(gentle piano)
- Psoriatic arthritis, in short called PSA,
is a rheumatologic disease,
and about one in three people
with the skin disease psoriasis,
tend to get psoriatic arthritis.
It affects the joints as well as the tendons,
and it may also affect the spine.
In addition to symptoms, if untreated,
it can lead to decreased function in people,
as well as to disability and joint and tendon damage.
(gentle piano)
So in most people, it's going to start off
with a skin rash, with psoriasis.
Most people develop psoriasis about 10 to 20 years
before being diagnosed with psoriatic arthritis.
They may also develop nail psoriasis,
which is much more frequent in psoriatic arthritis.
(soft delicate music)
To be honest, there is no specific thing
that we have discovered causes psoriatic arthritis.
It's certainly what we call
a multifactorial rheumatologic disease.
Genes definitely play a role.
That's why we see that psoriatic arthritis
is clustered in people with a skin disease psoriasis,
and then even more frequent in people
who have nail psoriasis.
There are a number of genes
that have been discovered to increase risk
for psoriasis and for psoriatic arthritis,
but there's no single gene that explains everything.
It's rather a combination of being at risk
from a genetic standpoint, and then
in addition to that, there may be
something in the environment that
may be causing this, something like
perhaps an infection that we don't know about
or perhaps exposure.
Another risk factor is being overweight or obese,
and the theory behind that, it's again,
it's just theory, it's not yet proven,
but part of the thought, part of the thinking
that goes into the relationship
of obesity with psoriatic arthritis is
that perhaps those people have more wear and tear,
and those places where we get wear and tear
are, for example, where tendons insert on joints
or the joints in the feet would be places
where inflammation can more easily start
in people who are genetically predisposed.
And then of course we know that
fat tissue, adipose tissue is a site
that favors inflammation, is a
pro inflammatory type of tissue,
so that could play a role as well.
Specifically for psoriatic arthritis trauma,
there are now a number of longitudinal studies
that show that people who have had joint trauma,
joint injury, are more likely to develop
psoriatic arthritis in the future
than people who didn't have this.
And again the relationship is small,
but because there are so many things
that increase this risk
perhaps every little bit counts and adds up.
That's how I see all these factors play a role
into developing psoriatic arthritis.
So it's not your fault, it's the genes in part,
it's environmental factors in part.
I'm pretty sure it's a bunch of other things as well
that we are just starting to discover.
(soft delicate music)
There are studies that show that people who develop
psoriatic arthritis and have access
to rheumatologic treatment within six months,
are the people who develop less damage
and disability in the long term.
So I think we can't change that,
it's developed and it's there,
but definitely managing it promptly
and using state of the art treatment
and treatment strategies has an impact
on long term prognosis.