Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Psoriatic arthritis is a chronic disease characterized by
a form of inflammation
of the skin (psoriasis) and joints
(arthritis). Psoriasis is a common skin condition affecting 2% of the Caucasian population in
the United States. It features patchy, raised, red areas of
skin inflammation with scaling. Psoriasis often affects the tips of the elbows
and knees, the scalp and ears, the navel, and around the genital areas or anus.
Approximately 10% of patients who have psoriasis also develop an associated inflammation
of their joints. Patients who have inflammatory arthritis and psoriasis are diagnosed as
having psoriatic arthritis.
The onset of psoriatic arthritis generally occurs in the fourth and
fifth decades of life. Males and females are affected equally. The skin
disease (psoriasis) and the joint disease (arthritis) often appear
separately. In fact, the skin disease precedes the arthritis in nearly 80%
of patients. However, the arthritis may precede the psoriasis in up to 15% of
patients. In some patients, the diagnosis of psoriatic arthritis can be
difficult if the arthritis precedes psoriasis by many years. In fact, some
patients have had arthritis for over 20 years before psoriasis
eventually appears! Conversely, patients can have psoriasis for over 20
years prior to the development of arthritis, leading to the ultimate diagnosis
of psoriatic arthritis.
Psoriatic arthritis is a systemic rheumatic disease that also can cause
inflammation in body tissues away from the joints other than the skin, such as in the eyes, heart, lungs, and kidneys. Psoriatic arthritis
shares many features with several other arthritic conditions, such as
ankylosing spondylitis, reactive arthritis, and arthritis associated with
Crohn's disease and ulcerative colitis. All of these conditions can cause
inflammation in the spine and other joints, and the eyes, skin, mouth, and
various organs. In view of their similarities and tendency to cause
inflammation of the spine, these conditions are collectively referred to
Reviewed by Melissa Conrad Stöppler, MD on 10/7/2011
In most patients, the psoriasis precedes the arthritis by months to years. The arthritis frequently involve the knees, ankles, and joints in the feet. Usually, only a few joints are inflamed at a time. The inflamed joints become painful, swollen, hot, and red. Sometimes, joint inflammation in the fingers or toes can cause swelling of the entire digit, giving them the appearance of a "sausage." Joint stiffness is common and is typically worse early in the morning. Less commonly, psoriatic arthritis may involve many joints of the body in a symmetrical fashion, mimicking the pattern seen in rheumatoid arthritis. Psoriatic arthritis can also cause inflammation of the spine (spondylitis) and the sacrum, causing pain and stiffness in the low back, buttocks, neck and upper back. In approximately 50% of those with spondylitis, the genetic marker HLA-B27 can be found. In rare instances, psoriatic arthritis involves the small joints at the ends of the fingers. A very destructive form of arthritis, called "mutilans," can cause rapid damage to the joints. Fortunately, this form of arthritis is rare in patients with psoriatic arthritis.
An MRI (or magnetic resonance imaging) scan is a
radiology technique that uses magnetism, radio waves, and a computer
to produce images of body structures. The MRI scanner is a tube
surrounded by a giant circular"...