Misunderstanding of Psoriatic Arthritis [Interview][Transcript]

Dr_Jason_Faller_autoimmune_disease_psaGuest: Dr. Jason Faller
Presenter: Neal Howard
Guest Bio: Jason Faller, MD originates from Beaver Falls, PA. He attended the University of Pennsylvania for both his undergraduate and his medical school education. During his fellowship in rheumatology at the University of Michigan, he was granted a fellowship to study purine metabolism from American Rheumatism Association. He has been in private practice in New York City since 1982.

Segment overview: Dr. Jason Faller, MD, talks about misunderstandings and misconceptions of this painful chronic condition of psoriatic arthritis, PsA.

Transcription

Health Professional Radio – Autoimmune Disease psa

Neal Howard: Hello and welcome to Health Professional Radio. I am your host Neal Howard, thank you so much for joining us again today. Psoriatic arthritis or PSA is a type of chronic inflammatory arthritis that occurs in some people who have had the skin condition known as “psoriasis.” Our guest in studio today is Dr. Jason Faller, he is the Chief of the Arthritis Clinic at Mount Sinai West Hospital, he’s also on the staff of Beth Israel and Lenox Hills Hospitals been in private practice in New York City since 1982. And he is here today to talk with us about PSA and in an effort to raise awareness and get the word out so that support for research and funding for treatments can just take off and sky rocket. How are you doing today Dr. Jason Faller?

Dr. Jason Faller: I’m doing very well. Thank you for having me.

N: Thank you. Psoriatic Arthritis you are spearheading an initiative on behalf of Celgene Corporation, the initiative called “Be counted.” Could you talk a little bit about Be Counted?

F: Absolutely. So there are many individuals who suffer from arthritis and some of those individuals may have psoriatic arthritis and not be aware of it. And we want those individuals to become educated so that they can pursue their proper diagnosis and treatment. And that campaign is called “Be Counted” and we are hoping that the word will get out that individuals should potentially see a rheumatologist who is a physician who specializes in the treatment of arthritis so that they can be evaluated and those with psoriatic arthritis receive proper treatment. And I’m goanna give you the website for that campaign, that website is psacounts.com.

N: How does the person who’s suffering know, I mean many don’t know they have it, but what should someone look for as opposed to just regular arthritis?

F: In psoriatic arthritis, often the involvement is asymmetric meaning it can involve one sided of the body and not in the other. It may start in the feet, we have an entity called “plantar fasciitis” that many individuals may have seen a podiatrist for or an orthopedist or they may have heel pain or tendonitis in their Achilles tendon. And those are all locations where psoriatic arthritis may come into play as well as having an arthritis in the end joints of the fingers or toes or a finger or a toe that just stays swollen or has been swollen recurrently and not diagnosed. So those are possible ways that psoriatic arthritis may present, and those individuals if any of that rings a bell may have psoriatic arthritis and should see a rheumatologist.

N: Okay. There are a lot of us who suffer from arthritis in one form or another. Talk about some of the misunderstandings about arthritis in general and about psoriatic arthritis specifically.

F: Often, all types of arthritis lumped together and individuals think that everything is just osteoarthritis, which is the “wear and tear” type of arthritis that one gets when one has worn out a joint or injured a joint and the joint had cartilage injury and then wore down over time. There are some genetic types of osteoarthritis in the hands but not all arthritis is osteoarthritis. Some arthritis as you know is rheumatoid, and some arthritis is as we’re speaking about today psoriatic arthritis, and it is important to distinguish those various types of arthritis because there are different approaches to them. The key to diagnosing psoriatic arthritis is the presence of the skin disorder psoriasis.

N: And how often is that misdiagnosed? I mean that’s something very easy to diagnose.

F: I can tell you time and time again when I see patients who are being referred here by other physicians and other practitioners that walk into my office. They have arthritis and have never put two and two together that the scaling on their head, the dandruff that they’ve had may represent a condition called psoriasis. That the rough elbows that they have aren’t just rough elbows, that they’re a skin condition called psoriasis.

N: And their coming in thinking that they have something else or not knowing it all?

F: They’re coming in thinking that their joints hurt and they’re not getting better and they want to try to find out how to make them better.

N: The bums, the rubs, the normal arthritis treatments once they take effect are they as effective on psoriatic arthritis for that short term relief as just like the other arthritis?

F: Sometimes they are effective, but often the patients I see have already been to a general doctor, a foot doctor, an orthopedic surgeon and they’ve tried a number of treatments and the problem is that they aren’t getting better.

N: Does this disease mimic any other? Is that why they’re taking so long to get some relief or at least get an answer?

F: Absolutely. There are patients who have, as I said run in to the mill osteoarthritis, there are patients who have inflammation in their Achilles tendon or in their plantar fascia on the bottom of their foot, that don’t have psoriatic arthritis. Though it does get confused from that end point and many times patients with psoriatic arthritis will actually show up in orthopedic surgery having a knee replacement or hip replacement and it’s gone that far, and they’ve never been diagnosed.

N: Oh, that is severe. Do you think that it is more important that people who are sufferers and discover from their physicians who become educated – is it sort of a hand and hand healthcare provider and patient going out there and getting the word out, or should physicians band together and use their power to get the word our even faster?

F: Well I would say that there are astute physicians who realize that this is a rheumatologic problem and make the referrals but there are many patients who are suffering, who have not been diagnosed and unfortunately not all physicians make the referral to rheumatologist or realize that the patient may have psoriatic arthritis and those are the physicians we want to inform. And we’re hoping that both through directly contacting those physicians as well as thru perhaps our patients bringing up to their physician the question of ‘Could this be psoriasis on my elbow? And could my pain be psoriatic arthritis?’ That they will then get the proper attention.

N: Do you see maybe a resistance to looking into psoriatic arthritis because it’s maybe a new thing? You’re trying to raise awareness so this is something isn’t as widely known as the other arthritic conditions. Do you see any resistance I guess anyone wanting to do even further research before they consider it? Maybe that is one of the reason that the condition goes so long without being detected.

F: I think that psoriatic arthritis has so many faces. We talked about the foot, we talked about the end joints of the hands. But even low back pain which can be chronic can represent psoriatic arthritis so it’s just the awareness that so many different types of symptomatology can come under this umbrella that makes it so difficult to recognized. And that is why we want everyone to be educated, to ‘Be Counted’ and we want them to go to the website psacounts.com

N: Great. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio today with Dr. Jason Faller, Chief of the Arthritis Clinic at Mount Sinai Roosevelt Hospital, also on the staff of Beth Israel and Lenox Hills Hospital. And we’ve been here talking about PSA or psoriatic arthritis some of the misunderstandings and misconception of this painful chronic condition, and I’m hoping that Dr. Jason Faller will come back and talk with us in future segments.

F: I will be happy to.

N: Thank you very much. Transcript and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.