I am writing to you now because I hope that you can explain psoriatic arthritis. This is a very painful, sometimes disabling, type of arthritis. Little is known about it, despite the fact that it affects a great number of people.

Patients with psoriatic arthritis also have psoriasis so they are doubly affected. They have to put up with the constant skin lesions on top of the painful arthritis. It is treated with the same biological medications as RA. I am a sufferer and am tired of trying to explain the difference so I hope you will be able to help get the word out in your column.

DEAR READER:
Psoriatic arthritis is fairly easy to figure out based on the name: arthritis which is related to and develops in those with the skin disorder psoriasis. This is not to say that every psoriasis sufferer will develop psoriatic arthritis. For those who do develop it, the skin manifestations often develop first followed by the symptoms of arthritis. However, for a few, the arthritis develops first.

Primary symptoms include joint pain and/or swelling, stiffness and joints that are warm to the touch. There are five different types known. Some patients may even experience more than one type.
Asymmetric psoriatic arthritis is pain in the joints on one side of the body or pain in more than one joint on both sides (for example, the right hip, left elbow, etc.). It is the mildest form, usually involving five or fewer joints.

Symmetric psoriatic arthritis is pain on both sides of the body. It often affects more than five joints and is more common in women than in men. The psoriasis associated with this type is often severe.

Distal interphalangeal (DIP) joint predominate psoriatic arthritis primarily affects the small joints of the fingers and toes that are nearest the nails. It is rare and is more common in men. It is most often associated with psoriasis of the nails.

Spondylitis is a form of psoriatic arthritis that affects the spine.

The final type is arthritis mutilans, better known as destructive arthritis. It occurs only in a small percentage of those with psoriatic arthritis. Over time it can destroy the small bones of the hands, usually the fingers, leading to permanent damage and disability.

Risk factors include already having psoriasis, a family history of psoriatic arthritis, and being between the ages of 30 and 50.

There is no cure, but fortunately, there are several treatment options available. As the first writer correctly stated, many of the treatments used for rheumatoid arthritis are also used for psoriatic arthritis. Non-steroidal anti-inflammatory drugs (NSAIDs) are a common first step. These medications reduce swelling and may help control pain and stiffness. Over-the-counter varieties include ibuprofen and aspirin. Your doctor may prescribe stronger NSAIDs if OTCs are unsuccessful.

Corticosteroids such as prednisone or methotrexate may be used. Because of the relatively high risk of side effects these medications are generally used at the lowest possible dose for short periods of time, such as during flare-ups.

Disease-modifying anti-rheumatic drugs (DMARDs) are used to limit the amount of damage done to joints. Because they are slow acting, they are usually prescribed in conjunction with NSAIDs.

Immunosuppressant medications literally suppress the immune system to limit the amount of joint damage. Because both arthritis and psoriasis are autoimmune (caused by the bodies inability to differentiate between self and invader), they can provide excellent results. However, because of potentially serious side effects, they are often only prescribed to those with severe or disabling symptoms.

TNF-alpha inhibitors may be considered in those with severe disease. These drugs block the protein that causes inflammation.

Rarely surgery may be necessary to repair or replace joints that have been severely damaged.

Regardless of which type you have, it is important to exercise regularly to keep joints limber. If overweight, losing weight can also reduce the pressure on affected joints and may delay the use of stronger medications.

Anyone who is interested in learning more about psoriatic arthritis, its causes, symptoms and treatments should go online. There are several excellent sites available.

For those individuals with symptoms, I recommend you see your primary care physician or a rheumatologist as soon as possible for a proper diagnosis. Early treatment can reduce the severity and potential damage done to the joints.

To give you related information, I am sending you copies of my Health Report “Dermatitis, Psoriasis and Eczema” and “Understanding Osteoarthritis”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

At that point, I decided it was time to see my physician who concluded that I needed a cortisone shot because I probably had fluid on my knee. She referred me to an orthopedist for the shot. Unfortunately it didn’t help. I was then referred for physical therapy. After only two sessions, I was told I needed to go back to the orthopedist. The physical therapist wouldn’t tell me why but called ahead to the doctor and spoke to him directly. When I got there I was told I had a Baker’s cyst and would need a knee replacement. I was further advised not to rush into the surgery because the cyst might improve to the point where the pain would lessen to a manageable level.

When I went back for physical therapy I told my therapist (and another who was standing next to her) what I had been told. Both adamantly told me to not to have the surgery. I continued with the therapy for another three sessions before I was dismissed because my therapist said she couldn’t keep taking my money as I wasn’t being helped.

Now I want to know what you think about this situation. Do Baker’s cysts appear suddenly, only to disappear over time? Do I really need a knee replacement? I am an 83-year-old otherwise healthy female.

DEAR READER:
A Baker’s cyst is an accumulation of joint fluid behind the knee. Most cysts do not cause symptoms but, occasionally, large cysts may cause discomfort and/or stiffness. In fact, most cysts are recognized only after they rupture, a process that can cause pain, swelling and bruising.

Baker’s cysts can occur in anyone of any age. The most common cause in older individuals is arthritis. Your cyst has probably been there for a while but was worsened by further injury.

Treatment is usually aimed at repairing the underlying cause. In your case that would be the arthritis. I hope you misunderstood your orthopedist when he recommended a knee replacement. It is not appropriate therapy to treat a Baker’s cyst; knee replacement would certainly help your arthritic knee, however.

Most Baker’s cysts disappear on their own but, depending on the cause and severity, it can take months or perhaps even years for that to happen. For those that cause severe pain and interfere with normal movement, there are a few treatments available. The most common is aspiration in which a physician drains the cyst with a needle and syringe. Very rarely, it may be necessary to remove the cyst surgically . This is avoided as much as possible because of the risk of damaging surrounding tissue, blood vessels and nerves located behind the knee.

I recommend you get a second opinion and start treating your arthritis which should help resolve the cyst.

To give you related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure mention the title.

Everyday I run into people that notice when I limp or move slowly in pain and ask what’s wrong. I inform them I have rheumatoid arthritis and before I can finish my sentence they are telling me how they have the same thing and start telling me how bad it is in their knee, etc.

When I question them, I realize they have normal aging and osteoarthritis. People do not understand RA patients and the difference because both have arthritis in the name.

Please dedicate one column to this subject. Your column will help educate the public as it has helped educate me on so many disorders.

DEAR READER:
I will gladly take your request because you make an excellent point; many people are not aware that there are several types of arthritis. I will start with typical age-related osteoarthritis.

Osteoarthritis is the result when the lining of joints begins to wear out. The most common cause of this is the aging process but athletes, landscapers and manual laborers also are prone to developing this condition earlier in age because of the constant wear and tear on their joints.

As the lining wears away, pain and stiffness develop because there is no longer a cushion to protect the sensitive nerves, muscle and bones. Osteoarthritis commonly develops in the knees, hips, wrists and hands as these areas are the most used in everyday activities.

Treatment consists of over-the-counter medications such as, acetaminophen and ibuprofen, hot or cold packs, menthol or capsaicin rubs, and topical castor oil. Low-impact exercise such as walking, water aerobics and swimming are also beneficial. Alternative treatments include glucosamine and chondroitin supplements, MSM and others may provide relief to some sufferers.

If symptoms become severe and interfere with daily activity, joint replacement may be an option. Commonly replaced joints are knees, hips and shoulders. This drastic measure is usually reserved for individuals who are affected at a younger age or lead an active life.

Rheumatoid arthritis on the other hand is not the result of age-related deterioration, rather it is caused by the bodies’ own defenses. Mild cases can last from a few months to a year or two while severe cases can last for several years or even a lifetime and lead to serious joint damage. Others may have repeated flare ups followed by periods of remission.

The most common symptoms include joint pain, swelling and stiffness. Some may experience fatigue, fever, weight loss, firm bumps of tissue under the skin on the arms, red, puffy hands and joint tenderness. Symptoms generally appear in small joints such as the wrists, hands, ankles and feet first. Over time the knees, hips, jaw, shoulders, neck and elbows may become effected.

Rheumatoid arthritis is caused by the body’s white blood cells (infection fighters) when they move from the blood stream to the membranes that around the joints (synovium). They then appear to cause the synovium to become inflamed which releases proteins that, if untreated, leads to thickening of the membrane. Cartilage, bone, ligaments, and tendons can also become affected which, over time, leads to malignment of the joint and the bone to lose its proper shape.

Doctors do not know what causes this process to start but suspect it may be the result of a combination of factors such as lifestyle choices, genetics, and environment. Risk factors include smoking, family history, age, and gender. Rheumatoid arthritis commonly affects women between the ages of 40 and 60. It is not thought that RA is passed from one parent to the child but that a predisposition to the disorder is passed down.

There is no cure for RA but several treatments are available. Ibuprofen and naproxen sodium are helpful in reducing inflammation in mild cases and are available over-the-counter or in stronger doses as prescriptions. Some individuals may need temporary treatment with steroids. Other medications include disease-modifying antirheumatic drugs (to limit joint damage), immunosuppressants (to bring the immune system under control), TNF-alpha inhibitors (to block the inflammatory agent associated with RA) and anakinra (to stop a chemical signal from causing inflammation).

Both osteo- and rheumatoid arthritis can be diagnosed and treated by a general practitioner or internist. Rheumatoid sufferers, however, should also be seen by a rheumatologist who specializes in disorders of the joints and bones. Only severe or disabling symptoms caused by osteoarthritis may require the assistance of this type of specialist.

In summary, osteoarthritis is a common, age-related deterioration of the joints. Rheumatoid arthritis is caused by an auto-immune response and can occur in anyone at any age.

To give you related information, I am sending you copies of my Health Report “Understanding Osteoarthritis” and “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR READERS: Your letters are just a sampling of many I have received over the last several weeks regarding this supposed “superfood” juice. I am unfamiliar with this product so will base my answer on an information packet and several pamphlets.

The packet is from the AIBMR Life Sciences, Inc., Natural and Medicinal Products Research that claims to have done a clinical study on MonaVie. As you would expect, the results show that the juice is beneficial when taken regularly.

Included was a four page list of “approved claims”. (Many are as simple as “glucosamine helps promote joint mobility, health and function” which are not product specific.) Whether this juice is actually beneficial is unclear to me. However, 100% fruit juices in general are good for the body because they are essentially providing the benefits of the actual fruit.

I would like to note here that the packet also contained a ‘frequently asked product questions’ section and in several areas it repeated similar sentiments. It advises to consult a physician before taking it and that it is not intended to prevent, treat or cure any disease or medical condition. I find the fact that this is put in print quite responsible.

If a person wants to drink this juice, go ahead. But drink it because you like it, not because you think you won’t get cancer if you do so. Until double blind, placebo-controlled studies are done by independent, third party research firms that publish their findings in peer-reviewed journals, I wouldn’t believe all that you hear.

In the end, I this juice may be a fad. I have received similar information regarding a number of products that appear to be popular for a year or two and then fade into the background.

To give you related information, I am sending you copies of my Health Report “Understanding Cholesterol”, “Managing Chronic Pain” and “Osteoarthritis”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

I have recently come across a “juice” called MonaVie. It is made from the Acai berry from the Amazon and is made in Utah. It claims to have 19 fruits in it and is supposedly all natural with no preservatives. I have enclosed a newsletter I received about it that says it is loaded with antioxidants and glucosamine, it is advertised as a remedy for arthritis, muscles aches, joint pain and, of course, to ward off some cancers and much more. Please help.

I went to my orthopedic doctor because of pain in my hip. It starts in the joint and travels down the thigh and is especially painful at the tendon along the shinbone. I also have right leg weakness when pressure is applied or when walking upstairs. He said the pain was caused by bursitis, not arthritis. He showed me an exercise to try and told me to continue my regular walks.

I take over-the-counter pain relievers, use castor oil and Castiva. Should I continue using these joint medicines or should I use muscle creams to relieve the nighttime pain? I am 88 and do not consider this worthy of surgery but it would be nice to sleep though the night. I’m tired of having to wake up to take another pill.

DEAR READER:
Arthritis and bursitis can be difficult to differentiate. Arthritis is joint inflammation with associated degeneration of connective tissue and bone. Bursitis is inflammation the bursa that is a sac-like cavity surrounding joints that is filled with fluid that reduces friction caused by movement. There are more than 150 bursa in the body. Most people have heard the term “water on the knee”. This is often caused by bursitis. Swelling and redness are often visible but if the hip is affected, the bursa simply appears to cause pain of the hip and thigh because it is located under bulky muscles.

Arthritis is more common in weight bearing joints such as the hips and knees. Bursitis is more common in the shoulders, elbows, big toe and hips.

Direct trauma, infection, joint or muscle stress, and arthritis are common causes of bursitis. Arthritis is generally caused by age-related wearing of cartilage and connective tissues leading to bone degeneration. It can also be caused by auto-immune disorders such as rheumatoid arthritis. Gout is a common cause of arthritis.

Treatment is similar for both arthritis and bursitis with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen sodium, ice, rest and steroid injections making up the primary course of therapy. If the cause is determined to be infection, treatment with antibiotics is necessary. For severe cases that last longer than a few weeks or if you have major swelling, the bursa may need to be drained. In rare instances removal may be necessary.

I recommend that you return to your orthopedist and ask for an X-ray if you have not had one already. Bursitis will not show on the film but other causes such as arthritis can be ruled out. Given your age, the most likely cause of your bursitis is age-related osteoarthritis. If you like, get a second opinion from another orthopedic specialist. You can then compare the results and go from there.

To give you related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I was wondering if you had ever heard of this and what your opinion is.

DEAR READER:
Raw pumpkin seeds for knee pain is new to me, but if it works for your sister and her husband they should stick with it. There is no harm (to my knowledge) in eating a small amount of raw pumpkin seeds daily. The best part is that they can easily be mixed with other foods such as oatmeal, cold cereal or salads.

Copper bracelets have been used by many to reduce the pain and inflammation associated with arthritis and there is a general belief that it will alleviate symptoms in many individuals. Therefore, it stands to reason that if pumpkin seeds contain copper that they can also be useful as a treatment option. To my knowledge there have been no studies on this effect, however.

Pumpkin seed oil is purported to relieve symptoms of bladder problems, enlarged prostates, kidney stones, irritable bowel syndrome and more. The oil is available in capsule form at many health food and vitamin stores.

Readers, if any of you have had experience with pumpkin seeds or pumpkin seed oil please let me know. I will print a follow up with the results, either positive or negative.

To give you related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Many of my readers have used fruit pectin successfully as an alternative treatment for arthritis. Therefore, because you are providing a service that can be beneficial for the relief of their pain, I am enclosing your information and thank you for forwarding it to me.

For those readers who would like related information, I suggest you send for my Health Report “Understanding Osteoarthritis” by sending a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

She currently gets a cortisone shot in her hip as often as she is allowed to, but the pain returns before she qualifies for another shot.

What creams or ointments without side effects do you recommend that can be used topically for bursitis, arthritis and inoperable pain?

My friend lives alone, eats heartily, and is up-to date on current affairs. Thank you for your input.

DEAR READER:
To begin with, Castiva is a topical pain-relief lotion used for the pain of arthritis. It is NOT to be taken internally, rather it should be rubbed onto painful joints. The product comes in two forms, warming and cooling. The warming lotion contains capsaicin, an ingredient found in chili peppers that works by blocking pain signals from nerves, while reducing inflammation. The cooling lotion contains menthol and cools as it is applied. Both contain natural castor oil, a product that has been used for over 4,000 years because of its healing properties.

Some people find relief from pain by using purple grape juice and pectin, a substance used in preparing jams and jellies. Simply pour eight ounces of 100% juice into a glass. Add one to two tablespoons of liquid pectin and stir. Drink two to three times daily. The remedy is reported to substantially reduce the pain of arthritis.

While I’ve been told pectin is in short supply unless it is jelly making season, I learned it can be purchased in bulk from Kauffman’s, 3096 Old Philadelphia Pike, Bird In Hand, PA l7505. This source was passed on to me by a reader, so I am making it available to you.

You might also have your friend visit your local pharmacy to determine what over-the-counters are available for relief of joint pain. In fact, enlist the services of the pharmacist who is a great resource. You might be glad you did.

To give you related information, I am sending you a copy of my Health Report “Understanding Osteoarthritis”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

I get mine from Kauffman’s, 3097 Old Philadelphia Pike, Bird-In-Hand, PA 17505. I hope this helps your arthritis sufferers who use grape juice and pectin.

DEAR READER:
I was not aware that pectin could be purchased in such large packages. I am passing on this information and the address for the benefit of my readers.

Thanks for writing.

To give you related information, I am sending you copies of my Health Reports “Understanding Osteoarthritis” and “Dr. Gott‘s Compelling Home Remedies”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).