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Psoriatic Arthritis

By Carine Nadel

There a many forms of arthritis, the most common and  prevalent are Osteo and Rheumatoid.  While Osteo is strictly in the joints, rheumatoid is an autoimmune disorder along with the joint disease.  There is another form that is very much on the top of the list of arthritis sufferers-Psoriatic.  

Psoriatic Arthritis is an inflammatory joint disease in combination with psoriasis, a chronic skin disease.  Psoriasis itself is displayed by showing up as itchy patches of skin that have a red base and a silvery scale on top.  It mainly hits the elbows, knees and scalp-but don't let that fool you!  Psoriasis can hit anywhere on the body.

Nail involvement is the only clinical feature that identifies patients with psoriasis who are most like to develop arthritis as well.  The nails become pitted, ridged and cracked and may even separate from the nail bed itself.  If the arthritis does develop it's usually within 10 years after the initial skin outbreak.  Between 5–23% of those afflicted with psoriasis will eventually develop into full blown psoriatic arthritis.

Men and women are equally likely to develop the disease.  White people are more inclined than African or Asians.  For the most part-all ages can be afflicted, but the largest incidences are between 30–55 years of age.

Usually, as soon as a general practitioner or dermatologist suspects a patient having this form of arthritis, they send them to a rheumatologist-a special in the field of arthritis and related inflammatory diseases.  Finding one that is able to work together with the patient to control the pain,  and skin outbreaks is essential to successful treatment.

There are many forms of treatment, depending on whether the rheumatologist decides if the patient has a mild, moderate or severe case.  If it is mild and joint problems aren't prevalent, the treatment is to keep the skin moisturized with creams, mild moisturizing soaps, humidifying the home, using bath oils and products with coal tar (if the doctor recommends their use).  For more pronounced lesions, moisturizing creams with steroids may be prescribed, as well as other topical medications that may contain salicylic acids and retinoids.

Many treatments will include sitting in the sun for a little while each day, but certainly not long enough to get sunburn.  PUVA treatment, a prescribed light therapy in which you apply psoralen (a medication) to the skin and then sit in ultraviolet A light.  Ultraviolet B light therapy, where you sit in front of an Ultraviolet B light box.

There are also a host of oral medications ranging from anti-inflammatories, steroids and disease modifying drugs-such as methotraxate and planquenil for those who have already begun to suffer from joint pain and swelling.  Many times these drugs are used in combinations, if the patient doesn't respond to single doses.

In more severe cases, tumor necrosis factor inhibitors-such as self-injected  drugs like Enbrel improve both joint pain and skin flares will be used.

As with other forms of arthritis, exercise will improve stiffness and pain.  Resting and getting an adequate amount of sleep will decrease fatigue and make the inflammation easier to live with.  Heat and cold treatments have been known to give relief as well.

The most important factor for patients with psoriatic arthritis is to get diagnosed, find the right doctor, decide and then implement the plan of action to get them back into living the full and productive life they want to lead.

Carine Nadel is a contributing writer for ““

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