(gentle piano) – Psoriatic arthritis, in short called PSA, is a rheumatologic disease, and about one in three people with the skin disease psoriasis, tend to get psoriatic arthritis. It affects the joints as well as the tendons, and it may also affect the spine. In addition to symptoms, if untreated, it can lead to decreased function in people, as well as to disability and joint and tendon damage. (gentle piano) So in most people, it’s going to start off with a skin rash, with psoriasis. Most people develop psoriasis about 10 to 20 years before being diagnosed with psoriatic arthritis. They may also develop nail psoriasis, which is much more frequent in psoriatic arthritis. (soft delicate music) To be honest, there is no specific thing that we have discovered causes psoriatic arthritis. It’s certainly what we call a multifactorial rheumatologic disease.
Genes definitely play a role. That’s why we see that psoriatic arthritis is clustered in people with a skin disease psoriasis, and then even more frequent in people who have nail psoriasis. There are a number of genes that have been discovered to increase risk for psoriasis and for psoriatic arthritis, but there’s no single gene that explains everything. It’s rather a combination of being at risk from a genetic standpoint, and then in addition to that, there may be something in the environment that may be causing this, something like perhaps an infection that we don’t know about or perhaps exposure.
Another risk factor is being overweight or obese, and the theory behind that, it’s again, it’s just theory, it’s not yet proven, but part of the thought, part of the thinking that goes into the relationship of obesity with psoriatic arthritis is that perhaps those people have more wear and tear, and those places where we get wear and tear are, for example, where tendons insert on joints or the joints in the feet would be places where inflammation can more easily start in people who are genetically predisposed.
And then of course we know that fat tissue, adipose tissue is a site that favors inflammation, is a pro inflammatory type of tissue, so that could play a role as well. Specifically for psoriatic arthritis trauma, there are now a number of longitudinal studies that show that people who have had joint trauma, joint injury, are more likely to develop psoriatic arthritis in the future than people who didn’t have this.
And again the relationship is small, but because there are so many things that increase this risk perhaps every little bit counts and adds up. That’s how I see all these factors play a role into developing psoriatic arthritis. So it’s not your fault, it’s the genes in part, it’s environmental factors in part. I’m pretty sure it’s a bunch of other things as well that we are just starting to discover. (soft delicate music) There are studies that show that people who develop psoriatic arthritis and have access to rheumatologic treatment within six months, are the people who develop less damage and disability in the long term.
So I think we can’t change that, it’s developed and it’s there, but definitely managing it promptly and using state of the art treatment and treatment strategies has an impact on long term prognosis..
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