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Introduction to Psoriatic Arthritis

Posted Aug 24 2008 1:49pm
ANNOUNCER: Four in a half million adults in the United States have been diagnosed with psoriasis.

DAFNA GLADMAN, MD: Psoriasis is an inflammatory skin condition that presents with red elevated scaly patches that can occur in the scalp, on the elbows and the knees most commonly, but may affect any part of the body. It also presents with changes in the nails, which can be a breakdown of the nails or just pits, as if somebody has taken a pin and made holes in the nail.

ANNOUNCER: Up to 30 percent of people with psoriasis will also develop psoriatic arthritis.

PHILIP MEASE, MD: Psoriatic arthritis is actually a disease in which immune cells in the body attack joints and cause inflammation and sometimes destruction of the joints. It also attacks the tissues around the joints. So ligaments and tendons can be stiff and painful.

Most often, we see psoriatic arthritis developing in someone in their late 30s, 40s or 50s. Occasionally it can occur in children. Sometimes people will have psoriasis for ten years and then develop psoriatic arthritis.

ANNOUNCER: Psoriatic arthritis affects men and women equally. Symptoms can vary from person to person.

BRUCE STROBER, MD: People wake up in the morning often feeling like their joints are exceedingly stiff. In the more severe types of arthritis that joint stiffness can last anywhere from 30 minutes to three hours. But what they'll notice is that as the morning moves on their joints their ligaments grow less stiff.

ANNOUNCER: Inflammation of ligaments and tendons is also a common feature. Symptoms can be erratic.

PHILIP MEASE, MD: A person may go for periods of time where the problem is not too great. They can do their things as they normally would. But other times, it can hit them hard, and they just can't do normal functions because of the pain.

ANNOUNCER: Psoriatic arthritis can involve virtually any joint, but most commonly it affects the extremeties or the spine.

BRUCE STROBER, MD: That could be a finger, it could be a toe, it could be the ankle, knee. It doesn't have to be lots of toes or fingers; it could be one. It could be just one of your ankles. It could be just your lower back or the spine. It could be the neck.

ANNOUNCER: There is no specific test for diagnosising psoriatic arthritis.

BRUCE STROBER, MD: And it requires the clinician, either the rheumatologist or the dermatologist, to put together many different pieces of a puzzle and arrive at the diagnosis correctly.

DAFNA GLADMAN, MD: A person has to have either psoriasis presently or a history of psoriasis or at least a family history of psoriasis in a first degree relative. In addition, there are several clinical features that are typical. So for example, about the half the patients with psoriatic arthritis have inflammation of the whole digit. It looks like a sausage digit. Medically we call it dactylitis.

ANNOUNCER: Psoriatic arthritis can mimic the symptoms of other forms of arthritis like rheumatoid arthritis, gout, and Reiter's syndrome which can complicate the diagnosis.

Tests may help rule out other conditions. These tests may include x-rays, a joint fluid test and an erythrocyte sedimentaton rate, a blood test to check for imflammation.

Additionally, patients' blood may be tested for rheumatoid factor. This antibody is usually present in people wth rheumatoid arthritis, but only rarely in people with psoriatic arthritis.

The treatment of psoriatic arthritis can vary.

PHILIP MEASE, MD: If the disease is very mild, not very severe joint disease, not very severe skin disease, then we may end up treating just with anti-inflammatory medicines, even medicines such as ibuprofen or over the counter Aleve can be helpful. For the skin, we may end up using topical steroid cream or topical vitamin D ointment, or sometimes light therapy.

Once we start to treat someone with more severe manifestations in either the joint or the skin, then we need to go to systemic therapies. There are some oral medications that have names like methotrexate, cyclosporine, sulfasalazine for the joints, etc., that can be helpful for the manifestations of the both the joints and the skin.

ANNOUNCER: Patients with severe psoriatic arthritis may be treated with biologic agents that inhibit inflammation.

BRUCE STROBER, MD: There are currently three FDA approved medications that are of that class. The first one that was approved is called etanercept; the trade name is Enbrel. And the second one that was approved for that condition, psoriatic arthritis, was called infliximab, or Remicade. And the third and most recent approval came for the medication adalimumab, also known as Humira.

ANNOUNCER: There are also new agents being tested in clinical trials.

BRUCE STROBER, MD: And I always say this to my patients, it's better to be a person with psoriasis and psoriatic arthritis in 2006 than it is in 1996. And it'll even be better in 2016, because there will only be more options.

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