Everyone with a television probably knows a little something about psoriasis, the skin condition with the raised red patches and silver-colored scales on the elbows and knees.
What far fewer people know is that psoriasis frequently is a harbinger of worse things to come.
Sometimes much worse things.
Dr. Ivana Parody, who served her residency at Mount Sinai Medical Center in Miami Beach, is a rheumatologist at Indian River Medical Center. She points out that “in 85 percent of cases [the skin condition] psoriasis will precede psoriatic arthritis,” which she says “is pretty much an inflammatory autoimmune disease.”
The Mayo Clinic is more specific. It says “psoriatic arthritis occurs when your body’s immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells.”
Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis and the condition can affect almost every part of your body.
Worse, according to Harvard Medical, people with psoriatic arthritis “are more likely to have other conditions linked to inflammation, including heart disease, diabetes, obesity, Crohn’s disease and ulcerative colitis.”
Parody, meanwhile, says psoriatic arthritis “may affect the small joints of the hands and the feet or it may affect the large joints like the hips and knees. It may also affect the spine and the joints in the pelvis called sacroiliac joints. That manifestation is called spondyloarthritis.
“It may cause inflammation of the fingers [so severe that] the fingers may look like sausages.”
In other words, it’s not a pretty picture. And it can get even worse.
Psoriatic arthritis, Parody continues, “may also inflame the attachments of the ligaments and the tendons to the bones. That is called enthesitis and usually presents as inflammation of the Achilles tendon or inflammation of the tendon in the knee, and it may also cause inflammation of the eye.”
And the worst news of all? The Mayo Clinic says “no cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to your joints.”
Parody says, “We have many medications we use now that target specific inflammatory pathways that are very active in psoriatic arthritis.”
These drugs include Cosentyx, Orencia, Stelara and Otezla, and Parody adds that one of the newer treatments on the market is a psoriatic arthritis version of the EpiPens used for asthma.
“We have these pens so patients can inject themselves every two weeks in the belly or the thigh,” she explains, though according to both the Mayo Clinic and Consumer Reports, none of the above treatments actually cure the disease. And they don’t come cheap, either.
A May 2018 report from the National Institutes of Health flatly states that psoriatic arthritis patients “incur substantially higher costs” than patients with other inflammatory diseases.
That’s at least in part because the newer “biologic” class of drugs like Cosentyx can cost between $15,000 and $25,000 a year and even a single tube of topical psoriatic ointment can carry a $600 price tag.
That makes it vitally important to have a detailed discussion with your rheumatologist about the right medication for you. And for your wallet.
As the National Psoriasis Foundation points out, “one in three people have trouble paying for the cost of care” for their psoriatic arthritis.
Even if the cost of care isn’t an issue, getting careful supervision definitely is.
Says Parody: “Whenever we put a patient on a treatment, we need to closely monitor that patient.”
Why? Because the side effects from some of the above treatments may, according to WebMD, lead to tuberculosis, pneumonia, hepatitis, staph and/or fungal infections and even lymphoma or blood cancer.
So what actually causes psoriatic arthritis?
No one really knows.
Genetic factors, the individual’s unique immune system and environmental factors are all believed to play a role in the onset of psoriatic arthritis.
Dr. Ivana Parody is with the Indian River Medical Center. Her office is at 3450 11th Court, Suite 302 in Vero Beach. The phone number is 772-794-1444.
