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Understanding Psoriatic Arthritis

by Owen Wiseman, H.BSc., on 2 November 2017, Muscle and joint
psoriatic arthritis

From the Greek words psora, meaning itch, arthron, meaning joint, and itis, for inflammation, we have the condition, psoriatic arthritis. This disease presents with chronic inflammation of any joints due to an autoimmune reaction where our immune system attacks our own healthy skin and joint tissues by mistake.

These areas could include your neck, eyes, spine, wrists, elbows, fingers, ankles…the list continues.

At first, you may notice new patches of dry, red & elevated skin that come to resemble flaking scales due to an overproduction of skin cells. These areas are often itchy, and like a mosquito bite, you’ll probably be tempted to scratch. This can lead to the areas cracking and bleeding, opening the wound to potential infection.

After some time, you may notice new aches in your joints and sensations of pain. Many would simply tack this up to the wonders of aging, but this should be investigated by your primary care provider. While most people show symptoms of psoriasis before the arthritis, this is not always the case and many suffering could show signs of inflammation before abnormalities of the skin.

As with many other disease, this one can show up in a variety of forms:

  • Spondylitis: symptoms, such as stiffness or inflammation, in the spine and neck region
  • Distal: symptoms found at the end of limbs, such as fingers and toes
  • Symmetric: symptoms are found in the same region on both sides of the body
  • Asymmetric: symptoms are found on only one side of the body
  • Arthritis mutilans: the most severe form that can lead to deformation and destruction of joints

The most current research has focused on the link between sex hormones, more specifically, estrogen and prolactin, and their role as a potential contributor to the development of arthritis. The research, while interesting, remains inconclusive. This disease commonly occurs in women, and with higher levels of these hormones circulating through their bodies, this probably doesn’t come as much of a surprise. Before diving into what makes the disease occur, research is still inconclusive as to just how strong the relationship is between the hormones and psoriatic arthritis.

Prolactin

Prolactin is known as a neuroendocrine hormone, secreted by a structure in the brain (neuro), known as the pituitary gland, directly into the bloodstream (endocrine). Prolactin can also be secreted by white blood cells in our immune system known as macrophages, which are basically structures that gobble up any bad guys who may invade our system and let the more powerful cells know that there’s an intruder. Macrophages react to the presence of prolactin and release pro-inflammatory agents known as cytokines and chemokines. These agents can stimulate the development of new blood vessels in a process known as angiogenesis.

Between our joints is something known as synovial fluid which can be thought of like the oil in an engine, it keeps all the surrounding parts lubricated so they can move with minimal friction. Without this fluid, our joints would rub against one another, wearing down the adjacent structures, and causing a host of problems. Higher amounts of macrophages are found in the synovial fluid of those diagnosed with arthritis, and they also present higher levels of prolactin receptors. So when the prolactin circulating through the blood passes by a macrophage in the synovial fluid, that macrophage reacts, producing pro-inflammatory agents that lead to swollen joints. It is important to understand that while much of the research has looked at the role of sex hormones, other factors may be involved that cause the macrophage to respond in such a manner.

While the disease cannot be cured, here are some tips to manage the associated symptoms:

  • Develop coping strategies! Stress has an exacerbating effect on many conditions and could cause a psoriatic flare and even more painful inflammation of joints. Keeping a journal can be a wonderful way to identify triggers or situations that may increase your levels of stress, allowing you to mitigate them or avoid them all together. Other strategies could include exercise, meditation, calling a friend to vent, or cuddling a nearby animal…though we wouldn’t suggest that fluffy raccoon you come across during your walk.
  • Symptomatic aid. On those days when you find the pain to be too much, taking something such as Joint Pain Relief can provide support. These tablets are made of a herb known as Devil’s claw. Historically, this has been used as an anti-inflammatory and to relieve pain because of its antioxidant properties, scavenging tissue damaging components known as free radicals.
  • Exercise! Many diagnosed with any form of arthritis may experience a loss of bone mineral density and a loss of muscle mass because of the pain associated with certain motions. Aerobic exercises such as cycling, walking, or exercise in water, have been shown to reduce joint tenderness and improve range-of-motion. Progressive resistance training can reduce disease activity, inflammation, and pain.
  • Diet, diet, diet. Nutrition has such a profound and often speedy effect on our bodies. For managing psoriatic arthritis, turmeric is well-known for its potent anti-inflammatory properties and goes well with many meals. In addition, omega-3 fatty acids, found in high amounts in fish such as salmon and mackerel, are converted into anti-inflammatory agents in the body.
  • Visit your primary care provider! As always, the way to ensure you receive optimal treatment is to see your physician. Together, you can develop a plan that targets the inflamed joints and whole body health to improve your condition.

References:
http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/what-is-psoriatic-arthritis.php
http://dermatology.ca/public-patients/skin/psoriasis/
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/home/ovc-20233896
https://www.ncbi.nlm.nih.gov/pubmed/28642278
https://www.ncbi.nlm.nih.gov/pubmed/28690611
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042669/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342259/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400101/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755472/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144667/
https://www.psoriasis.org/treating-psoriasis/complementary-and-alternative/herbal-remedies

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