(February, 1999)

P-Arthritis, PUVA & Skin Cancer
from Lydia

Dear Ed: I have had psoriasis for 38 years and have tried just about everything. I was one of the first PUVA patients and have now had several squamous cell carcinomas removed.

My problem is a very painful arthritic hip. It shows little real degeneration so far but is extremely painful and limits my life. Bone scans, MRI and X-rays showed fluid in the joint and it was drained and I received relief for a time. Obviously, that is not something they will do very often. The fluid was checked and my rheumatologist said it showed no evidence of psoriasis.

I'd like to know if anyone out there has had this experience, if there is a way to diagnose psoriatic arthritis and if anyone else has had arthritis in a hip joint and not in fingers or other typical places. This attack has been going on for a year and is pretty discouraging. By the way, my psoriasis has been kept fairly well controlled for years on Methotrexate.

Thanks for your website. -Lydia


Ed's Response: The National Psoriasis Foundation has this to say about the diagnosis of psoriatic arthritis:

Psoriatic arthritis is similar to three other forms of arthritis which may occur with psoriasis: rheumatoid, gout, and Reiter's syndrome. The diagnosis of psoriatic arthritis is made on the basis of a medical history and physical examination, blood studies, and x-rays of the joints that have symptoms. A certain antibody generally present in rheumatoid arthritis is not usually found in the blood of psoriatic arthritis patients. A blood test for the antibody will distinguish between rheumatoid arthritis and psoriatic arthritis. Fluid drawn from the affected joints can be examined to resolve the diagnosis of gout or psoriatic arthritis.


The description of the testing you went through, Lydia, is described in this excerpt. If I were you, I would tend to accept the diagnosis, that my arthritis was not related to my psoriasis.

My case is different. My "sore knee" emerged at a time when the psoriasis plaque covering the same knee was flaming. I asked, "Is it psoriatic arthritis?" The doc said, "Probably. If it gets worse we'll study it further." Well, it hasn't really gotten "worse"; it just comes and goes predictably, and I have not felt compelled—yet—to go that extra mile for the blood and joint fluid test confirmations. Over the past three Winters the knee pain has come more frequently and lasted longer, but it remains predictably triggered by temperature drops and wet weather. I feel I exacerbate the condition by working in a basement that is several degrees colder than the rest of the house, and separated from the damp by a thin membrane euphemistically referred to as a "garage door." In other words, my knee might feel better if I took greater pains to remove myself from the environment that aggravates it. I'm loathe to pay yet another doctor to tell me the same thing.

Your syntax suggests you, at least, connect your squamous cell carcinomas with PUVA treatments taken earlier. Has it been suggested to you by a doctor that this connection is probable, or do you simply feel it's more than coincidental? Of course, skin cancer is one of the great fears of extended light therapy—which is why I'm asking. I've heard from others who were among the first in the Great PUVA Trials, but you are the first to report contracting the dreaded SC. PUVA is such a common treatment, and so effective for so many, your case is dreadfully interesting (and potentially important), so please do write back with more detail. Thanks! -Ed

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