Category Archives: Psoriatic arthritis

The arthritis of psoriasis

What’s a “sausage finger” or “sausage toe”?

Many types of arthritis can cause a sausage digit.  The technical term for this is “dactylitis.”sausage-toe

This is not the kind of sausage you would have with your eggs and pancakes.

Sausage digits are typically seen in conditions such as psoriatic arthritis (the arthritis that accompanies psoriasis), Reiter’s disease, inflammatory bowel disease, and occasionally ankylosing spondylitis.  Of these, psoriatic arthritis is probably the most common culprit. Dactylitis means inflammation of an entire finger or whole toe.

It is caused by inflammation involving the synovium (lining of the joint) as well as the lining of the tendon sheath.  Tendons are tough fibrous bands that connect muscles to bones.  Most tendons glide through a lubricated sheath lined with synovium. When the synovium in the joint and the tendon sheath becomes inflamed, the entire finger or toe will swell.

The tendons that are most often affected are the tendons that allow a person to bend or flex their fingers or toes.

If a patient has dactylitis, their prognosis is poorer in that the joints are more likely to sustain damage.  The presence of dactylitis indicates a greater chance for disease progression.

Early on, dactylitis may be extremely painful.  However, over time, as destructive changes occur, the inflamed tissue is replaced with bony deformity and the dactylitis no longer causes severe pain.  However, the swelling persists.

The presence of dactylitis should prompt a diagnostic workup.  Diagnosis can be substantiated by magnetic resonance imaging (MRI).  Recently, diagnostic ultrasound has also been found to be helpful.

The treatment of dactylitis depends on the number of digits affected.  If only a few fingers or toes are involved, ultrasound-guided steroid injection can be helpful for the acute situation.

However, the more important part of treatment is to initiate disease modifying therapy as soon as possible.

Generally, the dactylitis is often accompanied by enthesitis.  This is inflammation at tendon insertions such as the Achilles tendon, patellar tendon (the tendon that connects the kneecap to the tibia-lower leg bone, and the iliac crest.

Every disease that causes dactylitis is a systemic disease.  This is because the underlying pathology involves an abnormal immune response. So other organ systems can become affected.  An example is the eye where uveitis- inflammation of the middle layer of the eye- can occur.  Uveitis is a potentially serious complication that can lead to blindness.

Institution of drugs like methotrexate or sulfasalazine (Azulfidine) may be useful.

However, most patients will require the use of biologic therapies.

For more information on  arthritis treatments and other arthritis problems go to:

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Don’t be a victim of arthritis myths… Arthritis treatment is effective!

Ashley Macha, writing in Health online, reported on four arthritis myths.  This was done as part of a May is Arthritis Awareness Month campaign, featuring Joe Montana, Hall of Fame quarterback.

1. Myth: Arthritis only affects the aging.  Reality: This is the most common misconception. Anyone, at any age can be affected, according to the Arthritis Foundation. The most common type is osteoarthritis, the kind due to wear and tear on the joints over time (which is what Montana has), but also rheumatoid arthritis, an autoimmune disease that can occur at any age, juvenile arthritis, an autoimmune disease in children, and other types.

2. Myth: Joint health is not a serious issue. Reality: The population of those with arthritis in the United States is increasing, with approximately 70 million Americans predicted to have arthritis by 2030. It is the number one cause of disability in the United States.

3. Myth: Patients with arthritis should avoid exercise. Reality: The Arthritis Foundation recommends starting out walking or doing water workouts. Montana lifts weights to keep his muscles in shape. “When muscles are strong, it takes pressure off them [joints].” Patience White, MD, and vice president of public health for the Arthritis Foundation says resistance training can provide numerous benefits for those who suffer from arthritis. Dr. White recommends simple exercises, including hamstring and calf stretches, or weightlifting with something as simple as 16-ounce soup cans.

4. Myth: There is no treatment for arthritis. Reality: “I always thought initially that there was nothing you could do to help to ease your everyday life,” Montana said. There are medication and treatments, as well yoga moves to help ease pain, natural remedies, and new treatments are in the pipeline. Treatment also varies with the type of arthritis. There are more than 100 different kinds of arthritis and each is treated differently.

There are many other myths but the key points to remember are that arthritis, when diagnosed early is very treatable and that newer treatments such as stem cell therapy for osteoarthritis look extremely promising.

For more information on arthritis treatments and other arthritis problems,  go to:

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TNF Inhibitors and the Placenta… Which Should You Worry About During Pregnancy?

Mary Ann Moon writing in Rheumatology News reported on the conclusions of two studies. One concern rheumatologists have had is what to do about pregnant patients who are on TNF inhibitors.  Two observational studies (one from University California San Francisco and the other from Erasmus Medical Center, pregnant-womanRotterdam) provide some information.

The upshot is that stopping Remicade and Humira at the end of the second trimester reduces the amount of antibody transferred to the infant and shortens the time for the infant to clear the antibody. Cimzia doesn’t need to be stopped since it doesn’t cross the placenta.

Comment: This is important since it reduces the likelihood of opportunistic infection in the infant.

For more information on arthritis treatments and other arthritis problems,  go to:

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And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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Long-Term Humira Use … Few Adverse Events

Nancy Walsh writing in MedPage Today reported, “Long-term immunosuppressive treatment with Humira,  a TNF inhibitor drug used in humiradiseases such as rheumatoid arthritis and psoriatic arthritis,  is associated with low rates of adverse events such as serious infections and malignancies, with differences being seen according to the underlying disease,” according to  a study published in the Annals of the Rheumatic Diseases.

Investigators found that “the most frequently reported serious adverse events across indications were infections.” The study indicated that “the most common infections among patients with rheumatoid arthritis were cellulitis – occurring at a rate of 0.3 per 100 patient-years – and pneumonia, seen at a rate of 0.7 per 100.”

For more information on arthritis treatments and other arthritis problems,  go to:

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And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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Anti-TNF Medications Lead To Higher Shingles Risk In RA Patients

One of the most painful and debilitating conditions is shingles.  Find out what a recent study showed…shingles

Nancy Walsh writing in MedPage Today reported, “Patients with rheumatoid arthritis (RA) undergoing treatment with agents such as Enbrel (etanercept), Remicade (infliximab) or Humira (adalimumab) appear to have a significantly increased risk for developing shingles,” according to a study published in the Annals of the Rheumatic Diseases. Researchers found that “the incidence of shingles among patients on anti-tumor necrosis factor (TNF) treatment was 1.6 per 100 patient-years, compared with an incidence of 0.8 per 100 patient-years among those receiving traditional disease-modifying anti-rheumatic drugs (DMARDs).”

Comment: What can I say?  These are worrisome findings and indicate that people with RA on biologics should be vaccinated.

For more information on arthritis treatments and other arthritis problems,  go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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Apremilast (Celgene) Effective in Psoriatic Arthritis

From the American College of Rheumatology…

Apremilast (Celgene), an investigational oral small-molecule inhibitor of phosphodiesterase 4 (PDE4), led to significant improvement in the signs and symptoms of psoriatic arthritis in patients who failed to respond to recommended drugs, including DMARDs and biologics, in the phase 3 PALACE-1 trial.

psoriasisLead investigator Arthur Kavanaugh, from University of California, San Diego, who reported the results, said the drug was “well tolerated and has a good side-effect profile.”

Psoriatic arthritis is a very common type of arthritis and unlike what many physicians think, is not the same as rheumatoid arthritis and must be treated differently.

For more information on arthritis treatments and other arthritis problems,  go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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What’s a good exercise program for arthritis?

This is one of the most asked questions when it comes to arthritis.

Exercise is an often neglected form of treatment.  I consider it as important for an arthritis patient as medication.

exercise-clipartThe three types of exercise an arthritis patient should engage in are:
1. Low impact cardio (bike, swimming, elliptical trainer).  Cardio helps with overall conditioning as well as increasing blood flow to joints.
2. Resistance (weights). Resistance training strengthens muscles that help support joints.
3. Stretching . Stretching prevents injury and keeps joints flexible. One very good form of stretching is yoga.

Exercise should be done on a daily basis.  I know this runs counter to the idea that a day of rest is needed.  The day of rest should be devoted to stretching.

Now these are general guidelines since some patients are much more into exercise than others. There are quite a few people with arthritis who are competitive athletes.

Bottom line: If you are relatively sedentary, you should start out very slowly and know your limits.  Consultation with a physical therapist is a good idea.

If you already are an experienced athlete, then you will be able to design a program that incorporates the above three components.

As a rheumatologist who also has osteoarthritis, I exercise regularly but know what I can and cannot do. One last important point is to set some goals before you start.  That will help keep you on track.

For more information on  arthritis treatments and other arthritis problems go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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Are anti-TNF drugs worth the cost?

No question… anti-TNF drugs, the new biologics that are used to treat diseases like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, are expensive. Are they worth the cost?anti-tnf-drugs

A new study says they are…

Susan London writing in Rheumatology News reported that a study presented at the Canadian Rheumatology Association from the Alberta Biologics Pharmacosurveillance Program, showed that “patients achieving remission were significantly less likely to have had a recent hospitalization, had lower monthly costs for over-the-counter drugs, and were less likely to have been unable to do usual activities in the past month, to have needed help from others with activities of daily living in the past month, and to have had to reduce their work hours in the past six months because of poor health, compared to other patients with high disease activity.”

In essence, then what is the price you place on quality of life?

For more information on arthritis treatments and other arthritis problems go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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Anti-TNF drugs increase risk of shingles in arthritis patients

A report filed in MedWire by Ingrid Grasmo highlighted the dangers of anti-TNF therapy.  She wrote about a study presented at the Annual European Congress of Rheumatology.  The investigators showed that patients with inflammatory forms of arthritis who are treated with anti-tumor necrosis factor medications are significantly more likely to experience herpes zoster infections –shingles- than shinglesthose treated with traditional disease-modifying anti-rheumatic drugs (DMARDs).

“Shingles” is a painful, blistering skin rash due to the same virus that causes chickenpox. While the infection can be treated with anti-viral medication, patients are often left with residual pain, called post-herpetic neuralgia.  This pain can be debilitating.

For more information on rheumatoid arthritis treatments and other arthritis problems go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

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Arthritis anti-TNF users more likely to get lung infections

According to a study published in the Annals of the Rheumatic diseases, patients anti-tnf-drugswith arthritis who take anti-TNF drugs were more than 4 times as likely to develop mycobacterial disease (eg, tuberculosis) and 14 times more likely to die from these diseases than patients not taking the medications.tuberculosis

The study was from the University of Oregon and looked at a database of 8,418 patients who took anti-TNF drugs from 2000 to 2008.

These findings are a bit shocking and surprising but underscore the need for vigilance.

For more information on rheumatoid arthritis treatments and other arthritis problems go to:

Arthritis Treatment

And don’t forget to sign up for  free weekly arthritis tips and a free copy of our special report “The Consumer’s Guide to Arthritis”

Just go here Contact