If you were to ask just about anyone on the street what psoriasis is, almost everyone can give you some idea about it.  It is not an uncommon disorder of the skin.  What is very uncommon and sometimes goes undiagnosed, however, is an arthropathy (disease or pathology of the joints) called psoriatic arthritis.  In keeping with my recent pattern of discussing arthropathies, I thought it was a good idea to bring up psoriatic arthritis.  Psoriasis is an aggravating and sometimes embarrassing problem.  I was riding on an airport shuttle the other day with a friend of mine who happens to have psoriasis, and someone asked out of the blue, “Oooohhh.  What happened to your knee?”  Of course nothing had happened.  This sort of encounter happens all the time and the usual explanation that it is not a scrape but is psoriasis ensued.

Psoriasis is a skin disorder which affects about 3 million Americans, according to the American College of Rheumatology.  It is characterized by a thick, rough, scaly sort of rash that appears most commonly on the elbows, knees, and scalp.  It can also occur on areas of the body where there are skin folds.  Some of the more severe cases involve pitting of the nails or thickening of the nails which causes the nails to lift off the surface of the fingers.  Some sufferers also experience a burning or itching sensation in the eyes.  In a person without psoriasis the skin replaces itself about once a month from the inside out.  New layers of skin form underneath as the old outer layers slough off.  If a person has psoriasis, however, this skin layer replacement happens much too quickly.  Rather than taking a month or more to replace itself, it takes only a few days.  The outer layers of skin don’t have time to slough off before a new layer is ready to take over.  This results in a buildup of dead skin cells which causes an itchy thick patch of skin to form.  These areas might be red, cracked, and raised or they might have a silvery scale appearance.  Psoriasis is not contagious, so coming into contact with the skin which is affected by it is harmless.

In roughly ten percent of the people with psoriasis, psoriatic arthritis develops.  Psoriatic arthritis is an inflammatory type of arthritis in which the soft tissues and the capsule which holds lubricating fluid for joints become irritated, swollen, and very painful.  It causes symptoms very similar to the ones caused by rheumatoid arthritis, but rheumatoid usually affects the wrists and joints closer to the wrist in the hand.  Most commonly the small joints of the fingers and toes closest to the ends of the digits are involved in psoriatic arthritis.  In most cases the arthritis associated with psoriasis is a mild form that affects fewer than four joints in the body, but in five percent of the cases a form of the disease called psoriatic arthritis mutilans develops. This form of the disease attacks the joint itself and not just the soft tissue surrounding the joint.  This results in severe deformation of primarily the joints in the hands and feet.

There is no particular known cause of psoriasis and psoriatic arthritis.  Some doctors suggest that heredity plays a role since forty percent of those with these conditions have at least one family member with the disorder.  The symptoms of the disease are sometimes made more severe if the sufferer is immunosuppressed such as those who are taking chemotherapy and those with HIV.  Stress, lack of or overexposure to the sun, injury to the skin, or some insect bites can aggravate the condition also.  There is no known cure for psoriasis or psoriatic arthritis, but the conditions are definitely treatable.

As hard as it might be for people whose joints are inflamed, exercise is one of the very best things for them.  Often the pain associated with arthritis is alleviated when the joints are put into motion.  Exercise definitely achieves this actively, while chiropractic adjustments achieve this passively.  Patients who suffer from arthropathies benefit greatly from joint mobilization which is achieved by chiropractic.  Your chiropractor can study x-rays of your joints and thereby determine the degree of mobilization which is safe for you.

A diet low in saturated fats is helpful, and some supplements have been found to have merit.  While there are no double-blind studies to confirm it, evening primrose oil and some of the fish oils are known to be of great benefit in reducing the inflammation associated with psoriatic arthritis.

It is difficult sometimes to manage chronic conditions for which there is no known cure.  It often is an issue of trial and error, and early detection is essential to getting a handle on this and any other inflammatory condition.  Like wildfires out of control, inflammatory arthropathies can consume what is left of comfortable quality of life for those who have them.  If you suspect that you might have one, do your homework.  Find out what works for you, and treat your body well.