Treatments for patients with psoriatic arthritis

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Phil Mickelson during the third round of play of the Cadillac Championship golf tournament in Doral, Fla. Saturday, March 12, 2011. (AP Photo/J Pat Carter)

Updated: March 15, 2011 4:24PM

Golf pro Phil Mickelson’s recent admission that he’s battling psoriatic arthritis has put the national spotlight on this chronic autoimmune disease that most often affects people between the ages of 30 and 50. Mickelson is 40 years old.

“Psoriatic arthritis is a chronic inflammatory disease of the joints and skin that affects as many as one million people in the U.S.,” said Dr. Majid Serushan, board-certified rheumatologist on staff at Ingalls Memorial Hospital. “It affects up to 30 percent of people who have psoriasis - a common skin disease that causes cells to build up rapidly on the surface of the skin, forming thick silvery scales and itchy, sometimes painful red patches.”

Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but joint problems can sometimes begin even before skin lesions appear.

Fifty-four-year-old Michael Zemaitis of New Lenox knows that firsthand.

The self-employed CPA has battled psoriatic arthritis since he was a child.

“I remember it like it was yesterday,” he recalls. “I would get stiff joints and have a hard time walking around. My parents would take me to the doctor, but my symptoms would go away.”

Damage to joins

Zemaitis’ experience with the disease was classic: Disease flare-ups alternating with periods of remission.

After nearly a dozen flare-ups without a definitive diagnosis, Zemaitis suffered permanent damage to the joints of his right wrist and several fingers on both hands.

“Once the damage is done, there’s no fixing it,” he said.

Eventually he was diagnosed with psoriatic arthritis and was put on nonsteroidal inflammatory medications — the only treatment available at the time.

Though he played sports throughout his childhood, Zemaitis admits it wasn’t always easy. He often tried hiding his enlarged joints and struggled with the outward signs of psoriasis.

New treatments effective

Today, Zemaitis’ condition is under control thanks to aggressive medical management by Serushan.

Like Mickelson, Zemaitis takes a biologic medication (Humira) to reduce the signs and symptoms of psoriatic arthritis. The medication not only reduces joint pain, stiffness and swelling, it also helps clear up the skin lesions caused by psoriasis.

“Biologic agents like Humira and Enbrel also help prevent further damage to the bones and joints, and enable patients to perform their daily activities,” Serushan said.

Like many individuals with severe forms of the condition, Zemaitis also takes Methotrexate, a powerful drug used to minimize the signs and symptoms of psoriasis.

“Dr. Serushan has taken great care of me,” he adds. “I can’t say enough good things about him. I’m able to work. I take care of my daughter, and I fish whenever I can. A positive attitude is everything.”

Don’t ignore symptoms

“There’s no cure for psoriatic arthritis exists, so the focus is on controlling symptoms and preventing damage to the joints,” Serushan said. “Without treatment, psoriatic arthritis may be disabling.”

Symptoms often resemble those of rheumatoid arthritis: Both diseases cause joints to become painful, swollen and warm to the touch.

However, psoriatic arthritis also causes:

A painful, sausage-like swelling of the fingers and toes. Individuals can also develop swelling and deformities in the hands and feet before having significant symptoms.

Foot pain. Psoriatic arthritis can also cause pain at the points where tendons and ligaments attach to the bones — especially at the back of your heel (Achilles tendinitis) or in the sole of your foot (plantar fasciitis).

Lower back pain. Some people develop a condition called spondylitis as a result of psoriatic arthritis. Spondylitis mainly causes inflammation of the joints between the vertebrae of your spine and in the joints between your spine and pelvis (sacro-iliitis).

“If you have psoriasis, be sure to tell your doctor if you develop joint pain,” Serushan added. “Psoriatic arthritis can come on suddenly or develop slowly, but in either case it can severely damage your joints if left untreated.”

Risk factors for psoriatic arthritis include having psoriasis; a family history of the disease; and age.

Medications most commonly used to treat the condition include non-steroidal anti-inflammatory drugs (NSAIDs); anti-rheumatic drugs; immunosuppressant medications; and biologic agents such as Humira and Enbrel, which block the protein that causes inflammation of the joints.

“There are many effective therapies available today,” Serushan said. “Most people whose disease is well-managed can enjoy many of the activities they always have. The most important thing is to see your doctor right away if you have symptoms of psoriasis or psoriatic arthritis. Early diagnosis is the key to preventing permanent joint damage.”

For more information or for a referral to an arthritis specialist with the Ingalls Advanced Orthopedic Institute, call Ingalls Care Connection at 800-221-2199.