Up to 15-30 percent of psoriasis sufferers will develop psoriatic arthritis. Psoriatic arthritis usually develops between the ages of 20 and 50, and is uncommon in children.
However, when the disease occurs in children, its development differs from that of adults. For example, in childhood, psoriatic arthritis affects females at three times the rate of males, whereas, in adulthood, women and men are affected equally. In addition, psoriatic arthritis develops before psoriasis in about 50 percent of children, compared to only 5 percent of adults. Almost 85 percent of adults with psoriatic arthritis develop psoriasis first.
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| Rheumatoid Arthritis Psoriasis |
Alice is a 55-year-old woman who has been married for thirty-five years, and has three daughters and five grandchildren. She is an enthusiastic, positive source of energy. I had the opportunity to meet her when her family doctor asked me to see her for scaly, red, raised areas of skin.
A year before I saw her, Alice's scalp began to itch and was scaly. After a few weeks of dealing with this symptom, she noticed patches of scaling, red skin developing on her legs. Her family doctor correctly diagnosed it as mild psoriasis, and she was started on a topical steroid cream and calcipotriol (Dovonex, Daivonex), a vitamin D-based cream. The topical creams had a modest effect in improving her symptoms; however, the affected areas would tend to recur as soon as the creams were stopped and, despite increasing strengths of topical steroids, new areas were appearing.
Alice was also developing two new problems. About eight months after Alice's first symptoms, she noticed that several of her nails were lifting from the skin. In addition, they were developing fine pits, as if a needle had been used to prick the surface of the nail, leaving multiple small defects in the nail plate. They were also becoming yellow, discolored, and thickened. Particularly troublesome was the fact that her right hip, both knees, and right ankle were becoming tender, swollen, and painful, as were her right index finger and the base of her left index finger. Alice was finding this arthritis crippling to the point where she could not pick up her grandchildren, and she was finding it difficult to sleep because of pain. Walking distances was becoming troublesome. She noted that the stiffness could improve sometimes throughout the day; however, it would tend to recur after a period of inactivity.
When I examined Alice, she had the classic symptoms of psoriasis in the scalp and elsewhere on the body. There were thick, red, well-demarcated patches and plaques involving approximately 15 percent of her body, particularly on the lower legs, arms, and scalp. Her fingernails had characteristic changes of psoriasis. She had obvious redness and swelling of the fingers, and these were painful and stiff on examination. Her fourth left toe had a characteristic change of psoriatic arthritis as there was diffuse swelling of the toe, and the skin was shiny and tight.
Given that she had extensive psoriasis and psoriatic arthritis, I explained to Alice that she would need a medication, taken orally or by injection, that would treat both of these conditions. Before starting this, we did some initial blood work, which revealed that she had a very mild anemia; tests for the rheumatoid factor and antinuclear antibody were both negative. I also ordered some X-rays of her joints and referred her to a rheumatologist for assessment and management of her painful joints. Given the extent of her psoriasis, we elected to start her on methotrexate (Rheumatrex) (15 milligrams), by mouth, once weekly.
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| Rheumatoid Arthritis Psoriasis |
When I saw her again three months later, Alice had had an excellent response to the methotrexate with clearing of almost all of her psoriasis. By this time, she had seen the rheumatologist, who had agreed that methotrexate was an appropriate choice for her psoriatic arthritis. Her joint symptoms were slower to improve, but she was making definite progress, with a reduction in the swelling and stiffness.
Alice was extremely happy with her progress and was encouraged by the fact that her activities had resumed to almost normal levels. To find out more, you can check out Rheumatoid Arthritis Psoriasis.