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

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There are many treatment products adult acne treatment dermatologists available today. However, they can be divided into 4 types: topical antibiotics, topical retinoids, oral antibiotics and oral contraceptives.

The first type of prescription acne treatments is topical antibiotics. Clindamycin and erythromycin are the most widely used and are usually used in mild to severe acne cases. They help to minimize and eliminate the papules and pustules by attacking directly the P.acnes bacteria and its inflammatory effects. They have been proven safe and are well tolerated. Their only possible side effects are dry and/or irritated skin. To avoid those side effects, one should use them only as directed. This is also an important step to avoid the risk of developing bacterial resistance.

The second type of prescription acne treatment is topical retinoids, a derivative of vitamin A. One example of topical retinoids is tretinoin. Like topical antibiotics, topical retinoids are also used in mild to severe acne cases. They prevent the dead skin cells from clogging the pores, thus reducing the acne breakouts. By unclogging the pores, they are also allowing other topical medications such as antibiotics to enter the hair shaft and fight the acne. However, they are two possible side effects of these topical retinoids. They are skin irritation and increased skin sensitivity. To avoid them, use sun protection and follow your doctor?s advice.

The third type of prescription acne treatments is oral antibiotics. Similar to topical antibiotics, oral antibiotics fight and reduce the P.acnes bacteria, thus decreasing the inflammation. Like all acne medications, they are to be used only as directed. This step is vital to lower the risk of bacterial resistance to all antibiotics.

The fourth type of prescription acne treatments are oral contraceptives. They have been used effectively to treat many women. The good news is they can be used long term, unlike antibiotics. They fight the acne by suppressing the overactive sebaceous glands which are responsible for the oily skin secretions, thus preventing clogged pores. However, there are some potential health risks associated with oral contraceptives such as blood clots, stroke and heart attacks.

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