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When to see a rheumatologist

Diseases and Conditions When to see a rheumatologist

Signs you may be at risk for psoriatic arthritis

January 16, 2024
signs you may be at risk for psoriatic arthritis

Psoriatic arthritis is a type of inflammatory arthritis that occurs in people with psoriasis, an autoimmune condition affecting the skin. It causes swelling, stiffness and pain in the joints as well as nail changes and overall fatigue.

Psoriatic arthritis can be difficult to diagnose in its early stages but it’s important to identify and treat it quickly. Early treatment helps relieve symptoms, improve quality of life, and potentially slow down the progression of joint damage that can occur if the disease advances untreated.

Joint Pain

One of the most common early symptoms of psoriatic arthritis is persistent joint pain, swelling, and stiffness (Mayo Clinic). This pain often affects the large joints like the knees, ankles, elbows, and wrists, but can also impact smaller joints like those in the hands and feet.

The joint pain of psoriatic arthritis tends to be asymmetric, meaning it occurs on just one side of the body rather than symmetrically on both sides. The pain and stiffness tend to be worse when joints are at rest, and improves with movement. Psoriatic arthritis joint pain may also alternate between periods of flare ups and remission.

It’s important to note that psoriatic arthritis joint pain can occur even in people who do not have skin psoriasis. The joint symptoms may precede the skin lesions in some cases. Persistent joint pain, swelling, and stiffness, especially when asymmetric and alternating between flares and remission, can be an early sign of psoriatic arthritis.

Fatigue

Fatigue is a very common symptom of psoriatic arthritis, with studies showing that up to 80% of people with PsA experience some degree of fatigue (SOURCE). The chronic inflammation associated with PsA can contribute to feelings of tiredness and lack of energy (SOURCE). This type of fatigue is different than normal tiredness after a long day – it is often described as an overwhelming, debilitating exhaustion that affects your ability to perform daily activities.

Psoriatic arthritis fatigue can range from mild to severe. You may feel generally run down or constantly drained. Simple tasks like grocery shopping, cleaning or caring for your family may wipe you out. This fatigue can be mentally exhausting as well, making it hard to concentrate or be productive. Unlike normal tiredness which gets better with rest, psoriatic arthritis fatigue may persist even when you get adequate sleep.

If you are experiencing new, unexplained and persistent fatigue along with other psoriatic disease symptoms like joint pain, stiffness or skin changes, be sure to contact your doctor. Finding the right treatment can help manage inflammation and greatly improve psoriatic arthritis fatigue.

Joint Redness and Warmth

One early symptom that should prompt suspicion of psoriatic arthritis is redness and warmth over the joints, especially when it is confined to one side of the body. Unlike regular aches and pains, the joints affected by psoriatic arthritis often become noticeably red and feel warm to the touch. This occurs when the immune system mistakenly attacks the joints, causing inflammation. According to the Mayo Clinic [“results”][0][“url”]}>, this redness and warmth is a hallmark feature of inflammatory types arthritis like psoriatic arthritis.

Some people first notice the redness and warmth before feeling any arthritic pain or stiffness. The joints most likely to develop redness and warmth are those in the hands, wrists, elbows, knees, ankles and feet. If you notice persistent redness and warmth in these joints, particularly if it is asymmetric and predominately affecting one side, be sure to point this symptom out to your doctor during your appointment. Redness and warmth in your joints in combination with other psoriatic symptoms should prompt referral to a rheumatologist for further evaluation for psoriatic arthritis.

Swollen Fingers/Toes

One early sign of psoriatic arthritis is dactylitis, also known as “sausage digit.” This refers to swelling in the fingers or toes that causes them to appear sausage-like. Dactylitis is caused by inflammation of the tendons and soft tissues of the digits. According to the National Psoriasis Foundation, dactylitis affects roughly 40-50% of people with psoriatic arthritis[1]. It often presents before any joint damage is apparent.

Dactylitis most commonly affects the middle joint of the fingers or toes, though it can occur in the wrist, ankles, and feet as well. The swelling and inflammation is often asymmetric, meaning it appears on just one finger or toe at a time, rather than symmetrically on both sides. Dactylitis causes stiffness, pain, and limited mobility in the affected digits. If you notice sausage-like swelling in your fingers or toes, it is important to see a doctor promptly, as it may be an early red flag for psoriatic arthritis[2].

Nail Changes

Nail changes are a common early sign of psoriatic arthritis. The most frequent nail manifestations are pitting, grooves, and detachment of the nail from the nail bed (onycholysis).

Pitting appears as small depressions or holes in the nail surface and gives the nail a spotted look. These pits are caused by defects in nail growth. Pitting occurs in up to 50% of those with psoriatic arthritis[1].

Nail grooves are furrows or channels that run vertically down the nail. They may be deep or superficial lines. Grooves are present in around 25% of psoriatic arthritis patients[2].

Onycholysis refers to separation of the nail from the nail bed. The nail becomes detached from the skin underneath. This occurs when inflammation damages the nail matrix. Onycholysis is seen in approximately 10-15% of those with psoriatic arthritis[3].

Getting early treatment for psoriatic arthritis can help prevent permanent nail deformities. See a doctor if nail changes accompany joint pains.

Lower Back Pain

Lower back pain is a common symptom of psoriatic arthritis. About 30-50% of people with psoriatic arthritis will experience pain and stiffness in their lower back caused by inflammation of the joints in the spine 1. This is known as axial arthritis or spondylitis. The lower back is commonly affected before other areas of the spine.

Lower back pain from psoriatic arthritis often comes on slowly and worsens over time. It can range from mild to severe. The pain and stiffness tend to be worse in the morning and improve with movement and activity. However, prolonged sitting or standing can also aggravate the pain. Lower back pain from psoriatic arthritis may switch between sides or stay on one side consistently.

If you have lower back pain along with other symptoms of psoriatic arthritis like joint swelling and skin changes, be sure to see a rheumatologist. Getting an early and accurate diagnosis is key to preventing permanent spinal joint damage. Treatment for psoriatic spondylitis aims to relieve pain, improve function, and slow the progression of the disease.

Signs you may be at risk for psoriatic arthritis

If you experience any symptoms of psoriatic arthritis, it’s important to schedule an appointment with your doctor to get an evaluation. The earlier psoriatic arthritis is diagnosed, the better the outcome with treatment. You should see a doctor if you have:

  • Joint pain, swelling, or stiffness that persists for more than 2 weeks (https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/symptoms-causes/syc-20354076)
  • Redness or warmth over joints
  • Swollen fingers or toes that look like sausages
  • Morning joint stiffness lasting over 30 minutes
  • New pitting, ridges, or separation of the nails (https://www.healthline.com/health/psoriatic-arthritis-early-signs)
  • Fatigue that is not relieved by rest
  • Lower back pain, especially with joints affected elsewhere

Don’t dismiss unexplained joint pain or wait and see if it goes away. The sooner psoriatic arthritis can be diagnosed, the better the outcome with early treatment to relieve symptoms and slow disease progression. See a doctor right away if you have psoriasis and develop any joint pain or swelling.

Medical Disclaimer

The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional

When to see a rheumatologist

What Are The Early Signs Of Rheumatoid Arthritis?

October 30, 2019
What Are The Early Signs Of Rheumatoid Arthritis?

What are the early signs of rheumatoid arthritis? Rheumatoid arthritis is one of the more common forms of autoimmune arthritis, affecting about 1% of the adult population.  This may not seem quite common, but in the world of rheumatology this is actually quite common.  Women tend to be affected more than men 2-3:1 and the disease tend to manifest between the ages of 40 – 60.  However, it can also happen in young adults and older individuals.  When it happens in children, we call it juvenile idiopathic arthritis.

Early Signs of Rheumatoid Arthritis

The following are some of the early signs of rheumatoid arthritis.

#1 Inflammatory joint pain

Most of us experience joint pain at some point in our lives.  This is simply a part of being human.  However, most of us experience non-inflammatory joint pain NOT inflammatory joint pain.  Non-inflammatory joint pain typically worsens as the day progresses.  There typically is no swelling, redness, or warmth.  There can be stiffness but typically this last just a few minutes and certainly less than 30 min.  Basically, things quickly get better as you get going.

People that suffer from rheumatoid arthritis present with inflammatory joint pain, which presents very differently.

  • Joint pain that is worse in the morning and improves as the day goes by.
  • There is joint swelling and usually they feel warm.  At times they can look red.

People suffering from rheumatoid arthritis experience stiffness that usually lasts more than one hour.

#2 Involvement of knuckles, wrists, ankles, and toes

Although rheumatoid arthritis certainly affects larger joints, like the knees, hips, and shoulders, it tends to affect smaller joints like the knuckles, wrists, ankles, and toes.

#3 Symmetrical joint distribution

This is pretty self-explanatory.  Rheumatoid arthritis inflames joints symmetrically.  If the second knuckle on the right hand is inflamed, the second knuckle on the left hand most likely will be too.  Maybe not as much, but inflamed nonetheless.  However, it’s important to take this with a grain of salt, particularly early in disease.

#4 Fatigue

People often feel very tired, when they suffer from rheumatoid arthritis.  I’m talking can’t make it through the day tired.

#5 Fevers

This often depends on how quickly symptoms emerge.  Symptoms of rheumatoid arthritis usually develop over the course of months (55 – 65% of cases), but at times can develop over a few weeks (15 – 20%), and even days (10%).  The quicker the onset, the more likely someone will experience low grade fevers.  Some people, particularly those aged greater than 65 years, can present like polymyalgia rheumatica.  These people often present with fevers as well.

What Are Some Other Symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis is a very complex autoimmune disease that can affect many different organs.  We discussed the 5 common early signs of the disease but the following are some other less common manifestations.

Cardiac

  • Pericarditis
  • Myocarditis
  • Coronary vasculitis

Dermatologic

  • Nodules
  • Skin vasculitis

Ocular

  • Scleritis
  • Episcleritis
  • Retinal nodules

Pulmonary

  • Pleuritis
  • Interstitial lung disease
  • Bronchiolitis obliterans
  • Lung nodules

Neuromuscular

  • Nerve entrapment – e.g., carpal tunnel syndrome
  • Neuropathy

Other

  • Severe dry eyes and dry mouth
  • Felty’s syndrome

What Are Some Of The Mimickers Of Rheumatoid Arthritis?

When faced with symptoms that look and sound like rheumatoid arthritis, it’s important to take a step back and consider alternative diagnoses.  Some of these include:

Next Steps

If you think you or one of your loved ones may be suffering from rheumatoid arthritis, I highly suggest you discuss your symptoms with your general practitioner or schedule as appointment with your local rheumatologist.  Although, signs and symptoms are very important, a good history and physical examination in conjunction with specialized bloodwork and x-rays, are essential to either rule in rheumatoid arthritis and rule out other possibilities.

References

Rheumatology Secrets 3rd edition

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 When to see a rheumatologist

What is a high CRP? Measuring inflammation

September 18, 2018
What is a high CRP? Measuring inflammation

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 When to see a rheumatologist

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

June 5, 2018
I have a positive HLA-B27 what does it mean?

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

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.

References

Rheumatology Secrets, 3rd edition

Diseases and Conditions When to see a rheumatologist

Signs and symptoms of polymyalgia rheumatica

May 22, 2018
Signs and symptoms of polymyalgia rheumatica

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

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.

References

Rheumatology Secrets, 3rd edition

UpToDate

[1] Adapted from Rheumatology Secrets, 3rd edition

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

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.

References

[1] Rheumatology Secrets, 3rd 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