Posts Tagged ‘psoriatic’
Thursday, May 28th, 2009
The exact cause of ankylosing spondylitis (AS) remains unknown. However, genetics may be a factor, because a gene called HLA-B27 occurs in more than 90 percent of patients with the disease, according to the Arthritis Foundation. However, not everybody with HLA-B27 develops ankylosing spondylitis. People with HLA-B27 who have no relative with AS have only a 2 percent chance of developing the disease, whereas people with the gene who do have a parent or sibling with AS have a 20 percent chance of developing AS.
In 2007 two other gene variants were linked to AS: IL23R and ARTS1. People who have both of these and HLA-B27 may have a 25 percent chance of developing AS.
AS is believed to be an autoimmune disease, meaning that the patient’s immune system is hyperactive and mistakenly attacks the body’s own tissues. Other examples of autoimmune diseases include rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease.
AS primarily affects boys and men between the ages of 16 and 35. It is less common in women, although it may develop during pregnancy. It is also normally less severe in women, making it harder to diagnose. AS is more common in American Indians than in other racial and ethnic groups, according to the American College of Rheumatology.
About 5 percent of cases develop in children. AS is more likely to appear in boys than girls. Symptoms in children usually begin in the hips, knees, heels or big toes before progressing to the spine.
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Wednesday, May 27th, 2009
Ankylosing spondylitis (AS) is type of chronic arthritis that primarily affects the spine. The joints between the vertebrae of the spine and ligaments that allow the back to move become inflamed, sometimes leading to the joints and bones fusing together. This inflammation often leads to stiffness of the back and hips.
The name of the disease describes its destructive nature. “Ankylosing” means stiff or rigid, “spondyl” refers to the spine, and “itis” means inflammation. AS belongs to a family of diseases known as spondylarthropathies that attack the spine. These diseases include psoriatic arthritis, Reiter’s syndrome (a form of reactive arthritis, sparked by infection) and enteropathic arthritis (arthritis related to digestive disorders such as inflammatory bowel disease or celiac disease).
While AS progresses, it can also cause inflammation of other organs in the body, including the eyes, lungs and heart valves. Anemia (reduced number of red blood cells) is also associated with the chronic inflammation of ankylosing spondylitis.
The impact of AS varies widely from individual to individual. Some patients experience episodes of back pain that come and go, whereas others have chronic symptoms that worsen and cause severe joint and back stiffness, loss of motion and deformity.
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Thursday, May 14th, 2009
Disease-modifying antirheumatic drugs (DMARDs) may be used independently or in combination with other drugs to treat various diseases, including:
* Rheumatoid arthritis (RA). A chronic, inflammatory disease that causes the body’s immune system to attack the joints. This is by far the most common disease treated with DMARDs.
* Psoriatic arthritis. A form of arthritis that develops in some people with the skin disease psoriasis.
* Felty’s syndrome. Associated with RA. Felty’s syndrome occurs when a person with RA also has an enlarged spleen (splenomegaly) and an unusually low white blood cell count.
* Palindromic rheumatism. Intermittent episodes of arthritis. Individuals with this rare disease have repeated arthritic attacks but without producing irreversible changes in the joints.
* Ankylosing spondylitis. A rare, painful form of arthritis that affects the spine, causing bones to grow together. DMARDs may be prescribed to treat Anatomy of the spine includes the cervical spine, thoracic spine, lumbar spine and sacral region.pain and inflammation.
* Scleroderma. A rare disease that causes hardening and tightening of skin and connective tissues. DMARDs may be used to treat symptoms of scleroderma, such as joint pain or stiffness, curling and pain or numbness in fingers.
* Systemic lupus erythematosus. A chronic autoimmune disorder in which natural antibodies attack several systems of the body. DMARDs may help treat and alleviate pain and inflammation from attacks of lupus. DMARDs can also address the kidney damage that can result from lupus or other conditions.
* Colitis. Inflammation of the colon with symptoms that include abdominal pain and cramps. DMARDs may help treat this condition.
* Cancer pain. DMARDs can help treat and alleviate pain associated with some cancers, including leukemia and lymphoma. And the primary use of some DMARDs is to fight the cancer itself.
As immunosuppressants, DMARDs are also used to prevent rejection of transplanted organs.
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Monday, May 11th, 2009
Disease-modifying antirheumatic drugs (DMARDs) decrease or stop joint damage caused by Lupus is a chronic autoimmune disease that can cause joint pain and inflammation (arthritis). Conditions including rheumatoid arthritis (RA), lupus, psoriatic arthritis and ankylosing spondylitis. DMARDs reduce swelling and pain, slowing or sometimes stopping the progression of the condition being treated.
Some DMARDs are used mainly to treat cancer or prevent rejection of an organ transplant.
Exactly how DMARDs work is not completely understood, but they appear to help suppress the immune system. RA, the condition for which DMARDs are most often prescribed, is an autoimmune disease, in which the body mistakenly attacks its own tissues. This causes joint inflammation that can cause irreparable damage.
Many physicians prescribe DMARDs early in the diagnosis of RA. Research has shown that DMARDs can prevent or delay damage to joints. However, they have some potentially serious side effects, such as headache, cold or flu-like symptoms and stomach pain. Patients who have been prescribed DMARDs are monitored regularly by a physician.
DMARDs do not provide immediate relief and may take months to be effective. Treatments may involve multiple DMARDs or a combination of DMARDs and other medicines, such as NSAIDs (nonsteroidal anti-inflammatory drugs). As a result, numerous drug combinations involving DMARDs are possible.
They are usually taken by mouth but can also be injected, usually in the physician’s office or in a hospital. DMARDs are available only by prescription.
Some medical conditions (e.g., alcoholism) make the use of DMARDs less effective or even dangerous, depending on the medication being used and the condition itself. Pregnant or breastfeeding women are generally discouraged from taking DMARDs in most circumstances. Children can take DMARDs for certain conditions, such as juvenile rheumatoid arthritis, but are monitored closely for side effects.
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Wednesday, April 29th, 2009
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about psoriatic arthritis (PA):
1. What tests are needed to determine whether I have PA?
2. What do these tests involve?
3. How does PA differ from other forms of arthritis I might experience?
4. What causes this disease?
5. Is PA likely to run in my family?
6. My psoriasis and arthritis rarely flare up at the same time. Is this normal?
7. What are my treatment options?
8. Which treatments do you recommend for me?
9. What side effects can I expect from medications used to treat my PA?
10. Is there a cure for my PA?
11. Can PA affect my children?
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Monday, April 27th, 2009
There is no sure way to prevent psoriatic arthritis (PA). However, people can take several steps that may lessen the likelihood of experiencing progression or flare-ups associated with arthritis and psoriasis.
Such steps include:
* Eat a healthy diet. To date, no specific food or nutrient has been proven to prevent or control arthritis. However, it is known that antioxidants, such as vitamins C, E and A, prevent cell damage that may contribute to arthritis. Diets high in olive oil and vegetables have been linked to reduced risk of rheumatoid arthritis, and the mineral selenium has been linked to reduced risk of osteoarthritis. Scientists have not conclusively linked any foods to arthritis flare-ups. Nonetheless, patients should exclude foods from their diets that appear to make symptoms worse.
* Maintain a healthy weight. A healthy weight places less strain on joints, leading to reduced pain and increased energy and mobility.
* Exercise regularly. In some patients, exercise alone can help relieve many of the symptoms of arthritic conditions such as pain and fatigue.
* Use cold and hot packs. Cold has a numbing effect and can dull the sensation of pain, whereas heat can relax tense muscles and relieve pain.
* Experiment with relaxation techniques. Stress can worsen symptoms associated with PA. Patients should try to reduce stress and increase relaxation through various techniques, such as meditation or prayer, yoga, tai chi, deep breathing, biofeedback, self-hypnosis, visualization or guided imagery.
* Use proper body mechanics. Individuals should observe good posture and ergonomics and avoid straining areas vulnerable to arthritis, such as finger joints.
* Care for skin. Daily bathing can help remove psoriasis scales. Use of hot water and harsh soaps should be avoided, and patients should pat themselves dry after a shower or bath and apply a moisturizing cream (without alcohol) while skin is still damp. Humidifiers can help keep inside air moist.
* Expose skin to moderate sunlight. Sunlight slows down cell growth, helping improve psoriasis. However, patients should remember that too much sunlight can damage the skin and cause skin cancer.
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Sunday, April 26th, 2009
Treatment of psoriatic arthritis (PA) can involve medication, patient education, physical therapy and occupational therapy. A physician is likely to prescribe a combination of medications. Some of these medications are designed to treat arthritis, others to treat psoriasis.
Medications used to treat PA include:
* Nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen and naproxen, which can help control pain, swelling and morning stiffness. NSAIDs are available in over-the-counter and in prescription formulations such as COX-2 inhibitors. In some patients, NSAIDs may cause stomach upset. They generally do not help psoriasis, and some may even make skin problems worse.
* Disease-modifying antirheumatic drugs (DMARDs). Reduce pain and inflammation while also helping to limit the amount of joint damage that occurs in PA. These drugs act slowly, and their effects may not be noticed for weeks or even months.
Gold salts, a class of DMARDs, are sometimes used to treat PA but less frequently than in the past. This is because they may make psoriasis worse in some people and can damage the kidneys and bone marrow.
- Corticosteroids. Medications that reduce inflammation and slow joint damage. Injection of corticosteroids directly into the joint can be useful for treatment of a few joints. However, corticosteroids usually are not recommended for long-term treatment of PA, because long-term use can make them less effective and cause serious side effectsOsteoporosis involves the bones becoming thin, brittle and more prone to fracture, causing pain., including easy bruising, thinning bones (osteoporosis), cataracts, glaucoma, diabetes, high blood pressure and a decrease in resistance to infection. In addition, some patients who stop therapy aggravate skin symptoms and even trigger pustular psoriasis, a severe form of the disease.
- Other immunosuppressants. Suppress the immune system, which mistakenly attacks healthy tissue in people with PA. Immunosuppressants include biological response modifiers (BRMs) such as tumor necrosis factor (TNF) inhibitors. TNF inhibitors block an immune system protein called tumor necrosis factor. This protein acts as an inflammatory agent in some types of arthritis. TNF blockers may slow structural damage to joints caused by PA. Side effects of immunosuppressives include increased risk of serious infections such as tuberculosis.
- Retinoids. Synthetic derivatives of vitamin A that may be prescribed for psoriasis or PA.
- Antimalarial drugs. Sometimes used to treat arthritis, but may cause flare-ups of psoriasis in people with PA.
Arthritis also may be treated with physical therapy, exercise therapy and occupational therapy, as well as treatments such as thermotherapy, massage therapy and transcutaneous electrical nerve stimulation (TENS), a form of electrical therapy.
Medications that may be used to treat mild forms of psoriasis include the following creams and ointments:
* Coal tar. Likely the oldest treatment for psoriasis, it is a thick, black byproduct of the manufacture of gas and coke. Exactly how it works is not known, but it is effective for all forms of the disease except the severe generalized pustular types.
* Anthralin. Normalizes DNA activity in skin cells and reduces inflammation. However, it can also irritate healthy skin and stain skin, clothing and bedding.
* Vitamin D analogues. Synthetic forms of vitamin D that reduce skin inflammation and help prevent skin cells from proliferating.
* Regular moisturizing creams. These can prevent skin dryness that accompanies many forms of psoriasis therapy.
Oral medications may be used to slow cell growth and suppress the immune system. In addition, psoriasis may be treated with phototherapy. This uses natural or artificial light to suppress the growth of skin cells. It is usually reserved for severe psoriasis, as it may increase the long–term risk of skin cancer.
Arthroscopy and synovectomy (removal of a joint’s synovial membrane) have been effective in some patients with synovial or cartilage damage. In rare cases, joint replacement surgery (arthroplasty), typically involving the hip, knee or hand, may be performed if PA has significantly impaired joint functioning. However, few studies have been performed on the long-term outcomes. The chance that surgery becomes necessary appears to depend on how long a patient has the disease.
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Saturday, April 25th, 2009
Psoriatic arthritis (PA) can be difficult to diagnose because in adults, psoriasis and arthritis rarely occur at the same time. In addition, PA also mimics other conditions, such as:
* Rheumatoid arthritis (RA). Occurs when an autoimmune response causes inflammation in the lining of the joints, especially those in the hands and feet.
* Gout. Arthritis characterized by sudden, severe attacks of pain, redness and tenderness in a single joint, usually at the base of the big toe.
* Reiter’s syndrome. Form of reactive arthritis that inflames the joints, eyes, genitals, and urinary or digestive tract.
* Infection. An infection of the joint can mimic arthritis as it causes a red, swollen and inflamed joint. Psoriasis patients can have an episode of infectious joint without any evidence of arthritis related to the psoriasis.
In attempting to diagnose PA, a physician will review the patient’s medical history and perform a physical examination.
Additional tests that may be used to diagnose PA include:
* X-rays. Can reveal changes in the joints that occur in PA. In severe disease, the distal interphalangeal (DIP) joints of the fingers or toes give a distinctive “pencil-in–cup” appearance on an x-ray.
* Arthrocentesis. A small sample of fluid is removed from a joint, typically in the knee, for laboratory analysis. A physician can use this test to rule out gout, which is indicated by the presence of uric acid crystals.
* Erythrocyte sedimentation rate (ESR). Blood test that checks ESR, or “sed rate,” by measuring how far from the top of a glass tube red blood cells (erythrocytes) fall in a given time. Generally, blood cells fall when inflammation is present. However, this test alone cannot confirm the presence of PA as inflammation can be caused by many factors.
* Rheumatoid factor (RF) test. Lupus is a chronic autoimmune disease that can cause joint pain and inflammation (arthritis). RF is an antibody (protein made by the immune system) present in the blood of people with RA, lupus or certain other diseases. This test can help determine if a patient’s symptoms are due to PA or another condition.
* Skin biopsy. This may be needed to rule out other conditions, such as fungal infection.
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Friday, April 24th, 2009
Most people with psoriatic arthritis (PA) develop psoriasis long before arthritic symptoms appear. In addition, there are rare cases in which joint pain may occur – sometimes for as long as decades – before skin symptoms appear. As a result, people are usually diagnosed with either psoriasis or arthritis before they are eventually diagnosed with PA, the combination of these disorders. It can be very difficult to diagnose PA without skin symptoms.
Patients are diagnosed with PA if they display the following symptoms related to each condition:
* Patches of thick, red skin covered with silvery or gray scales. These most often appear on the elbows, knees, scalp or the lower end of the spine. These patches, known as plaques, often itch or burn. Skin at the joints may crack.
* Pain, redness, swelling and reduced motion in the joints. About 95 percent of patients with PA experience swelling in joints outside the Anatomy of the spine includes the cervical spine, thoracic spine, lumbar spine and sacral region.spine, according to the Arthritis Foundation (AF). Joints most often affected include the small joints at the ends of fingers and toes, giving them a “sausage” appearance. Joints in the spine and sacroiliac joints (two large joints connecting the pelvis and the triangular bone at the end of the spine) may also be affected.
* Morning stiffness (often lasting more than 30 minutes) and fatigue. Physical activity usually helps alleviate stiffness.
* Pitted, discolored nails. About 80 percent of patients with PA have nail lesions, according to the AF. Nails in these patients often separate from the nail beds.
* Pain in the lower back or buttocks.
* Inflammatory eye conditions and eye pain. These include conjunctivitis or iritis. About 10 percent to 20 percent of children diagnosed with juvenile PA will experience inflammation of the eye, according to the AF.
Symptoms of PA often go through cycles where they improve or worsen. It is not unusual to experience outbreaks of psoriasis when joint pain goes into remission, and vice versa.
Juvenile PA is a condition that affects children (most often girls), who usually develop symptoms of the disease around age 9 or 10. Symptoms are usually mild, although they can be severe and debilitating and last into adulthood. Although children typically display symptoms similar to those of adults, they are more likely to develop skin and joint problems simultaneously. In other cases, arthritis may appear in the child before psoriasis. Because their bones are still growing, children with PA are at risk for abnormal bone development that can affect growth.
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Thursday, April 23rd, 2009
Psoriatic arthritis (PA) can develop only in people who have psoriasis, a common skin disease. PA is more common in patients whose nails are affected by psoriasis. Both diseases are autoimmune disorders, which occur when a person’s immune system is hyperactive and mistakenly attacks the body’s own tissues.
This abnormal response in psoriasis patients causes excessive production of skin cells, which build up as rough and dry dead skin cells that become thick scales. PA develops in about 15 percent of psoriasis patients, with the joint inflammation caused by the immune system’s overreaction to the skin disease, according to the American College of Rheumatology.
People who have a parent or sibling with PA are at greater risk of developing the disease. Researchers have found gene mutations that appear to be associated with PA. In some cases, fungal, viral or bacterial infection or physical trauma may trigger PA in people who have a genetic predisposition to the disease. Factors that may contribute to PA include:
* Skin injuries
* Reactions to medications or vaccines
* Infections, especially streptococcal (strep) infections
* Stress
* Alcohol and poor nutrition
* Overexposure to the sun
* Prolonged exposure to irritating chemicals such as disinfectants and paint thinners
Factors that increase the risk of developing PA include:
* Heredity. About half of the people with PA have a close relative who has the disease.
* Age. PA most commonly affects adults between the ages of 30 and 50.
* Race. Caucasians are most likely to develop PA.
* Sex. PA tends to affect men and women equally, although certain forms of the disease are more likely to affect men (DIP and spondylitis) or women (symmetric arthritis).
* Human immunodeficiency virus (HIV) infection. PA occurs more often in patients who are HIV-positive. In addition, HIV infection may exacerbate cases of psoriasis.
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