dr p          303 BAY SREET, SUITE 402, GADSDEN, AL 35901

         PHONE (256) 439-9223  FAX (256) 439- 9225                                           

 

     

 

 

Daniel S. Prince, M.D., F.A.C.R 
Specializing In Arthritic and  InflammatoryDiseases

PSORIATIC ARTHRITIS,

POLYMYALGIA RHEUMATICA,

and GOUT

PSORIATIC ARTHRITIS

Patients with Psoriasis can develop a chronic arthritis that is almost identical to Rheumatoid Arthritis. The treatment of this type psoriatic arthritis of hands and fingersarthritis is the same as for R.A.  The difference is that tests for Rheumatoid are negative in the vast majority of Psoriatic arthritis patients.  A few differences noted are the increased rates of spinal arthritic involvement as well as more inflammatory tendon problems compared to R.A.  Also, the skin disorder and the arthritis do not have to occur at the same time.  Some patients have only a small area of skin disease but can have severe inflammatory arthritis.  Almost 20% of patients with the skin disease go on to develop the Arthritic disease.  Combined consultations with a Dermatologist and a Rheumatologist is the Optimal approach   

 

POLYMYALGIA RHEUMATICA   

Polymyalgia Rheumatica pain sites     Polymyalgia Rheumatica is an acute onset inflammation of the shoulder and pelvic muscles seen in elderly people. It is easily diagnosed with a simple blood test known as the SED RATE.  The Sedimentation Rate is elevated to moderately high levels.  The disease responds quickly and dramatically to Low Doses of Cortisone pills.  But, the condition lasts for 2 years or more and patients Must stay on Cortisone to control the Sed Rate.   

     Rarely, a similar disorder, Temporal Arteritis, can be present and requires a biopsy of aSite of Temporal Arteritis small scalp artery, Temporal artery, to make the diagnosis. If the biopsy reveals “giant cells” in the artery, then there is a great danger of Blindness in one of the eyes.  Treatment is with Very High Doses of Cortisone over several months or longer in order to reduce the risks of blindness.  Other therapies include immunosupressants such as Methotrexate and Imuran. 

 

 

GOUT      

Gout in the right ankleGout is a very common medical disorder that is poorly understood and usually treated incorrectly by the vast majority of doctors. Only a rheumatologist has the required experience to treat this chronic disorder .  Some medical specialists do manage this problem correctly, and they usually are Internists and Nephrologists.  Gout is the most common Inflammatory arthritic disease in American men over the age of 40.  Up to 7 % of US Males over 60 have Gout. Gout is a problem caused by the overproduction of URIC ACID, a normal byproduct of protein metabolism in all of us. This chemical is overproduced in young men over many years.  The uric acid excesses are deposited in the joint and cartilage tissues of the feet and lower extremities.  Under certain conditions these deposits cause a sudden Attack of acutely red and swollen joints in the feet. This attack is one of the most painful conditions known that occurs in an otherwise healthy young male.  The acute attack requires pain relievers and cortisone often given over several days before the painful swelling goes away.  The proper approach should be for the patient to have a blood test of the Uric Acid level and then a course of medication begun in order to lower the blood level of Uric Acid over a long time.  The standard goal is to lower uric acid to a level below 6.0.  There are only 2 drugs that are proven to do this: Allopurinol and Uloric.

     The major problem is that most patients only take medications when they have an attack then discontinue their meds over a long-term basis.  The overproduction of uric acid continues and the untreated patient is at risk for more and more attacks over time.  This disease requires daily use of a drug to lower the uric acid level in the blood and this is a long-term treatment just like diabetes and hypertension. Of course, weight loss, low fat diet and avoidance of excess alcohol intake are very important. Many remedies are commonly used, but are Not a substitute for the standard use of medications mentioned above.