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Psoriatic arthritis

Other Names: Arthritis psoriatica,Arthropathic psoriasis or Psoriatic arthropathy

Definition:
Psoriatic arthritis is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin lesions appear.

Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis. They can affect any part of your body, including your fingertips and spine, and can range from relatively mild to severe. In both psoriasis and psoriatic arthritis, disease flares may alternate with periods of remission.

It is a type of inflammatory arthritis that will develop in up to 30 percent of people who have the chronic skin condition psoriasis. Psoriatic arthritis is classified as a seronegative spondyloarthropathy and therefore occurs more commonly in patients with tissue type HLA-B27.

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No cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to the joints. Without treatment, psoriatic arthritis may be disabling.

Classification:
There are five main types of psoriatic arthritis:

*Asymmetric: This type affects around 70% of patients and is generally mild. This type does not occur in the same joints on both sides of the body and usually only involves fewer than 3 joints.

*Symmetric: This type accounts for around 25% of cases, and affects joints on both sides of the body simultaneously. This type is most similar to rheumatoid arthritis and is disabling in around 50% of all cases.

*Arthritis mutilans (M07.1): Affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage. Arthritis mutilans has also been called chronic absorptive arthritis, and may be seen in rheumatoid arthritis as well.

*Spondylitis (M07.2): This type is characterised by stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis.

*Distal interphalangeal predominant (M07.0): This type of psoriatic arthritis is found in about 5% of patients, and is characterised by inflammation and stiffness in the joints nearest to the ends of the fingers and toes. Nail changes are often marked.

Symptoms:
*Pain, swelling, or stiffness in one or more joints is commonly present.

*Asymmetrical oligoarthritis (70%) (Involvement of the distal interphalangeal joints (DIP) is a characteristic feature).

*Sacroiliitis/spondylitis (40%)

*Symmetrical seronegative arthritis (15%)

*Distal interphalangeal joint arthritis (15%)

*Hand joints involved in psoriasis are proximal interphalangeal (PIP) + distal interphalangeal (DIP) + metacarpophalangeal (MCP) + wrist
Joints that are red or warm to the touch.

*Sausage-like swelling in the fingers or toes, known as dactylitis.

*Pain in and around the feet and ankles, especially tendinitis in the Achilles tendon or plantar fasciitis in the sole of the foot.

*Changes to the nails, such as pitting or separation from the nail bed.

*Pain in the area of the sacrum (the lower back, above the tailbone).

*Along with the above noted pain and inflammation, there is extreme exhaustion that does not go away with adequate rest. The exhaustion may last for days or weeks without abatement. Psoriatic arthritis may remain mild, or may progress to more destructive joint disease. Periods of active disease, or flares, will typically alternate with periods of remission. In severe forms, psoriatic arthritis may progress to arthritis mutilans which on X-ray gives pencil in cup appearance.

*Because prolonged inflammation can lead to joint damage, early diagnosis and treatment to slow or prevent joint damage is recommended.

*Scaly skin lesions are seen over extensor surfaces (scalp, natal cleft and umbilicus).

*The nail changes are pitting, onycholysis, sub–ungual hyperkeratosis and horizontal ridging.

Causes:
Psoriatic arthritis occurs when the body’s immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in your joints as well as overproduction of skin cells.

It’s not entirely clear why the immune system turns on healthy tissue, but it seems likely that both genetic and environmental factors play a role. Many people with psoriatic arthritis have a family history of either psoriasis or psoriatic arthritis. Researchers have discovered certain genetic markers that appear to be associated with psoriatic arthritis.

Physical trauma or something in the environment — such as a viral or bacterial infection — may trigger psoriatic arthritis in people with an inherited tendency.

Diagnosis:
There is no definitive test to diagnose psoriatic arthritis. Symptoms of psoriatic arthritis may closely resemble other diseases, including rheumatoid arthritis. A rheumatologist (a doctor specializing in diseases affecting the joints) may use physical examinations, health history, blood tests and x-rays to accurately diagnose psoriatic arthritis.

Factors that contribute to a diagnosis of psoriatic arthritis include:

*Psoriasis in the patient, or a family history of psoriasis or psoriatic arthritis.

*A negative test result for Rheumatoid factor, a blood factor associated with rheumatoid arthritis.

*Arthritis symptoms in the distal Interphalangeal articulations of hand (the joints closest to the tips of the fingers). This is not typical of rheumatoid arthritis.

*Ridging or pitting of fingernails or toenails (onycholysis), which is associated with psoriasis and psoriatic arthritis.

*Radiologic images indicating joint change.

*Other symptoms that are more typical of psoriatic arthritis than other forms of arthritis include inflammation in the Achilles tendon (at the back of the heel) or the Plantar fascia (bottom of the feet), and dactylitis (sausage-like swelling of the fingers or toes)

During the exam,the doctor may ask for the following tests:

Imaging tests:

*X-rays. Plain X-rays can help pinpoint changes in the joints that occur in psoriatic arthritis but not in other arthritic conditions.
Magnetic resonance imaging (MRI). MRI utilizes radio waves and a strong magnetic field to produce very detailed images of both hard and soft tissues in your body. This type of imaging test may be used to check for problems with the tendons and ligaments in your feet and lower back.
Laboratory tests:

*Rheumatoid factor (RF). RF is an antibody that’s often present in the blood of people with rheumatoid arthritis, but it’s not usually in the blood of people with psoriatic arthritis. For that reason, this test can help your doctor distinguish between the two conditions.

*Joint fluid test. Using a long needle, your doctor can remove a small sample of fluid from one of your affected joints — often the knee. Uric acid crystals in your joint fluid may indicate that you have gout rather than psoriatic arthritis.

Treatments:
The underlying process in psoriatic arthritis is inflammation; therefore, treatments are directed at reducing and controlling inflammation. Milder cases of psoriatic arthitis may be treated with NSAIDS alone; however, there is a trend toward earlier use of disease-modifying antirheumatic drugs or biological response modifiers to prevent irreversible joint destruction.

Nonsteroidal anti-inflammatory drugs:
Typically the medications first prescribed for psoriatic arthritis are NSAIDs such as ibuprofen and naproxen followed by more potent NSAIDs like diclofenac, indomethacin, and etodolac. NSAIDs can irritate the stomach and intestine, and long-term use can lead to gastrointestinal bleeding. Other potential adverse effects include damage to the kidneys and cardiovascular system.

Disease-modifying antirheumatic drugs:
These are used in persistent symptomatic cases without exacerbation. Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. Most DMARDs act slowly and may take weeks or even months to take full effect. Drugs such as methotrexate or leflunomide are commonly prescribed; other DMARDS used to treat psoriatic arthritis include cyclosporin, azathioprine, and sulfasalazine. These immunosuppressant drugs can also reduce psoriasis skin symptoms but can lead to liver and kidney problems and an increased risk of serious infection.

Biological response modifiers:
Recently, a new class of therapeutics called biological response modifiers or biologics has been developed using recombinant DNA technology. Biologic medications are derived from living cells cultured in a laboratory. Unlike traditional DMARDS that affect the entire immune system, biologics target specific parts of the immune system. They are given by injection or intravenous (IV) infusion.

Biologics prescribed for psoriatic arthritis are TNF-(alfa) inhibitors, including infliximab, etanercept, golimumab, certolizumab pegol and adalimumab, as well as the IL-12/IL-23 inhibitor ustekinumab.

Biologics may increase the risk of minor and serious infections. More rarely, they may be associated with nervous system disorders, blood disorders or certain types of cancer.

Other treatments:
Retinoid etretinate 30mg/day is effective for both arthritis and skin lesions. Photochemotherapy with methoxy psoralen and long wave ultraviolet light (PUVA) are used for severe skin lesions. Doctors may use joint injections with corticosteroids in cases where one joint is severely affected. In psoriatic arthritis patients with severe joint damage orthopedic surgery may be implemented to correct joint destruction, usually with use of a joint replacement. Surgery is effective for pain alleviation, correcting joint disfigurement, and reinforcing joint usefulness and strength.

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Lifestyle and home remedies

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Prognosis:
Seventy percent of people who develop psoriatic arthritis first show signs of psoriasis on the skin, 15 percent develop skin psoriasis and arthritis at the same time, and 15 percent develop skin psoriasis following the onset of psoriatic arthritis.

Psoriatic arthritis can develop in people who have any level severity of psoriatic skin disease from mild to very severe.

Psoriatic arthritis tends to appear about 10 years after the first signs of psoriasis. For the majority of people this is between the ages of 30 and 55, but the disease can also affect children. The onset of psoriatic arthritis symptoms before symptoms of skin psoriasis is more common in children than adults.

More than 80% of patients with psoriatic arthritis will have psoriatic nail lesions characterized by nail pitting, separation of the nail from the underlying nail bed, ridging and cracking, or more extremely, loss of the nail itself (onycholysis).

Men and women are equally affected by this condition. Like psoriasis, psoriatic arthritis is more common among Caucasians than Africans or Asians

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Psoriatic_arthritis
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/tests-diagnosis/con-20015006
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/causes/con-20015006
http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/definition/CON-20015006

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Healthy Tips

Happiness Wards off Heart Disease

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Being happy and staying positive may help ward off heart disease, a study suggests.

US researchers monitored the health of 1,700 people over 10 years, finding the most anxious and depressed were at the highest risk of the disease.

They could not categorically prove happiness was protective, but said people should try to enjoy themselves.

But experts suggested the findings may be of limited use as an individual’s approach to life was often ingrained.

At the start of the study, which was published in the European Heart Journal, participants were assessed for emotions ranging from hostility and anxiousness to joy, enthusiasm and contentment.

They were given a rating on a five-point scale to score their level of positive emotions.

By the end of the analysis, some 145 had developed heart disease – fewer than one in 10.

But for each rise in the happiness scale there was a 22% lower risk of developing heart disease.

The team believes happier people may have better sleeping patterns, be less liable to suffer stress and be more able to move on from upsetting experiences – all of which can put physical strain on the body.

“Essentially spending a few minutes each day truly relaxed and enjoying yourself is certainly good for your mental health and may improve your physical health as well” Says  Dr Karina Davidson

Lead researcher Dr Karina Davidson admitted more research was needed into the link, but said she would still recommend that people try to develop a more positive outlook.

She said all too often people just waited for their “two weeks of vacation to have fun” when instead they should seek enjoyment each day.

“If you enjoy reading novels, but never get around to it, commit to getting 15 minutes or so of reading in.

“If walking or listening to music improves you mood, get those activities in your schedule.

“Essentially spending a few minutes each day truly relaxed and enjoying yourself is certainly good for your mental health and may improve your physical health as well.”

It is not the first study to suggest there is a link between happiness and health.

But Ellen Mason, of the British Heart Foundation, suggested such an association may be of limited value anyway.

“We know that improving your mood isn’t always easy – so we don’t know if it’s possible to change our natural levels of positivity.”

Cardiologist Iain Simpson, of the British Cardiovascular Society, added: “Things like reducing cholesterol and diabetes are more important when it comes to reducing heart disease.

“But at the end of the day it heart disease is still the biggest killer  so anything you can do to help should not be ignored.”

Source : BBC News: Feb.18th.2010

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Now, Heart Can be Repaired Through the Wrist

For the first time, cardiologists at the University of Illinois and Jesse Brown VA medical centers have repaired an ailing heart by clearing Now, heart can  blocked arteries via the wrist.
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Called transradial angiography, the approach might lead to reduced patient complications and recovery time and decreased hospital costs. The cardiologists offered the approach to heart angiograms and clearing blocked arteries.

In the procedure, a catheter is threaded through the small radial artery in the wrist rather than the larger femoral artery in the groin.

“It’s a simple change that has a dramatic impact on the experience and recovery of the patient,” said Dr. Adhir Shroff, assistant professor of cardiology at UIC.

The transradial approach can reduce bleeding— the most common complication, particularly among women and the elderly— to under 1 percent. It also eliminates much of the discomfort associated with the procedure.

After a standard angiogram and angioplasty through the femoral artery, the patient needs to lie still on his or her back for four to six hours.

Shroff said that this can be very uncomfortable for elderly patients with back problems and walking can be uncomfortable for days.

On the other hand, patients who have the procedure done via the wrist can immediately sit up, eat, and walk without pain, said Shroff.

“The issue is really just the learning-curve. The change requires dozens of small changes — everything from redesigning the sterile drape so that the openings are at the wrist rather than the leg and finding smaller needles, wires and catheters to the way the table is set up,” said Shroff.

Source: The Times Of India

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Diagnonistic Test

Electrophysiological Testing of the Heart

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Definition:
An electrophysiology (EP) study is a test that records the electrical activity and the electrical pathways of your heart. This test is used to help determine the cause of your heart rhythm disturbance and the best treatment for you. During the EP study, your doctor will safely reproduce your abnormal heart rhythm and then may give you different medications to see which one controls it best or to determine the best procedure or device to treat your heart rhythm.
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Sometimes doctors will recommend a treatment called ablation that can be done during EPS testing. Ablation uses electricity to kill the cells in the heart muscle that seem to cause the abnormal rhythm.

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Why Do you Need an Electrophysiology Study?
*To determine the cause of an abnormal heart rhythm.

*To locate the site of origin of an abnormal heart rhythm.

*To decide the best treatment for an abnormal heart rhythm.

Sometimes an EP study is conducted before implantable cardioverter/defibrillator (ICD) placement to determine which device is best and afterwards to monitor treatment success.

How do you prepare for the test?
*You will need to sign a consent form giving your doctor permission to perform this test. Tell your doctor if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Also tell your doctor if you have ever had an allergic reaction to any heart medicines.

*Talk with your doctor ahead of time if you are taking insulin, or if you take aspirin, nonsteroidal antiinflammatory drugs, or other medicines that affect blood clotting. It may be necessary to stop or adjust the dose of these medicines before your test. Most people need to have a blood test done some time before the procedure to make sure they are not at high risk for bleeding complications.

*Your doctor may tell you not to eat anything for 12 or more hours before the test. A few people require an anti-anxiety medicine which occasionally causes nausea, and therefore some doctors prefer to have you come with an empty stomach. You might need to plan to spend the night in the hospital afterwards for recovery.

*Ask your doctor what medications you are allowed to take. Your doctor may ask you to stop certain medications one to five days before your EP study. If you have diabetes, ask your doctor how you should adjust your diabetes medications.

*Do not eat or drink anything after midnight the evening before the EP study. If you must take medications, take them only with a small sip of water.

*When you come to the hospital, wear comfortable clothes. You will change into a hospital gown for the procedure. Leave all jewelry or valuables at home.

*Your doctor will tell you if you can go home or must stay in the hospital after the procedure. If you are able to go home, bring a companion to drive you home.

What happens when the test is performed?
The test is done by a specialist using equipment and cameras in the cardiology department. You wear a hospital gown and lie on your back during the procedure. You have an IV (intravenous) line placed in a vein in case you need medicines or fluid during the procedure. Your heart is monitored during the test.

A catheter (a hollow, sterile tube that resembles spaghetti) is inserted through the skin into a blood vessel-typically in your groin, but possibly in the neck or arm. Before the catheter is placed, medicine through a small needle is used to numb the skin and the tissue underneath the skin in that area. The numbing medicine usually stings for a second. A needle on a syringe is then inserted, and some blood is drawn into the syringe, so that the doctor knows exactly where the blood vessel is located. One end of a wire is threaded into the blood vessel through the needle and the needle is pulled out, leaving the wire temporarily in place. This wire is several feet long, but only a small part of it is inside your blood vessel. The catheter can then be slipped over the outside end of the wire and moved forward along it like a long bead on a string, until it is in place with one end inside the blood vessel. The wire is pulled out of the catheter, leaving the catheter in place. Now the catheter can be moved easily forwards and backwards inside your blood vessel by the doctor, who holds the outside end of the catheter while using special controls to point the tip of the catheter in different directions. The doctor carefully moves the catheter to the large blood vessels in your chest and into the chambers of your heart.

As your physician maneuvers the catheter, he or she watches a live video x-ray to know exactly where the catheter is. Instruments on the tip of the catheter allow it to sense electrical patterns from your heart and also to deliver small electrical shocks to the heart muscle (or a stronger electrical burn if you are having ablation). The electrical shocks, too small for you to feel, are used to “tickle” the heart muscle in different places to see if your abnormal rhythm is triggered by one sensitive area of your heart. If the rhythm changes, your doctor gives you small doses of different medicines through this catheter to see which ones work best to change the rhythm back to normal. In some cases the doctor may need to give your heart some additional mild shocks to get it back into a normal rhythm. Because this catheter is in place inside your heart and can give the shocks directly to the heart muscle, very small amounts of electricity are used.

After the catheter has been pulled out, a pressure bandage (basically a thick lump of gauze) is taped tightly to your groin to reduce bleeding. The test usually requires one to two hours to perform.

Many patients are able to feel palpitations (an irregular or fast heartbeat) from the rhythm changes. A few patients also experience shortness of breath or dizziness when they are not in a normal heart rhythm. Other than the brief sting of the numbing medicine and some soreness in your groin area afterward, you are not likely to feel any pain. For some people, the procedure provokes anxiety. Some patients also have a difficult time lying still for the time it takes to perform this test.
What Can you Expect During the Electrophysiology Study?
*You will lie on a bed and the nurse will start an intravenous (IV) line into your arm or hand. This is so you can receive medications and fluids during the electrophysiology study. You will be given a medication through your IV to relax you and make you drowsy, but it will not put you to sleep.

*The nurse will connect you to several monitors.
Your groin will be shaved and cleansed with an antiseptic solution. Sterile drapes are used to cover you, from your neck to your feet. A soft strap will be placed across your waist and arms to prevent your hands from coming in contact with the sterile field.

An electrophysiologist (a doctor who specializes in the diagnosis and treatment of abnormal heart rhythms) will numb your groin with medication and then insert several catheters into the vein in your groin. Guided by the fluoroscopy machine, the catheters are threaded to your heart. The catheters sense the electrical activity in your heart and are used to evaluate your heart’s conduction system. The doctor will use a pacemaker to deliver the electrical impulses through one of the catheters to increase your heart rate.

You may feel your heart beating faster or stronger. Your nurses and doctor will want to know about any symptoms you are feeling. If your arrhythmia occurs, your doctor may give you medications through your IV to test their effectiveness in controlling it. If necessary, a small amount of energy may be delivered by the patches on your chest to bring back a normal heart rhythm. Based on the information collected during the study, the doctor may continue with an ablation procedure or device implant (pacemaker or ICD).

The EP study takes about two to four hours to perform. However, it can take longer if additional treatments such as catheter ablation are performed at the same time.

Risk Factors:
There are significant risks from this procedure. Most important, some abnormal heart rhythms (arrhythmia) can be life-threatening, and your doctors will purposefully cause you to go through a few extra episodes of arrhythmia during the testing. If your doctors recommend electrophysiologic testing, they feel that this is a risk worth taking because it will allow them to take better care of you in the future. Because you are right in the lab and attached to a monitor while you undergo the rhythm changes, it is easy for them to treat you should your arrhythmia occur and cause you symptoms.

Ablation has some additional risks, because it intentionally causes some scarring of a small part of the heart muscle. Complications are rare, but new rhythm changes can occur. A very rare complication occurs if the ablation instrument burns a hole through the heart muscle. This causes bleeding and may require immediate surgery.

There are some more minor risks from the test. Among them is bleeding from the place where the catheter was inserted. If bleeding occurs but the blood collects under the skin, it can form a large painful bruise called a hematoma. A few people are allergic to the medicines used in the procedure, and this can cause a rash or other symptoms.

Must you do anything special after the test is over?
You will need to lie flat for around six hours after this procedure. If you received anti-anxiety medicine through your IV during the procedure, you might feel sleepy at the end of the procedure and you might not remember much of the test. You should not drive or drink alcohol for the rest of the day.

Depending on what happened during your test, you might need to wear a heart monitor in the hospital for a few hours or overnight.

What Happens After the EP Study?
The doctor will remove the catheters from your groin and apply pressure to the site, to prevent bleeding. You will be on bed rest for about one to two hours.

An EP study can be frightening, but this test allows the doctor to decide the best treatment for you. In many cases, EP testing and the therapy following can greatly reduce the likelihood of spontaneous arrhythmia. If you have any questions, do not hesitate to ask your doctor or nurse.

How long is it before the result of the test is known?
Your doctors can tell you how the testing went as soon as it is over. If you had ablation done, the results will not be certain until you have had some time to see if your arrhythmia seems to be under control after the treatment.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/electrophysiological-testing-of-the-heart.shtml
http://www.webmd.com/heart-disease/guide/diagnosing-electrophysiology

http://www.londoncardiac.ca/pages/bfs.html

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Stem Cell Therapy Newsletter.

Theravitae trumpets cardiomyopathy treatment success :
Millions of cardiomyopathy patients have been told their future lies in drugs or, rarely, a transplant as they await an otherwise certain death. This is no longer true as Theravitae s VesCell therapy is giving them a new, more active and longer life.
BANGKOK, Thailand, 24 August 2007  VesCell, the world’s leading adult stem cell product for heart patients is transforming the lives of dilated cardiomyopathy patients. These patients are gaining a new lease on life and leading more active and energetic lives with fewer distressing symptoms such as shortness of breath.

Theravitae is determined to lay to rest the myth that all severely ill heart patients can look forward to is a gradual decline in the quality of life, suffering, dependence on a cocktail of drugs and an early death. The more patients can demonstrate clinically measurable improvements the more the medical establishment will be forced to face the fact that objective measures do not lie.

Citing Amy Banner, a young wife and mother with cardiomyopathy from Spokane,Washington, Theravitae believes its therapy has measurable clinical benefits that can only be attributed to stem cell therapy. Just one month after receiving VesCell in Bangkok Heart Hospital Amy had her first follow-up appointment with her hometown cardiologist to learn the following clinical results.

Firstly, the report on her Premature Ventricular Contractions (PVCs) as recorded by her pacemaker. These contractions are like an extra heartbeat coming from an irritable area in the struggling ventricles and indicate rhythm disturbances. Prior to stem cell therapy Amy was experiencing some 35,000 uncomfortable PVCs a month. In the last month she recorded only 2200. No wonder I am feeling so good! she said.  This alone made it all worthwhile and now I don’t even notice them they are so mild, or maybe they are happening in my sleep.

Secondly, Amy’s cardiologist told her that her heart had shrunk from 8.7cm to 8cm and that as the left ventricle shrunk further her Ejection Fraction, which measures the ability of the ventricle to pump blood to her body, would rise further as efficiency increased.

Thirdly, Amy had a BNP blood test which measures a secretion in the ventricle indicating the degree of heart failure. From a dangerous level of 3000 she was told it now was 190  almost in the normal range.

For Amy the clinical measurements just added weight to how she was feeling. The bottom line is that I feel great. I have way more energy. My mom is no longer doing my housework and laundry for me. I can walk and play with my seven-year old daughter. Everything is running along very smoothly,  she said. Prior to stem cell therapy Amy could do little and as she deteriorated even small things like taking a shower or washing her hair became more of a challenge.

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Source:Vescell <pr@theravitae.com>

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