Diseases and Conditions When to see a rheumatologist

What is a high CRP? Measuring inflammation

September 18, 2018

What does it mean when your doctor tells you that you have a high CRP? The answer is both simple and yet complex. Simply put, an elevated CRP means that something inside your body is causing inflammation. A CRP, also known as a C-reactive protein, is one many proteins found in the blood referred to as acute phase reactants (APR).

Acute phase reactants

The name is slightly misleading as APRs increase both with acute and chronic inflammation. Acute phase reactants are proteins that increase or decrease by at least 25% during inflammation. That being said, you can have positive or negative APR. CRP is a positive APR, whereas albumin is a negative APR as it tends to decrease with inflammation. It’s also important to note that APR changes are terribly non-specific, occurring in a multiple of situations:

Infection
Trauma
Clots
Systemic autoimmune diseases
Cancer

Basically, anything that can cause inflammation or tissue injury can affect acute phase reactants.

Inflammation

Think of inflammation as a highly complex orchestra. You have your wind instruments, brass, strings, percussion, etc. Together in perfect unison, they can produce a variety of music: melancholic, invigorating, soothing, frantic, etc. Now instead of musical instruments think of inflammation as an orchestra of cell types and molecules initiating, amplifying, attenuating, and abolishing inflammation.

Chronic inflammation often cause the following symptoms:

Fever
Anemia
Weight loss
Fatigue
Muscle loss
Swollen lymph nodes

What does CRP do?

CRP has both proinflammatory and anti-inflammatory effects. It helps recognize and eliminate pathogens and helps clear necrotic tissue and apoptotic cells (i.e., cells that self-destructed). These actions help reduce inflammation.

However, CRP can increase inflammation by activating the complement system and by forcing cells to release inflammatory cytokines. These actions can actually worsen tissue injury depending on the situation.

How is CRP used in a clinical situation?

Broadly speaking, CRP and acute phase reactants in general detect the presence and intensity of an inflammatory process. They do not help us decide what exactly is causing the inflammation, simply that it is there.

There are certain exceptions. For example, an APR called procalcitonin sometimes helps us differentiate infection from autoimmune inflammation or that caused by cancer.

What is a normal CRP level?

We actually don’t really know was normal or clinically benign CRP is. Instead we refer to inflammation as low, moderate, or high-grade inflammation.

What is low-grade inflammation and what causes it?

Low-grade inflammation refers to a situation resulting in a CRP between 0.3 and 1 mg/dL. The following are some situations that can cause low-grade inflammation.

Atherosclerosis
Obesity
Sleep apnea
Diabetes mellitus
High blood pressure
General poor health
Sedentary lifestyle
Unhealthy diets
Social isolation
Stress!!!

Moderate to marked elevation of CRP

These are CRP levels that are greater than 1 mg/dL. What is “moderate” and what is “marked” is a matter up for debate. It really depends on the clinician. Essentially, the higher the level the more inflammatory the situation.

Why does my doctor get a CRP and an ESR?

An erythrocyte sedimentation rate (ESR) or sed rate is another way of measuring inflammation, although in this situation indirectly so. An ESR measures the rate at which red blood cells suspended in plasma settle when place in a vertical tube. Systemic inflammation increases the ESR, but other situations that are not related to inflammation can also influence the level.

Increased ESR

Increased age
Female sex
Anemia
Kidney disease
Obesity (fat cells secrete interleukin-6)
Technical problems (tilting the tube or performing the test in high room temperature)

Decreased ESR

Have abnormal red blood cells (e.g., sickle-cell anemia, polycythemia)
High white blood count (WBC)
Heart failure
Having low levels of fibrinogen
Technical problems (e.g., low room temperature, short ESR tube)

We often get a CRP and an ESR because oftentimes there is a bit of discrepancy between these levels.

Discrepancies between acute phase reactants

This happens actually happens quite frequently. As previously discussed many situations can alter the result of the ESR and to a certain degree also the CRP. These in and of itself, can influence the discrepancy.

Moreover, ESR level change relatively slowly, whereas CRP levels tend to change rapidly. For example, if someone is experiencing a rheumatoid arthritis flare-up, I usually will prescribe prednisone to decrease the inflammation. Before the prednisone both the ESR and CRP will be high. If I were to repeat the test in 3 days, the ESR will most likely still be elevated but the CRP may be low.

There are also some diseases where the discrepancy exists and can help differentiate it from other rheumatic diseases. For example, in macrophage activation syndrome the ESR is famously low and the CRP is strikingly raised.

Summary

A CRP is a type of acute phase reactant seen in both acute and chronic inflammation. Elevations occur in a variety of situations including but not limited to infection, autoimmune conditions, trauma, and malignancy. Rheumatologist often order acute phase reactants to help monitor disease activity. But labs are not perfect. Oftentimes, a rheumatologist will order many acute phase reactants.

References

UpToDate

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Diseases and Conditions

Lupus Nephritis Q&A

August 14, 2018

By Paul Der Mesropian, M.D. Nephrologist

How often does lupus involve the kidneys?

Lupus is an autoimmune, systemic disease that can affect several organs. It affects the kidneys about half the time. Kidney disease is more likely if lupus is active (i.e., there are active inflammatory symptoms or certain blood tests indicating disease activity). However, even patients whose lupus is controlled with medications such as Plaquenil (hydroxychloroquine), are at risk for developing a lupus flare involving the kidneys. It is important to periodically monitor for “lupus nephritis”.

What findings may signal lupus nephritis?

Typically, people with lupus nephritis have abnormal laboratory testing about the kidneys. Symptoms related to kidney dysfunction are usually present but are more likely to appear when the kidney disease is more advanced.

What are some of the symptoms associated with kidney disease?

Foamy or dark/ bloody urine
Decrease in urination
Fatigue or malaise
Swelling (in the legs, arms, or face)
Weight gain
Increase in blood pressure (above 130/80)

What laboratory tests detect lupus nephritis?

Kidneys clean the blood of waste products. They do this by filtering the blood through millions of small filtration units (about 1 million in each kidney), resulting in the production of urine. Normally, when this process occurs, blood or proteins found within it should not enter (or “leak”) into the urine. However, if there is inflammation of the small filters which make up the kidneys, blood or an abnormal amount of protein can leak in the urine. Inflammation can also impair kidney function (i.e., the cleaning ability of the kidneys as measured on bloodwork). For this reason, it’s important to regularly perform a urinalysis to check for blood or protein, and routinely monitor kidney function with a blood test called creatinine (a value of generally 1 mg/dl or below is considered normal in adults).

At what intervals should kidney tests be monitored?

Scenario #1

If there is no previous history of lupus nephritis, a urinalysis and creatinine in the blood should be checked at least semi-annually (every 6 months).

Scenario #2

If there is a history of lupus nephritis, quarterly lab monitoring (every 3 months).

Scenario #3

If there is active lupus nephritis, frequent lab monitoring, at least monthly, is recommended during treatment.

When should a kidney specialist be seen?

Patients with evidence of active lupus nephritis, characterized by blood or significant protein leaking into urine and/or reduced kidney function, should see a kidney doctor. Almost always, a kidney biopsy would be necessary to confirm the diagnosis, determine how advanced the process is, and direct the treatment plan.

A kidney biopsy is a procedure in which a small sample of kidney tissue is taken with a needle and then examined under the microscope by a pathologist to obtain the most accurate diagnosis possible.

What are the treatment options for lupus nephritis?

Specific treatment usually involves powerful immunosuppressive medications —either Cytoxan (cyclophosphamide) or CellCept (mycophenolate mofetil) in combination with steroids—to calm down the inflammation and hopefully improve kidney function.

Nonspecific medications known as “ACE inhibitors” (such as lisinopril) or “angiotensin receptor blockers” (such as losartan) may also be used to reduce protein leaking into the urine, if present (these are also blood pressure-lowering medications).

Special attention to the medication regimen needs be paid in patients who are or want to get pregnant.

In the worst-case scenario, lupus nephritis can severely damage the kidneys to the point where therapy that replaces kidneys—namely, dialysis or kidney transplantation—becomes necessary.

Conclusion

If you live with lupus or someone dear to you does, and you want to get involved fighting “one of the world’s cruelest, most unpredictable, and devastating diseases, support your local Lupus Foundation of America chapter!

Medical Disclaimer

Diseases and Conditions When to see a rheumatologist

I have a positive HLA-B27 what does it mean?

June 5, 2018

During the course of a workup for possible autoimmune arthritis or autoimmune back disease, your rheumatologist may order something called a HLA-B27 test. So what does a positive HLA-B27 mean?

HLA-B27 antigen

HLA-B27 is a genetic test. The majority of people who have a positive HLA-B27 are perfectly healthy. HOWEVER, having a positive HLA-B7 can put you at increased risk of developing what we call spondyloarthritis-associated diseases. This is a family of autoimmune diseases.

Spondyloarthritis-associated diseases

Ankylosing spondylitis (AS), now called axial spondylitis
Peripheral spondyloarthritis
Reactive arthritis
Psoriasis
Psoriatic arthritis
Uveitis
Crohn’s disease
Ulcerative colitis

I have a positive HLA-B27, what does it mean?

The answer to this question highly depends on your situation. As I mentioned earlier, many people who have a positive HLA-B27 are perfectly healthy. More specifically, the majority of these people do NOT have an autoimmune disease. Here are a few stats to put things into perspective.

About 6 to 9 % of Caucasians and 3 % of African-Americans have a positive HLA-B27.
However, having a positive HLA-B27 increases a person’s risk of ankylosing spondylitis by 50 to 100 times.
But only 2 % of people who have a positive HLA-B27 go on to develop ankylosing spondylitis.
About 50% of people with psoriatic arthritis that involves the spine have a positive HLA-B27.
60% of people diagnosed with reactive arthritis have a positive HLA-B27. These people tend to have more severe symptoms, non-joint symptoms (e.g., uveitis), and it tends to last longer.
In the West, 50% of cases of anterior uveitis is associated with a positive HLA-B27 and about half of these people will develop spondyloarthritis.

I was diagnosed with AS, should I have my kids tested?

Technically not unless a family member is experiencing symptoms suggestive of ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or any other spondyloarthritis-associated disease. Remember, only 2% of people with a positive HLA-B27 go on to develop ankylosing spondylitis, which is the main autoimmune disease associated with this test.

However, people who have a positive HLA-B27 AND have a first-degree relative with ankylosing spondylitis have a 15% to 20% risk of developing the disease at some point during their lifetime.

I guess the answer whether to or whether not to test your kids really is a matter of choice. My opinion is, if it’s going to happen it’s going to happen. All we really can do is try to make healthy life choices like eating clean, staying active, reduce stress, and making sure we sleep enough. Remember the Blue Zones Principles?

For some people, knowing they tested positive for HLA-B27 may increase their stress level and for others not knowing whether they test positive or not may be more harmful. Whatever decision you make is highly personal.

In summary

Why having a HLA-B27 increases risk of having ankylosing spondylitis as well as a host of different autoimmune diseases is still uncertain: arthrogenic peptide hypothesis, molecular mimicry, free heavy chain hypothesis, and unfolded protein hypothesis. These are very complex concepts, which I will hold off on discussing further.

If you want to learn more about HLA-B27 and spondyloarthritis, I invite you to read the following articles: What is autoimmune back pain? Guide to living with psoriatic arthritis: part 1, and What is autoimmune joint pain?

If you think you may be suffering from a spondyloarthritis-associated condition, I encourage you to get in touch with your local rheumatologist. Here is a link to the American College of Rheumatology physician directory.

Medical Disclaimer

References

Rheumatology Secrets, 3^rd edition

Diseases and Conditions When to see a rheumatologist

Signs and symptoms of polymyalgia rheumatica

May 22, 2018

Polymyalgia rheumatica is a systemic inflammatory disease that almost exclusively affects people aged 55 and above. How this disease occurs and why it more-or-less exclusively affects the elderly is poorly understood. Like most autoimmune diseases, it’s thought that something in the environment be it a virus, bacteria, or in the case of polymyalgia rheumatica seasonal variation, triggers autoimmunity in a genetically susceptible person.

The hallmark symptoms of polymyalgia rheumatica include severe pain and stiffness involving the shoulder and or pelvic muscles.

However, it’s very important to understand that polymyalgia rheumatica is a diagnosis of exclusion. It’s important to rule out other conditions before making this diagnosis.

Polymyalgia rheumatica statistics

Polymyalgia rheumatica is the second most common autoimmune condition. It affects 2.4% of women and 1.7% of men. It can affect people as young as 50 years, but mainly affects people aged 60 years and above. Finally, Caucasians are mainly affected. It very rarely affects African Americans, Asians, or people of Hispanic descent.

What are the signs and symptoms of polymyalgia rheumatica?

People suffering from polymyalgia rheumatica typically describe a slow and insidious process of worsening stiffness and pain involving their shoulders and their pelvis. Sometimes the process is quick but typically it progresses over 3 months. Usually there is a dramatic loss of function. This includes difficulty getting up from a seated position, difficulty getting out of bed, difficulty dressing.

“I feel 20 years older than I am”.

What are some other symptoms of polymyalgia rheumatica?

Some other symptoms include fevers, chills, drenching night sweats, and unintentional weight loss. Importantly, giant cell arteritis, a type of vasculitis, can occur in about 15% of people suffering from polymyalgia rheumatica.

People suffering from giant cell arteritis typically report very similar symptoms, as well as the following:

Recent onset headache
A cramping sensation while chewing
Change in vision
A recent change in hearing, taste, as well as smell
Tenderness of the scalp

I’ll go into this later, but people suffering with giant cell arteritis usually do NOT improve with 20 mg of prednisone, whereas, people with pure polymyalgia rheumatic do.

Do people with polymyalgia rheumatica get arthritis?

The simple answer is yes they can. About 30% of people with polymyalgia rheumatica develop inflammatory arthritis that can look a lot like rheumatoid arthritis. However, unlike rheumatoid arthritis, this type of arthritis does not cause permanent damage.

How do you differentiate polymyalgia rheumatica from rheumatoid arthritis?

This can get very tricky and sometimes can take months of observation to finally figure it out. However, here are some distinguishing features that can help:

Absence of rheumatoid factor and other rheumatoid arthritis antibodies
Lack of involvement of small joints
Lack of joint damage

What are some differential diagnoses in polymyalgia rheumatica?

Diagnosis	Features
Fibromyalgia	Tender points and normal inflammation
Underactive thyroid (hypothyroidism)	Normal thyroid tests, normal inflammation
Depression	Normal inflammation
Osteoarthritis, rotator cuff, frozen shoulder	Abnormal x-rays and MRI, normal inflammation
Myositis	Mainly weakness, elevated muscle enzymes, abnormal nerve conduction test
Infection	Clinical suspicion and positive cultures
Cancer	Clinical suspicion with positive workup
Rheumatoid arthritis	Positive rheumatoid factor, small joints involved
Spondyloarthritis	History of psoriasis or inflammatory bowel disease[1]

How is polymyalgia rheumatica diagnosed?

The diagnosis of polymyalgia rheumatica is predominantly clinical. It’s very important to exclude other potential diagnoses as listed above. Levels of inflammation are typically very high but can be normal in select cases.

The American College of Rheumatology and EULAR have established criteria, but these are not the greatest in the world. They have a sensitivity of 68% and specificity of 78%. Finally, sometimes ultrasound studies and a PET scan can help as well.

How is polymyalgia rheumatica treated?

Steroids. People suffering from polymyalgia rheumatica often describe a dramatic resolution or improvement of the symptoms on 15 to 20 mg of prednisone a day. By dramatic I mean it typically take less than 24 hours for symptoms to resolve. In about 25% of cases, the response will not be dramatic and will take a few more days or a higher dose of prednisone.

Unlike other rheumatic conditions, prednisone must be tapered very slowly in polymyalgia rheumatica. It’s not uncommon for a person to be on steroids for over two years. At times, we need to taper by 1 mg every month or two!

My best friend, my worst enemy

Prednisone is both your best friend and worst enemy. Unfortunately, it remains the mainstay of therapy. While on high doses of steroids for a prolonged period of time, it’s very important to remain active and pay attention to possible side effects such as osteoporosis, diabetes, heartburn/stomach ulcers, and infection. Not to mention an ever expanding waist line.

Regular weight-bearing exercise, vitamin D supplementation, as well as keeping up-to-date with vaccines (flu shot, pneumonia shot, shingles shot) are essential.

Conclusion

If you think you or one of your loved ones suffers from polymyalgia rheumatica, I encourage you to make an appointment with your local rheumatologist.

Medical Disclaimer

References

Rheumatology Secrets, 3^rd edition

UpToDate

[1] Adapted from Rheumatology Secrets, 3^rd edition

Diseases and Conditions

Shingrix: The new shingles shot

May 8, 2018

Benjamin Bergen, Doctor of Pharmacy Candidate Class of 2018, Albany College of Pharmacy and Health Sciences

In Fall 2017, a new inactivated recombinant shingles vaccine, Shingrix, came to the market to help people better protect themselves against the herpes zoster (shingles) virus.¹

What is shingles?

Shingles is a painful rash that usually develops on only one side of the body, caused by the chickenpox virus reactivating in the body years after initial infection. Since over 99% of people over 40 have had chickenpox, vaccination is recommended regardless of the person remembering if they had it. Blisters appear that scab over in 7 to 10 days and clear up within 2 to 4 weeks. Some people with shingles have a long-lasting burning sensation that can last for months or years after the rash goes away, called postherpetic neuralgia (PNH). The risk to get both shingles and PHN increases with age.¹

Zostavax: The “old” shingles shot

Previously, the only available product for protection against shingles was Zostavax, Merck’s live vaccine which was approved in 2006. Zostavax was FDA approved for people over 50 years of age, but the Centers for Disease Control and Prevention (CDC) only recommended it for people 60 years of age and older. Zostavax should not be given to any person that has:^1,2

An anaphylactic allergy to gelatin, neomycin, or any other component of the vaccine
Immunosuppression for any reason, including:
- Primary or acquired immunodeficiency states
- AIDs or other clinical manifestations of HIV
- Leukemia or lymphoma, or any other malignant neoplasms affecting the bone marrow or lymphatic system
- Receiving immunosuppressive therapy
  - Cancer treatment such as radiation or chemotherapy
  - Long-term steroids (ie: prednisone)
  - Biologic therapy such as adalimumab (Humira) or etanercept (Enbrel)
- Women should not become pregnant for at least 4 weeks after receiving the vaccine

Shingrix: The new shingles shot

The CDC now recommends Shingrix over Zostavax for the prevention of shingles and related complications for all immunocompetent adults aged 50 and older:^1,3

Regardless of having a history of shingles
Regardless of prior Zostavax vaccination. There should be at least 8 weeks between the vaccinations.
With chronic medical conditions such as diabetes, chronic kidney disease, or rheumatoid arthritis
At the same time as the flu or pneumonia vaccines

There are exceptions

The CDC still recommends Zostavax in certain cases, such as if Shingrix is unavailable or if a person is allergic to Shingrix.¹ Shingrix has been shown to be much more effective than Zostavax for preventing shingles in different age groups, illustrated in the following table:^2,3

Age Group	Zostavax Efficacy	Shingrix Efficacy
50-59	70%	96%
60-69	64%	97%
70-79	41%	91%
>80	18%	91%

Shingrix should not be given to any person that:^1,3

Has a history of a severe allergies reaction to any component of the vaccine or after a previous dose of Shingrix.
Tested negative for immunity to varicella zoster virus (the chickenpox vaccine should then be given)
Currently has shingles
Is currently pregnant.

Possible side effects

The most common side effect with Shingrix is pain at the injection site. This is more common in younger people. Other side effects include muscle pain, fatigue, headache, shivering, fever, and gastrointestinal symptoms.

Head-to-head comparison

Shingrix is covered by Medicare Part D, the prescription drug plan, and may have a copay. A full comparison of the two vaccines is shown below:

Zostavax²	Shingrix³
Live attenuated vaccine	Recombinant Inactivated Vaccine
Cannot be given to immunosuppressed patients	Has not been studied in immunosuppressed patients
No longer CDC recommended	CDC recommended for patients aged 50 or older
Single vaccination	Two vaccinations, 2-6 months apart
Patients over 60: 39% decrease in postherpetic neuralgia	Patients over 70: 88% decrease in postherpetic neuralgia

Call to action

If you are interested in learning more about vaccines and autoimmune disease, I encourage you to read our flu vaccine and pneumonia vaccine articles.

Medical Disclaimer

References:

Herpes Zoster Shingrix Vaccine Recommendations. The Centers for Disease Control and Prevention. Cited 1 May 2018.
Zostavax Prescribing Information. Food and Drug Administration 2006. Revised 2018.
Shingrix Prescribing Information. Food and Drug Administration 2017. Revised Oct 2017.

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Diseases and Conditions When to see a rheumatologist

8 Warning signs of psoriatic arthritis

April 10, 2018

Most people think psoriasis is an autoimmune disease that only affects the skin, but did you know that about 26% of people also have psoriatic arthritis? Did you know that psoriatic arthritis is more common than rheumatoid arthritis?[1] What are the signs of psoriatic arthritis?

8 Warning signs of psoriatic arthritis

1. Having nail psoriasis

A recent Japanese study tried to find risk factors that predispose people with psoriasis to develop psoriatic arthritis. First, they found that about 17% of people with psoriasis also had psoriatic arthritis. Furthermore, they found that people who had psoriasis involving their nails had a higher chance of having psoriatic arthritis: 29% (PsO) versus 62% (PsA). In conclusion, they found that people who had high uric acid levels also had a higher risk of having psoriatic arthritis 9% (PsO) versus 22% (PsA).[2]

How does nail psoriasis look like?

Nail psoriasis can sometimes mimic nail fungus. It can also make pits in the nail and can cause nails to break very easily.

Follow the link for examples.

2. Having autoimmune joint pain

Autoimmune joint pain typically causes swelling and warmth of the joints. People often describe stiffness that lasts more than one hour. Symptoms are worse in the morning. Furthermore, psoriatic arthritis can affect almost any joint: knuckles, toes, wrists, ankles, knees, etc.

3. Inflammation involving the tips of your fingers

I’m referring to the tips of the fingers, also called the distal interphalangeal joints. Osteoarthritis (i.e., wear and tear arthritis) in the hands can sometimes cause similar symptoms. Typically, the symptoms in psoriatic arthritis happen more quickly and typically there is more swelling and redness.

4. “Sausage fingers”

This happens when the tendons and ligaments that supply fingers get inflamed. This can happen in a variety of different diseases such as ankylosing spondylitis, reactive arthritis, inflammatory bowel disease, infection, sickle cell anemia, sarcoidosis, and gout to name a few. Follow the link to look at some examples.

5. Having inflammation of tendons and ligaments

Enthesitis means inflammation of connective tissue that attaches to bones. These include tendons, ligaments, and bursae. Most cases of enthesitis are due to injury or overuse. Think of a marathon runner with Achilles tendinitis or a tennis player with tennis elbow. In psoriatic arthritis, the immune system attacks these connection points. So you can have someone who leads a fairly sedentary life who suddenly develops Achilles tendinitis on both feet, runner’s knee, and plantar fasciitis happening all at once, for no good reason.

6. Autoimmune back pain

Inflammation involving the back causes symptoms that are very different from your usual mechanical back pain. Here are some key features:

Back pain present for more than three months.
Pain improves with exercise.
Pain improves with anti-inflammatory medications like naproxen or ibuprofen.
Rest usually worsens the pain.
Back pain that wakes you up during the second half of the night.
Pain and prolonged stiffness in the morning, typically lasting more than an hour.
Alternating deep buttock pain.

7. History of uveitis

Uveitis is a general term used to describe a group of diseases that cause inflammation in the eye: uvea, lens, retina, optic nerve, and the vitreous. Depending on where the inflammation is happening, your ophthalmologist may describe it as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis. As a result, people can experience blurry vision, eye pain, redness, sensitivity to light, and sometimes headaches.

Uveitis is associated with many diseases including psoriasis and psoriatic arthritis. Sometimes uveitis is the first manifestation of psoriatic arthritis. This is why I’ve included this topic here, even though technically it isn’t arthritis. It’s important to keep this in the back of your mind.[3] While uveitis is one of the signs of psoriatic arthritis, psoriatic arthritis is not the most common cause of uveitis.

8. Having a first degree family member with psoriasis or psoriatic arthritis

This means mom, dad, siblings, and children. Furthermore, other diseases also increase risk. These include Crohn’s disease, ulcerative colitis, ankylosing spondylitis, reactive arthritis, and uveitis.

Call to action

In conclusion, if you think you may have psoriatic arthritis, I encourage you to contact a rheumatologist to get tested. Time is of the essence. Click on “FIND A RHEUMATOLOGIST” above to search the American College of Rheumatology database to find a rheumatologist near you.

Want to learn more? The Arthritis Foundation and the Arthritis Society are also great starting points.

Medical Disclaimer

References

[1] Rheumatology Secrets, 3^rd edition

[2] Tsuruta N, Imaguku S, Narisawa Y. Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients. J Dermatol. 2017 Jul 10. doi: 10.1111/1346-8138.13968. [Epub ahead of print]

[3] https://nei.nih.gov/health/uveitis/uveitis

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