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 diagnosis made mainly on clinical
grounds, based on the finding of psoriasis and the typical inflammatory arthritis
of the spine and/or other joints. There is no laboratory test to diagnose psoriatic
arthritis. Blood tests such as sedimentation
rate may show an abnormal elevated result and merely reflect presence of inflammation in the
joints and other organs of the body. Other blood tests, such as rheumatoid factor are obtained to exclude rheumatoid arthritis. When one or two large joints (such a knees) are inflamed,
arthrocentesis
can be performed. Arthrocentesis is an office procedure
whereby a sterile needle is used to withdraw (aspirate) fluid from the
inflamed joints. The fluid is then analyzed for infection, gout crystals,
and other inflammatory conditions. X-rays may show changes of cartilage or bone injury indicative of
arthritis of the spine, sacroiliac joints, and/or joints of the hands. Typical
X-ray
findings include bony erosions resulting from arthritis, but these may not be present in early disease. The blood test
for the genetic marker HLA-B27, mentioned above, is often performed. This marker can be found in over 50% of patients with
psoriatic arthritis who have spine inflammation.
What is the treatment for psoriatic arthritis?
The treatment of the arthritis aspects of psoriatic arthritis is discussed below. The treatment of
psoriasis and the other involved organs is beyond the scope of this
article.
Generally, the treatment of arthritis in psoriatic arthritis
involves a combination of anti-inflammatory medications (NSAIDs) and exercise. If
progressive inflammation and joint destruction occur despite NSAIDs
treatment, more potent medications such as methotrexate (Rheumatrex, Trexall), corticosteroids, and
antimalarial medications (such as hydroxychloroquine, or Plaquenil) are
used.
Exercise programs can be done at home or with a physical therapist and
are customized according to the disease and physical capabilities of each
patient. Warm-up stretching, or other techniques, such as a hot shower or
heat applications are helpful to relax muscles prior to exercise. Ice
application after the routine can help minimize post-exercise soreness and inflammation. In
general, exercises for arthritis are performed for the purpose of
strengthening and maintaining or improving joint range of motion. They
should be done on a regular basis for best results.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications
that are helpful in reducing joint inflammation, pain, and stiffness.
Examples of NSAIDs include aspirin, indomethacin (Indocin), tolmetin
sodium (Tolectin), sulindac (Clinoril), and diclofenac (Voltaren). Their
most frequent side effects include stomach upset and ulceration. They can
also cause gastrointestinal bleeding. Newer NSAIDs called COX-2 inhibitors (such as celecoxib or Celebrex) cause gastrointestinal problems less frequently.
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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