Reality star and meta-celebrity Kim Kardashian West made the rounds on the network news and talk shows last week to promote her new line of shapewear. But she also talked about the recent health scare that was revealed on the latest episode of “Keeping Up with the Kardashians.”
Talking to Savannah Guthrie and Hoda Kotb on Today, she reported that she had been feeling exceptionally tired, and had severe pain and swelling in her hands. She underwent testing and was told that she had tested positive for antibodies for “lupus and rheumatoid arthritis.” She also said that she had been put on medication to control her symptoms.
But true to reality show form, she did not reveal that she had received an actual diagnosis. That would have to wait until the next week, when the next episode of “Kardashians” was to air. After undergoing an ultrasound of her hands, her doctor told Kim:
“You do not have lupus and rheumatoid arthritis. So, you can be reassured. You probably have psoriatic arthritis because psoriasis comes and goes. There’s nothing there right now.”
This diagnosis isn’t that surprising, as Kim had been diagnosed with psoriasis back in 2011. She did not say what medication treatment she is currently undergoing, but she reassured viewers that “Luckily everything is under control.”
What is psoriatic arthritis?
Psoriatic arthritis is a condition involving joint inflammation that usually occurs in combination with the skin disorder psoriasis. Psoriasis is a chronic inflammatory condition characterized by patches of red, irritated skin frequently covered by flaky white scales. People with psoriasis may also have changes in their fingernails and toenails, such as nails that become pitted or ridged, crumble, or separate from the nail beds.
Signs and symptoms of psoriatic arthritis include stiff, painful joints with redness, heat, and swelling in the surrounding tissues. When the hands and feet are affected, swelling and redness may result in a “sausage-like” appearance of the fingers or toes (dactylitis).
In most people with psoriatic arthritis, psoriasis appears before joint problems develop. Psoriasis typically begins during adolescence or young adulthood, and psoriatic arthritis usually occurs from the ages of 30 to 50. However, both conditions may occur at any age. In a small number of cases, psoriatic arthritis develops in the absence of noticeable skin changes.
Psoriatic arthritis may be difficult to distinguish from other forms of arthritis, particularly when skin changes are minimal or absent. Nail changes and dactylitis are two features that are characteristic of psoriatic arthritis, although they do not occur in all cases.
Psoriatic arthritis is categorized into five types:
- Distal interphalangeal predominant
- Asymmetric oligoarticular
- Symmetric polyarthritis
- Arthritis mutilans
The distal interphalangeal predominant type affects mainly the ends of the fingers and toes; the distal interphalangeal joints are those closest to the nails. Nail changes are especially frequent with this form of psoriatic arthritis.
The asymmetric oligoarticular and symmetric polyarthritis types are the most common forms of psoriatic arthritis. The asymmetric oligoarticular type of psoriatic arthritis involves different joints on each side of the body, while the symmetric polyarthritis form affects the same joints on each side. Any joint in the body may be affected in these forms of the disorder, and symptoms range from mild to severe.
Psoriatic arthritis affects an estimated 24 in 10,000 people. Approximately 5-10% of people with psoriasis develop psoriatic arthritis, according to most estimates. Some studies suggest a figure as high as 30%. Psoriasis itself is a common disorder, affecting approximately 2-3% of the population worldwide.
This condition has an unknown inheritance pattern. Approximately 40% of affected individuals have at least one close family member with psoriasis or psoriatic arthritis.
The specific cause of psoriatic arthritis is unknown. Its signs and symptoms result from excessive inflammation in and around the joints. Researchers have identified changes in several genes that may influence the risk of developing psoriatic arthritis.
The most well-studied of these genes belong to a family of genes called the human leukocyte antigen (HLA) complex, specifically HLA-B, HLA-C, and HLA-DRB1. Variations in several other genes have also been associated with psoriatic arthritis. Many of these genes are thought to play roles in immune system function, such as interleukin (IL) 17, IL12B, IL13, IL 23R, and TRAF31R2.
How is psoriatic arthritis treated?
A doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) or salicylates to reduce pain and inflammation of the joints.
More severe arthritis requires treatment with more powerful disease-modifying antirheumatic drugs (DMARDs), such as:
A growing variety of new medications for the treatment of psoriasis and psoriatic arthritis have been approved by the FDA and are becoming the treatments of choice. They work by either blocking an inflammatory protein called tumor necrosis factor (TNF) or against cytokines such as interleukins. According to the National Psoriasis Foundation, these include:
- Cimzia (certolizumab pegol)
- Cosentyx (secukinumab)
- Enbrel (etanercept)
- Humira (adalimumab)
- Ilumya (tildrakizumab-asmn)
- Orencia (abatacept)
- Remicade (infliximab)
- Siliq (brodalumab)
- Simponi (golimumab)
- Simponi Aria (golimumab)
- Skyrizi (risankizumab-rzaa)
- Stelara (ustekinumab)
- Taltz (ixekizumab)
- Tremfya (guselkumab)
Occasionally, particularly painful joints may be injected with steroid medications, and in rare cases, patients need surgery to repair or replace damaged joints.
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