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The condition affecting 2-3 million Americans that may go undiagnosed

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There's a deeply unpleasant condition. It afflicts both genders equally and is not seasonal. Its sufferers may awaken in a great deal of pain, likely in the peripheral joints such as the fingers, hands, and knees, but the axial joints—which is to say, the hips and spine—are also vulnerable. The joints are tender to the touch. The condition may even affect the Achilles tendon, and ligaments around the hips and spine. "There's stiffness," said Dr. Amit Garg, chairman of the North Shore-LIJ Health System's dermatology department.

It's psoriatic arthritis—not to be confused with osteoarthritis and rheumatoid arthritis—and it affects approximately 2-3 million Americans. What's unique about psoriatic arthritis is it's characterized by inflammation of not only joints, but also tendons and ligaments. "That is pretty unique to psoriatic arthritis," Dr. Garg said. "It is quite distinct."

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How is it diagnosed? Well, there's no single diagnostic test, said Dr. Garg. A blood test alone, for example, is insufficient. Patients are given an evaluation that includes taking a history around the systems, an examination of the joints and ligaments, and then blood work to exclude other conditions that may mimic psoriatic arthritis. Imaging via x-ray and ultrasound can also be useful.

Typically, psoriatic arthritis is diagnosed in people ages 35-55. By and large, they don't get it out of the blue, but have an underlying condition—a skin disease called psoriasis—that long precedes the onset of symptoms, by up to ten years. This means, unfortunately, that if you have psoriasis, you are at greater risk for developing psoriatic arthritis; a quarter to a third of patients who have the former ultimately develop the latter. (Psoriasis affects 2-3 percent of the American population, and psoriatic arthritis affects 25-30 percent of that segment.) "Less than 10 percent of people develop the symptoms of arthritis before the systems of psoriasis," said Dr. Garg.

Ashley Eisenman, a 32-year-old graphic designer in California, was diagnosed with psoriasis when she was two months old. When she was 27, she noticed that her elbows and neck were hurting. "Thinking back on it, I was always sore and groggy, and I've never been a morning person," she said. "I thought that's just how I was."

Eisenman didn't realize, until she was diagnosed, that psoriatic arthritis was the cause of her elbow pain, her red joints, her constantly sore feet, and her swollen hands. At one point, she even had to use petroleum jelly to get a ring off her bloated finger.

Psoriatic arthritis most commonly affects the bottoms of the feet, the plantar fascia, the heel, and ligaments around the hips and spines. When ligaments and tendons are involved, patients tend to notice stiffness and creakiness. Around the fingers and toes, digits will have uniform swelling and perhaps redness. Dr. Garg called them "sausage digits."

The doctor also stressed that patients of psoriatic arthritis, which is an inflammatory condition, can exhibit symptoms that extend beyond joints and tendons and ligaments. (These are called 'constitutional symptoms.') Among them are dry, irritated eyes, fatigue and fever, or the nails can take on an abnormal shape and color.

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There is nothing a patient can do to either contract psoriatic arthritis or to prevent its occurrence. There are genetic factors—if your parents have it, you're more likely to get it—and possibly some environmental factors. But the condition is no one's fault.

The good news is a) most patients have mild to moderate symptoms and b) psoriatic arthritis is treatable. It progressively gets worse if untreated in both symptoms and damage to the joints. Patients can have disease that's aggressive enough that it can result in disability, to the extent that the joints are no longer functional.

Lifestyle changes are also important to relieving pain. Eating well and exercise are just general good rules of thumb.

As for Eisenman, a cheerful, lifelong athlete, she's managed her ailment well, through a combination of medication and swimming.

"The bright side is, [psoriatic arthritis] has forced me to eat better and take care of myself," she said. "I feel older than my age, sometimes like I'm a 60-year-old woman. Sometimes even rolling out of bed can be an effort. But it makes me stronger."