My Dermatologist Told Me to See An Arthritis Doctor... I Have Psoriasis and My Joints Hurt

Psoriatic arthritis is a distinct disease, different from rheumatoid arthritis and ankylosing spondylitis- another common type of arthritis- but sharing similar features to each. The disability and functional impairment in psoriatic arthritis can be as severe as that occurring from rheumatoid arthritis.

Typically, a patient will have had psoriasis for a number of years before the arthritis develops. A small proportion of patient will develop the arthritis concurrently with the skin disease and an even smaller percentage will develop the skin disease after the joint disease.

Psoriatic arthritis may affect most joints in an oligoarticular pattern, meaning a few scattered joints are affected and the joint inflammation does not have the symmetrical pattern seen in rheumatoid arthritis. Enthesitis, which is inflammation of the tendons that attach to bone, is common in psoriatic arthritis. “Sausage digits” – swelling of the fingers and toes so that they look like little sausages is frequent. Nail changes are also common. These include "pitting" and separation of the nail from the nailbed. Some patients will develop carpal tunnel syndrome because of inflammation in the wrist. Inflammation of the eyes is a serious complication, as is involvement of the aortic valve of the heart.

Joint deformity is frequent and affects 40% of patients with the disease. Psoriatic arthritis has a significant impact on quality of life. The skin disease is a tremendous burden and often leads to depression.

The inflammatory process that causes both the skin disease as well as the joint disease is driven by elevated levels of a substance called tumor necrosis factor, or TNF.

A patient with psoriasis who complains of joint pain, swelling, morning stiffness, and fatigue should raise a high level of suspicion for the diagnosis of psoriatic arthritis.

Laboratory testing will show evidence of inflammation and imaging procedures such as magnetic resonance imaging (MRI) can help confirm the diagnosis.

Treatments that improve the skin disease do not necessarily improve joint symptoms and vice versa.

Treatment goals include symptomatic relief and control of disease progression.

Non-steroidal anti-inflammatory drugs are helpful for relieving some symptoms. However the majority of patients with psoriatic arthritis will require a combination of methotrexate and anti-TNF biologic therapy. Anti-TNF therapies have provided a significant advance in the treatment of both the skin as well the joint disease in patients with psoriatic arthritis.

Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: Types of Arthritis

Dermatologist Shortage?

It seems the demand for good dermatologists has increased dramatically over the past decade or so. It's no wonder, with all the new skin care products and procedures that have burst onto the skin care scene in the past twenty years.

These new skin care procedures and products range in appeal to ages for their effectiveness on everything from eczema and acne to facial firming and wrinkle removal.

This explosion in skin care technology has resulted in a related increase in demand for skin care professionals - AKA dermatologists, and there are currently not enough dermatologists in some major metropolitan areas to fulfill these demands.

What does this mean for patients? Apparently months-long waiting times for appointments, and the occasional turn-away for preferred providers who cannot accept new patients or have such long waiting periods that patients are forced to go elsewhere. So what does this mean if you have an urgent skin emergency?

Will you be bumped out of the way in favor of a patient who is solely having a cosmetic enhancement procedure performed?

According to some new surveys recently released, most practices do have some sort of backup system in place or alternative scheduling for those with urgent needs, and if they don't, the patient needs to stress their concern over say a spot on their body that appears to be cancerous or may be a worriesome irritation or rash of some sort.

I myself was put on a three month wait to get in to see one particular dermatologist who practices in a fairly metropolitan area near me. She was on my list of preferred providers for my health insurance, and I was referred to see her for a birthmark my primary care physician wanted checked out and have removed as a precautionary measure against cancer.

Since there was no imminent threat though, and it was strictly precautionary, I was pushed to the back of the line. This particular dermatologist, I noticed, had advertisements for various cosmetic procedures in the office, and I couldn't help but wonder how many of them had gotten in ahead of me.

To be fair though, my situation was not an emergency, and I'm sure if it were, they would have worked around their other appointments that were less urgent. However, this may not be the case with every practice, and the patient should be fairly forceful if they feel they need to see the doctor right away.

The shortage of dermatologists may resolve itself. Heck, it looks like it's a growing profession that many might be stepping into for areas of opportunity, so that may actually help the situation.

The fact still stands though, that with the ever changing world of dermatology and more and more demand for anti aging skin care, dermatologists will be a hot in-demand professional for years and years to come, and we may be fighting those wait lists for longer than we think!

Danna Schneider is the founder of two skin care and beauty online magazines with the latest cosmetic and beauty news, tips, "Skin Science", and top shelf products in skin and acne care : Acnezine reviews and Wrinkle cream and skin care reviews.

Dermatologist: The Most Qualified Physician for Skin Problems

The skin is the largest and most visible organ of the body. It reflects the health of the body and acts as a barrier against injury and bacteria. Sadly, at one time or another, nearly everyone has some type of skin disease that only a skin doctor can absolutely give the scientific explanation for those skin problems. Dermatologist is a medical doctor specializing on the study of the skin, diseases of the skin and the relationship of cutaneous lesions to systemic disease. Dermatologist is a medical doctor trained to usually combine several activities like seeing patients in public hospitals and/or in private practices, acting as consultants to other specialists, teaching and delving into clinical or basic research.

The dermatologist must have expertise in basic sciences including pathology, biochemistry, physics, physiology, microbiology and endocrinology. Because skin diseases are often associated with internal conditions, dermatologist must also be familiar with all the other medical specialties because of their consultant work. Dermatologist likewise perform skin surgery in several situations like preventing or providing early control of disease such as skin cancer; improve skins appearance by removing growths, discolorations or damage caused by ageing; and to establish a definite diagnosis.

There are several responsibilities that dermatologist has including examining patients, performing biopsies and other diagnostic techniques of dermatology, interpreting test results and evaluating examination findings before prescribing treatments, including x-ray therapy, physical therapy and medication. Dermatological services are as well managed by dermatologist like formulating plans and procedures for dermatological services, scheduling operation of diagnostic and treatment facilities, and assigning nurses, physical therapists, x-ray therapists and other medical technicians. The dermatologist advises on the types and quantity of dermatological supplies and equipment, coordinate dermatological services with other medical activities.

There are however several types of health care providers who can take care of your skin conditions aside from dermatologist. The first thing that you need to know about picking a skin specialist is the probability that you are really badly in need to see a specialist as sometimes your condition may not need the specialist. Therefore, it is important that you know when you really need to see a dermatologist. Some conditions are exclusively treated by a dermatologist especially with severe forms of common diseases such as acne, rosacea and atopic dermatitis. Most skin cancers are treated by dermatologist, sometimes in conjunction with a surgeon. There is also the dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the bodys immune system.

Getting a referral from your physician is a great help and of high importance in finding the right dermatologist who will be working with you. It is important that you are assured that the dermatologist has the right credentials for the medical procedure(s) that your skin demands. You may have to do some preliminary check that will enable you to be prepared and educated prior to your consultation. Such steps are critical as it will help you achieve a successful outcome. You have to have a give-and-take dialogue assuring that you and your dermatologist have the same vision of what you want the end result to be as well as your expectations are realistic. The communication between you and the skin doctor is of most importance as you are considering things about your skin or associated problems.

Michael Sanford

For more infoormation on acne skin care please visit http://www.no-more-acne.org