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.
The cause of psoriatic arthritis is currently unknown. A combination of genetic, immune, and environmental factors is likely involved. In patients with psoriatic arthritis who have arthritis of the spine, a gene marker named HLA-B27 is found in about 50% of cases. Blood testing is available to test for the HLA-B27 gene. Several other genes have also been found to be more common in patients with psoriatic arthritis. Certain changes in the immune system may also be important in the development of psoriatic arthritis. For example, the decline in the number of immune cells called helper T cells in people with AIDS may play a role in the development and progression of psoriasis in these patients. The importance of infectious agents and other environmental factors in the cause of psoriatic arthritis is being investigated by researchers.
What are psoriatic arthritis symptoms and signs?
In most patients, the psoriasis precedes the arthritis by months to
years. The type of psoriatic arthritis depends on the distribution of the joints affected. Accordingly, there are five types of psoriatic arthritis: symmetrical, asymmetric and few joints, spondylitis, distal interphalangeal joints, and arthritis mutilans.
The arthritis frequently involves 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. Occasionally, 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.
Patients with psoriatic arthritis can also develop inflammation of the
tendons (tendinitis) and around cartilage. Inflammation of the tendon
behind the heel causes Achilles tendinitis, leading to pain with walking
and climbing stairs. Inflammation of the chest wall and of the cartilage
that links the ribs to the breastbone (sternum) can cause chest pain, as seen in costochondritis.
Aside from arthritis and spondylitis, psoriatic arthritis can cause
inflammation in other organs, such as the eyes, lungs, and aorta. Inflammation in the colored portion of the eye (iris) causes iritis,
a painful condition that can be aggravated by bright light as the iris opens and closes the opening of the pupil.
Corticosteroids injected directly into the eyes are sometimes necessary to
decrease inflammation and prevent blindness. Inflammation in and around
the lungs (pleuritis) causes chest pain, especially with deep breathing, as well as shortness of breath.
Inflammation of the aorta (aortitis) can cause leakage of the aortic valve
valves, leading to heart failure and shortness of breath.
Acne
and nail changes are commonly seen in psoriatic arthritis. Pitting and ridges
are seen in fingernails and toenails of 80% of patients with psoriatic arthritis.
Interestingly, these characteristic nail changes are observed in only a minority
of psoriasis patients who do not have arthritis. Acne
has been noted to occur in higher frequency in patients with psoriatic
arthritis. In fact, a syndrome has been described that features
inflammation of the joint lining (synovitis), acne and pustules on the
feet or palms, thickened and inflamed bone (hyperostosis), and bone
inflammation (osteitis). This syndrome is, therefore, given the eponym SAPHO
syndrome.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Psoriasis is a long-term skin condition that may cause large plaques of red, raised skin, flakes of dry skin, and skin scales. There are several types of psoriasis, including psoriasis vulgaris, guttate psoriasis, inverse psoriasis, and pustular psoriasis. Symptoms vary depending on the type of psoriasis the patient has. Treatment of psoriasis may include creams, lotions, oral medications, injections and infusions of biologics, and light therapy. There is no cure for psoriasis.
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Costochondritis is inflammation of the cartilage where the ribs attach to the sternum. Tietze syndrome affects the same region of the chest and causes inflammation, tenderness, and swelling. Anti-inflammatory medications, rest, physical therapy, and cortisone injections are suitable methods of treatment for both costochondritis and Tietze syndrome.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Relapsing polychondritis is an uncommon, chronic disorder of the cartilage that is characterized by recurrent episodes of inflammation of the cartilage of various tissues of the body. Tissues containing cartilage that can become inflamed include the ears, nose, joints, spine, and windpipe (trachea). Tissues that have a biochemical makeup similar to that of cartilage such as the eyes, heart, and blood vessels, can also be affected. Nonsteroidal antiinflammatory medications (NSAIDs) is used as treatment for mild cases of the disease. Steroid-related medications also are usually required.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
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