Psoriatic Arthritis And Parkinson’s Disease

Parkinson’s Misdiagnosis: Depression Or Anxiety

It is shocking how many times Parkinsons is dismissed as nothing more than anxiety or depression. It is true that physical symptoms can sometimes result from mental conditions. However, reducing PD to a mental condition is usually the result of not enough testing or not taking enough time to talk to a patient.

My husband was diagnosed with anxiety.

My husband was diagnosed with anxiety and low testosterone years before his diagnosis.

Yes… they said it was all in my head!

Mental illness.

Malassezia Over Proliferate In Aids

Over proliferation of normally well-tolerated microbes is frequently observed in immunodeficient patients. The very first symptoms of AIDS often involve the over proliferation of fungi, such as Candida in the mouth , Malassezia on the skin , or Pneumocystis in the lungs . Such fungi are normally present in healthy individuals , and are considered benign members of the human microbiome.

Latent microbes which are not considered part of the normal microbiome can also cause severe illness in AIDS patients. Toxoplasma gondii is a protist which colonizes the CNS of a large subset of the population for life . It rarely causes severe symptoms in immunocompetent individuals, but often causes life-threatening encephalitis in AIDS patients or during immunosuppression . Though much rarer today, Treponema pallidum also colonizes the CNS of infected individuals for life, typically without causing symptoms until old age . AIDS hastens neurosyphilis in previously asymptomatic Treponema pallidum carriers, placing young patients at an unusually high risk of this disease .

Painful Joints And Weakened Bones

For about a third of people with psoriasis, the immune system also attacks the joints. This triggers inflammation and swollen, painful joints. This condition is called psoriatic arthritis.

Psoriatic arthritis often appears 10 years after psoriasis develops. It can affect different parts of your body, such as your fingers, toes, and spine.

Other symptoms of psoriatic arthritis include:

• Fatigue
• Stiff, tender, swollen, and throbbing joints or tendons
• Reduced range of motion

Although theres no cure, a doctor can prescribe treatments to ease the pain and prevent permanent damage to your joints.

Along with harming joints, psoriasis can also weaken bones. Research shows that people with psoriasis are three times as likely to have bone loss, called osteopenia, and the bone disease osteoporosis. It also raises your risk of breaking a bone.

Thats because chronic inflammation can take a toll on your skeleton. People with psoriasis also tend to have low levels of bone-building vitamin D. Whats more, steroids a common treatment for psoriasis can weaken bones over time.

Psoriasis raises your odds of getting osteoporosis by 30%

These two conditions often overlap, but you can get one without having the other.

30% of people with psoriasis will also get psoriatic arthritis.

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Malassezia Are Found In The Cns In Multiple Sclerosis

MS has many direct links with the immune response against fungi and with SpA . The distribution of the age at onset of MS is nearly identical to ankylosing spondylitis and CD . The fungicidal compound dimethyl fumarate is effective in psoriasis , psoriatic arthritis , and MS . MS is moderately associated with SpA , inflammatory bowel disease , and psoriasis . These associations are surprising because SpA shares few genetic susceptibility loci with MS , and unlike SpA, MS is mainly B cell-mediated . The simplest explanation is that MS shares a necessary environmental factor with SpA , such as colonization of internal organs by Malassezia .

A recently published study compared fungi in the CNS of MS patients vs. controls, and found Malassezia in 9 of 10 MS cases, and in 1 of 9 controls . Myelin producing Schwann cells are lipid-rich , thus can fulfill Malassezia‘s requirement for lipids.

Unlike in SpA, direct links between Malassezia and MS are currently limited to a single study . The role of Malassezia in MS is mainly supported by the many associations between MS and SpA , which suggest the same fungal infection is necessary for both . This means Malassezia likely cross the blood-brain-barrier and colonize the CNS. The closely related fungus Cryptococcus neoformans survives phagocytosis, and uses macrophages to move within the body and CNS . A recent study reported that Malassezia also survive phagocytosis , suggesting they might use macrophages to reach the CNS.

Malassezia Are A Necessary Factor In Crohn’s Disease And Spondyloarthritides

Spondyloarthritides are a group chronic immune-mediated diseases mainly driven by alpha beta T cells recognizing intracellular peptides through HLA-B*27 presentation . Affected organs include the spine, joints, skin, eyes, gut, and prostate . Historically, isolated inflammation of the eyes, gut, and skinrespectively acute anterior uveitis, inflammatory bowel disease and psoriasiswere considered separate diseases unrelated to SpA. However, SpA, acute anterior uveitis, inflammatory bowel disease and psoriasis run together in families , and share many polymorphisms in genes controlling T cell activation , strongly suggesting that they are the same immunological pathology . In particular, the fact that HLA-B*27 increases the risk of each disease strongly suggests the same antigens are being targeted . Varied lines of evidence support the presence of an elusive necessary intracellular fungal infection in each affected organ, which is efficiently detected by HLA-B*27 and CARD9 . CARD9 is an essential signaling protein for fungal immunity: homozygous loss-of-function CARD9 mutations cause severe mycoses . CARD9 polymorphisms are associated with inflammatory bowel disease and SpA . Oral antifungal drugs are effective in psoriasis , psoriatic arthritis , and likely in Crohn’s disease as well .

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How Can You Care For Yourself

You can do things at home to help protect your joints and ease pain. Try these tips:

• Rest your joints when they are sore or overworked. Ask your doctor or therapist about using braces, splints, or shoe supports to help protect your joints.
• Try to limit or avoid activities that may cause joint pain or swelling. Writing down these triggers may help you keep track of them.
• Try ice or a cold pack on the joint area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin. Or try using heat to ease pain.
• Try to reach and stay at a healthy weight. Regular exercise and a healthy diet will help you do this. Extra weight can strain the joints. Losing even a few kilograms may help.

Reduced Range Of Motion

One possible sign of PsA is a reduced range of motion in your joints. You might find it harder to extend your arms, bend your knees, or bend forward.

You may also have problems using your fingers effectively. This can lead to problems for people who work with their hands in any way, including typing and drawing.

When the joint becomes permanently fixed or unable to move beyond a certain point, its known as a contracture deformity. This can lead to complications such as:

• Dupuytrens contracture, a thickening of the tissue layer beneath the skin in the hands and wrist
• Volkmanns contracture, or lack of blood flow to the forearm that causes muscle shortening

Prevention involves range of motion exercises prescribed by a doctor or done with a physical therapist.

Fatigue is a common symptom in people with PsA. You may begin to have difficulty making it through the day without taking a nap.

According to a , up to 50 percent of people with skin conditions report having moderate to severe fatigue, while 25 percent experience severe levels of fatigue.

In the case of PsA, fatigue may be due to symptoms or complications like:

• inflammation

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Use In Specific Populations

Pregnancy There are no adequate well-controlled trials of secukinumab in pregnant women. Secukinumab should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.8

Nursing mothers It is not known whether secukinumab is excreted in human milk or absorbed systemically after ingestion. Caution should be exercised when secukinumab is administered to a nursing woman.8

Pediatric use

Understanding Biologic And Biosimilar Medications

Most people are familiar with conventional medications such as pain relievers. These medications are made from chemicals .

Some of you may also have heard about biological or biologic medications which are used to treat serious illnesses, such as cancer, inflammatory bowel disease, psoriasis and rheumatoid arthritis. Biologics are special medications created using the biologic processes within liviarthritis. Biologics are special medications created using the biologic processes within living cells.

Conventional medicines and biologic medicines have important differences.

It is common knowledge that when the patent expires on a conventional medication, other companies are allowed to make copies called generics. Although the active ingredient in a generic is exactly the same as the active ingredient in the original conventional medication, non-medicinal ingredients, like fillers and colouring, may be different.

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Cosentyx A New Treatment Option For Plaque Psoriasis

On January 21, 2015, secukinumab , a human IL-17A antagonist, was approved by the US Food and Drug Administration for the treatment of adults with moderate-to-severe plaque psoriasis.7 Secukinumab, a biologic immunomodulator drug administered by subcutaneous injection, is indicated for patients who are candidates for systemic therapy or phototherapy or a combination of both therapies.7,8 Secukinumab is the first IL-17A to receive FDA approval for the treatment of patients with moderate-to-severe plaque psoriasis.9

As part of its approval, the FDA required the manufacturer to include a medication guide to inform patients that because secukinumab affects the immune system, it may increase the risk for infection.7

Pd Genetics And Lipids

Malassezia are lipid-dependent fungi which consume host lipids by secreting extracellular lipases . On the skin, they consume extracellular lipids in sebum , though they can also utilize intracellular lipids by invading keratinocytes . The best documented cases of Malassezia inside the body were reported following lipid-rich parenteral nutrition . In these cases, Malassezia were mainly found within the wall of arteries which contained lipid deposits, suggesting high lipid concentrations are required to sustain Malassezia in tissue .

Interestingly, four LRRK2 risk alleles in PD also increase the risk of CD . CD is likely caused by a T cell-mediated immune response against Malassezia in the gut . It is important to note that only LRRK2 PD risk allele Y1699C has been tested for lipid-droplet formation, and that LRRK2 alleles associated with both CD and PD have not been tested for excess lipid-droplet formation. It is also important to note that the most important LRRK2 PD risk allele G2019S did not reach statistical significance in one of the CD studies : The LRRK2 N2081D CD risk allele is located in the same kinase domain as G2019S, a mutation that is the major genetic cause of familial and sporadic PD . Notably, G2019S did not have nominally significant CD association , likely because of subtle stochastic fluctuations in allele frequencies during imputation. However, it amply reached statistical significance in the other CD study .

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Is A Biosimilar A Generic Version Of The Original Biologic Drug

No, biosimilars are similar to, but not identical to the original biologic drug. This is because the group of cells used to produce the drugs , the actual drug molecule and the manufacturing process are different.

In Canada, manufacturers of biosimilars are required to show Health Canada that their product is similar to the original biologic and that the benefits of their product outweigh the risks. SEBs must have a label that is different from the original biologic medication.

Trials 3 And : The Feature And Juncture Studies

The FEATURE study included 177 patients randomized in a 1:1:1 manner to secukinumab 300 mg, secukinumab 150 mg, or to placebo. In this study, treatment was self-administered via a prefilled syringe once weekly to week 4, followed by the same dose every 4 weeks for up to 12 weeks.8,11

In the JUNCTURE study , 182 patients were randomized to receive secukinumab 300 mg, secukinumab 150 mg, or placebo. Treatment was self-administered via the Sensoready pen once weekly to week 4, followed by the same dose every 4 weeks for up to 12 weeks.8,12

The results of Trials 3 and 4 are shown in Table 2. In both studies, secukinumab 300 mg and 150 mg were superior to placebo at week 12.8,11,12 The PASI 90 responses at week 12 were similar to those in Trials 1 and 2.8 Moreover, the secukinumab prefilled syringe and Sensoready/autoinjector pen were associated with high usability.11,12

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What Causes Psoriatic Arthritis

Psoriatic arthritis is caused by a malfunction of the immune system, in which your immune system mistakenly attacks healthy cells in your own body, in this case your joints and skin. Scientists are not sure why this happens, but the nature of PsA puts it in the category of autoimmune diseases.

Scientists are studying the potential causes:

• Genetics: some people have genes that set them up to develop psoriatic arthritis – although carrying these genes is not enough to develop the disease
• Triggering event: the condition is set off when the body reacts to a stressful period in life, an infection, or something else in the environment
• Family link: someone who has a relative with PsA is at higher risk of developing the disease
• Psoriasis first: up to 40% of people with psoriasis develop psoriatic arthritis. Most have psoriasis for about 10 years before PsA develops

Psa And Life Expectancy

People with psoriatic arthritis have a 60% higher risk of a lifespan that is three years shorter than the general population, because they often have other health conditions. The most common condition in people with PsA that can shorten lifespan is heart disease, but there is also a higher risk of obesity, diabetes, metabolic syndrome , and liver disease.

Up to 40% of people with PsA have three or more health conditions and close to half are obese. Researchers believe the higher risk of developing chronic health conditions may be due to inflammation, side effects of certain medications, and lack of exercise due to joint pain. Medication and lifestyle choices can help the symptoms of PsA and lower the risk of developing serious health problems.

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Uveitis And Vision Problems

Uveitis is inflammation of the middle layer of your eye that consists of your iris, the muscles underneath, and the tissue filled with blood vessels. It can cause eye pain, redness, and vision problems.

Research from 2019 estimates that of people with psoriasis have uveitis. It tends to be more common among people who have both psoriasis and PsA.

Tips For Vertigo Management

Its hard to live with vertigo. While youre waiting to get help, try to avoid getting into dangerous situations like driving, standing on public transportation, or riding a bike.

Stabilize yourself by sitting or lying down during a dizzy spell. Lean on a wall, shopping cart, or something stable if you are unable to sit. I know these things arent always practical. We all have busy lives and cant take the time to stop, but safety should always be your priority.

Dont be afraid to ask for help and let others know whats going on. Many people have experienced vertigo or know someone who does and understand how dangerous it could be. In my experience, others have expressed empathy when Ive needed accommodations.

Im thankful for how much others have helped me theyve been my rock while my world was spinning. Or, at least helped me dodge all the people at the train station.

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How Does Psoriasis Impact Your Life Day

In the beginning when it was mild, not very much. As time passed and it got more aggressive it was difficult and embarrassing to meet socially and function in the world of work. Scaling was a problem. I would have to wear clothing that would catch the scales before they hit the floor. Today, and since 2005, I have had little impact from psoriasis, but a huge impact from psoriatic arthritis.

Is Vertigo A Side Effect Of Psoriatic Arthritis

While its true that some people with PsA experience vertigo due to their condition, its not safe to make assumptions. It could be a side effect of a medication or a sign something else is going on.

For example, sometimes during allergy season, I experience vertigo if Im suffering from a lot of sinus congestion. Treating my allergies with nasal steroids significantly reduces my symptoms!

If you suspect your jaw is the cause of your dizziness, it helps to see a dentist. There are many options to help treat TMJ inflammation, such as splinting, physical therapy, or even acupuncture. Addressing the issue at the source will significantly reduce or could eliminate vertigo.

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Can Psoriatic Arthritis Affect The Esophagus

• Other symptoms

Psoriatic arthritis is an autoimmune condition that affects many parts of the body, such as the eyes and gastrointestinal tract, including the esophagus. Symptoms of PsA may include inflamed, itchy skin, swollen joints, and the possibility of infections.

The inability to swallow effectively is known as dysphagia. Studies have not yet found a clear link between PsA and dysphagia, but research is ongoing.

This article examines whether PsA affects the esophagus. It also explores potential esophageal-related problems PsA may cause and possible treatment options.

People who have dysphagia may experience symptoms such as:

• difficulty swallowing starchy foods, such as bread or potatoes
• feeling as though food is too big to swallow
• pain in the chest when food travels down the esophagus
• acid reflux after a meal or after eating particular foods
• gastroparesis, where the stomach muscles that push food through the intestines stop working or slow down
• weakness in the esophagus that can cause a pocket to form and trap food
• inflammatory bowel syndrome that has links to PsA through triggering chronic inflammation
• ulcerative colitis that relates to PsA and may cause mouth ulcers

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