Psoriasis Sometimes More Than Skin Deep

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DEAR DR. DONOHUE: Your article on arthritis was very interesting, but you did not explain about the arthritis that comes with psoriasis. I have it, and I know of two other people who have it. We don’t understand it at all. Please explain. — B.E.

ANSWER: Autoimmunity is the explanation for many illnesses, including both skin and joint psoriasis. “Autoimmunity” indicates that the immune system — our protection against germ invasion and other harmful attacks — for reasons not yet understood, turns against our own bodies; in this case, it’s the skin and joints. The immune system targets joints in as many as 7 percent of those who suffer from skin psoriasis. That’s a considerable number of people when you consider that as many as 3 percent of the entire population suffers from skin psoriasis.

Skin psoriasis precedes joint psoriasis most of the time, but there are instances when both occur simultaneously or when joint involvement appears before any skin manifestations.

The fact that skin and joint psoriasis run in some families also points to a gene influence on these conditions.

Any joint can be affected. The topmost finger joint, the one below the fingernail, is frequently targeted. Back, neck, knees, you name it — psoriasis can strike it. Like all arthritic joints, psoriatic arthritic joints are swollen, red, tender and stiff. The severity of joint involvement doesn’t always mirror skin involvement, but it does correspond to nail changes. Nails have small pits, become loosened from their attachment to underlying skin, often turn yellow and crumble.

Treatment of psoriatic arthritis depends on how bad the arthritis is. For mild to moderate cases, NSAIDS do a good job. They include the familiar Aleve, Advil, Motrin and many others. For more severe involvement, doctors prescribe drugs like methotrexate. And for severe arthritis, a breakthrough has come with the introduction of drugs like Enbrel, Remicade and Humira.

The arthritis booklet deals with some of the more common forms of arthritis. Readers can obtain a copy by writing: Dr. Donohue — No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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