopped. Laser therapy has also been approved by the Food and Drug Administration for use in treating these patches. In some cases, the patches may disappear from one location and reappear in another – for example, remaining on the right knee for several months and then appearing on the left ankle or knuckles.
The condition is not contagious, but it often runs in families. Environment may also be a factor, but that role has not been determined. It is triggered by the immune system, though the mechanism is not fully understood. The National Psoriasis Foundation (NPF) recently reported that the search for the gene that triggers the disease is ongoing and has narrowed the search to chromosome 6.
Psoriatic arthritis affects at least 10% of those who have psoriasis. Unlike the common view of arthritis, this form commonly attacks people as early as their 20s, and can even begin in childhood. Men and women seem to be equally susceptible. Like psoriasis, it is an auto-immune disease.
The disease is fairly similar to the more commonly-known rheumatoid arthritis, except that people with the former will test negative for the latter. However, diagnosis may be tricky if the psoriasis has not been recognized or other factors are overlooked. Some of these other symptoms would not, at first glance, seem to have any bearing on a disease of the joints. For example, two signs are pitting of the fingernails and inflammation of the eyes.
As with other types of arthritis, symptoms of psoriatic arthritis include joint pain, stiffness, and swelling and the inability to move the affected extremities in the full range of motion. Any of the more than 100 different joints in the human body can be affected, depending on the specific type of psoriatic arthritis that manifests itself. The onset of these symptoms may take several years or can occur suddenly, making it more difficult to properly diagnose. While the patches of psoriasis do, as noted earlier, often appear on the joints, their appearance seems to be unrelated to which joints the arthritis may strike.
Within the category of psoriatic arthritis, there are five different types, which occasionally go by different names. The most common descriptions the following: Symmetric arthritis is almost as bad as rheumatoid arthritis. It is also often associated with the most severe cases of psoriasis. Asymmetric arthritis generally only affects a few joints, and does not affect both sides of the body equally. Distal Interphalangeal Predominant arthritis affects the fingers and toes. Spondylitis primarily affects the spine and neck, but can also extend to the extremities and even ligaments. Arthritis Mutilans is the most destructive type, and also the least common, doing most of its damage to the hands and feet.
Patients may show overlap between these different types, and symptoms may shift throughout the progress of the disease, making it difficult to provide a more specific diagnosis than “psoriatic arthritis.”
Treatment for psoriatic arthritis is similar to that for other forms of the disease. This includes nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen, for example), heat, exercise, and physical therapy. A warm and stable climate may be of some benefit to those who suffer from this condition, but diet has not been found to have any impact. If the disease becomes more severe, it may be necessary to resort to stronger drugs to suppress the immune system or even to surgery.
Newer therapies, still under development, work to target the immune system, which is the origin of the disease. Numerous drugs that may be able to treat psoriasis and psoriatic arthritis are currently in development.
While a family doctor can treat the early stages of this disease, patients whose symptoms worsen should consider seeing a rheumatologist and/or dermatologist for more specialized treatment.
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