Psoriasis and Psoriatic Arthritis

By Anne Wolski - 2007-10-04 Find more articles like this in our Skin Disorders category.

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What Is Psoriasis?

Psoriasis

Although the disease occurs in all age groups, it primarily affects adults. It appears about equally in males and females. Psoriasis occurs when skin cells quickly rise from their origin below the surface of the skin and pile up on the surface before they have a chance to mature. Usually this movement (also called turnover) takes about a month, but in psoriasis it may occur in only a few days.

In its typical form, psoriasis results in patches of thick, red (inflamed) skin covered with silvery scales. These patches, which are sometimes referred to as plaques, usually itch or feel sore. They most often occur on the elbows, knees, other parts of the legs, scalp, lower back, face, palms, and soles of the feet, but they can occur on skin anywhere on the body.

How Does Psoriasis Affect Quality of Life?

Individuals with psoriasis may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care, walking, and sleep. Plaques on hands and feet can prevent individuals from working at certain occupations, playing some sports, and caring for family members or a home.

The frequency of medical care is costly and can interfere with an employment or school schedule.

People with moderate to severe psoriasis may feel self-conscious about their appearance and have a poor self-image that stems from fear of public rejection and psychosexual concerns. Psychological distress can lead to significant depression and social isolation.

What Causes Psoriasis?

Psoriasis is a skin disorder. T cells help protect the body against infection and disease. In the case of psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses, which lead to inflammation and to rapid turnover of skin cells.

People with psoriasis may notice that there are times when their skin worsens, then improves.

Conditions that may cause flareups include infections, stress, and changes in climate that dry the skin. Also, certain medicines, including lithium and betablockers, which are prescribed for high blood pressure, may trigger an outbreak or worsen the disease.

How Is Psoriasis Diagnosed? Occasionally, doctors may find it difficult to diagnose psoriasis, because it often looks like other skin diseases. It may be necessary to confirm a diagnosis by examining a small skin sample under a microscope.

There are several forms of psoriasis. Some of these include:

Plaque psoriasis Skin lesions are red at the base and covered by silvery scales.

Guttate psoriasis Small, drop-shaped lesions appear on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by upper respiratory infections (for example, a sore throat caused by streptococcal bacteria).

Pustular psoriasis Blisters of noninfectious pus appear on the skin. Attacks of pustular psoriasis may be triggered by medications, infections, stress, or exposure to certain chemicals.

Inverse psoriasis Smooth, red patches occur in the folds of the skin near the genitals, under the breasts, or in the armpits. The symptoms may be worsened by friction and sweating.

Erythrodermic psoriasis Widespread reddening and scaling of the skin may be a reaction to severe sunburn or to taking corticosteroids (cortisone) or other medications. It can also be caused by a prolonged period of increased activity of psoriasis that is poorly controlled.

Psoriatic arthritis Joint inflammation that produces symptoms of arthritis in patients who have or will develop Psoriasis.

I was in my early twenties when I became aware of a reddening of my elbows and knees.

At first, I took little notice but then the scaly patches and the itching began. These then spread to my knuckles, ankles and some small patches on the lower legs. No amount of moisturising lotions or the like seemed to make any difference. Finally, I went to my physician who diagnosed my condition as psoriasis.

I began a regime of applying corticosteroid lotions and creams and using coaltar solutions to the affected parts of my body but even these appeared to have little effect.

At times, I experienced significant physical discomfort. Itching and pain interfered with basic functions, such as sleep. This in turn left me feeling constantly tired and unable to cope with day-to-day chores, thus putting a strain on my family relationships.

I began to feel self-conscious about my appearance and had a poor self-image that stemmed from fear of public rejection. Psychological distresses in turn lead to significant depression and social isolation.

Sometimes the condition got worse and then improved so I was then able to identify a number of things that produced flare-ups including infections, stress, and climate changes. There were also certain medications that seemed to trigger outbreaks or worsen existing patches.

The years rolled by and the disease continued to progress until I had large patches of psoriasis on my knuckles, elbows, finger joints, knees, lower legs, feet, and even the webbing of my toes. I also had it in my scalp and covering a large portion of my back. I lived in misery with the constant itching and discomfort.

Around six months ago, I received a phone call from my mother telling me she had just been diagnosed with psoriatic arthritis. Because this condition is genetic and I already had the skin condition, it was important that I see a rheumatologist to be tested. Of course, it was no surprise when I found that I too had psoriatic arthritis.

Blood tests conducted for this condition may rule out other conditions such as gout or rheumatoid arthritis. There is a particular antibody normally present in rheumatoid arthritis that is not present in psoriatic arthritis. These tests will often also show elevated erythrocyte sedimentation rate or ESR which measures inflammation. They often show mild anaemia and elevated levels of uric acid.

My rheumatologist prescribed Methotrexate, an immunosuppressive drug. This medication has been used very successfully in the treatment of psoriasis and psoriatic arthritis. I take a low dose of this drug once weekly.

Methotrexate works by binding to and inhibiting an enzyme involved in the rapid growth of cells, thus slowing down the rate of skin cell growth. It was originally used in the treatment of cancer but was discovered in the 1950s to be effective in the treatment of psoriasis and was eventually approved for use in this condition in the 1970s.

Methotrexate is generally well tolerated in small doses but it does potentially have a number of side effects. For this reason, it is imperative that a patient on this drug follows the instructions of their physician very carefully. People taking this medication need to have regular blood tests to be sure that the body is processing the drug safely and not creating other problems, particularly in the liver.

I have been on Methotrexate now for around four months. During the first six weeks or so, I noticed little reduction in my pain levels although the skin condition did show signs of subsiding. However, in the past couple of months, my need for painkillers has definitely been reduced and the skin condition is almost gone.

My family laugh when they see how excited I get about having knuckles now instead of great patches of scales. I can even go barefoot without the embarrassment of the condition in the webbing of my toes. Some people used to think I had a severe case of tinea and would look at me as though doubting my hygiene habits.

The only downside I have is a feeling of tiredness and the fact that I am prone to infections. This is caused by a reduction in my white blood cell count. However, under careful monitoring by my doctor, these symptoms are reduced by antibiotics when needed and a good multivitamin.

Despite these downsides, my life has greatly improved and continues to do so. I am kept aware of all the possible side effects and regular blood testing keeps my physician and my rheumatologist informed about any concerns. Hopefully, I will be able to live a far better quality of life in the future.

Also see Psoriasis Treatment Breakthrough?