Who's Most at Risk for Psoriatic Arthritis?
If doctors can determine which patients are at greater risk even before they develop it, we may be able to prevent the onset of psoriatic arthritis
It is less familiar to the general public than psoriasis, but psoriatic arthritis has been gaining in public awareness since famed golfer Phil Mickelson announced last summer that he had been diagnosed with the disease.
Peter S. Hays, a 50—year—old middle school teacher in West Linn, Ore., needs no introduction to psoriatic arthritis. For him, developing the disease proved to be a life—altering event.
Hays had always been active in sports and outdoor life and enjoyed physical work such as construction. But when he was 35, his feet started hurting while he was carrying cabinets and tools. His toes and fingers ached, and his fingernails and toenails were pitted.
Doctors were stumped. "It took me three years to find out what I had," he says. "That was the most frustrating thing about it. They thought it was a fungus. They couldn't figure out what it was."
A rheumatologist finally diagnosed psoriatic arthritis and prescribed methotrexate and gold flakes, which were sometimes used to treat some forms of arthritis but are rarely prescribed now. The regimen helped keep his pain under control. After biologic drugs became available for treating psoriatic arthritis, Hays took Enbrel, then switched to Humira. The medications changed his life, he says.
Today, his disease and the pain it causes are under control. His health is good, and he takes only one pain pill a day. He's even contemplating going back to work in the construction industry.
Thanks to research into psoriatic arthritis, Peter Hays has shown life—changing improvement in his condition. Yet, because psoriatic arthritis affects fewer people than psoriasis does, fewer scientists are researching it. (As many as 7.5 million Americans have psoriasis. Up to 30 percent of people with psoriasis, or about 2.25 million, also develop psoriatic arthritis.) Another reason is that, as in Hays's case, psoriatic arthritis often is hard to diagnose.
But researchers recognize that psoriatic arthritis affects a lot of people, and that it can be disabling for many. Two of those researchers—Dr. Christopher T. Ritchlin and Dr. M. Elaine Husni—each received two—year, $200,000 translational research grants from the National Psoriasis Foundation last year to study psoriatic arthritis. (Husni's grant was cofunded by the Arthritis National Research Foundation.)
Can psoriatic arthritis be prevented?
Ritchlin, a rheumatologist and a professor at the University of Rochester School of Medicine and Dentistry, has been studying psoriatic arthritis for more than two decades. The disease has gotten more attention in recent years within the medical community, a result of the development of medicines that help it, he says.
Because the disease develops an average of 10 years after psoriasis appears on the skin, scientists would like to find "biomarkers" ahead of time that indicate that a psoriasis patient is more at risk of developing psoriatic arthritis, he explains.
If doctors can determine which patients are at greater risk "even before they develop it, we may be able to prevent the onset of psoriatic arthritis," Ritchlin says." That would be phenomenal if we can do that."
Finding the link to heart disease
Husni, vice chair of rheumatology and director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic, has a long—standing interest in collaborative medicine, a concept in which different medical specialties such as rheumatologists and dermatologists practice together in the same clinic. She believes that approach is particularly beneficial in studying psoriatic arthritis, owing to its close connection with psoriasis.
At her previous post at Harvard Medical School, Brigham and Women's Hospital, she helped establish the first joint rheumatology—dermatology clinic and created the Psoriatic Arthritis Screening and Evaluation questionnaire. The two—minute survey's purpose is to screen psoriasis patients early for symptoms of inflammatory arthritis, a step she saw as needed because of the often lengthy gap before psoriatic arthritis appears.
“The problem is, 10 years is a long time," so psoriasis patients and their dermatologists might not make the connection when psoriatic arthritis develops, she says.
Over the last decade, medicine has become aware that patients with psoriasis and psoriatic arthritis are at increased risk of heart disease, Husni says.
Her study will examine the connection between joint inflammation and cardiovascular inflammation. This research could identify key markers in the blood that may allow for early detection of these risks in psoriasis patients.