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On PA: Heredity, Blood, Stress and Alcohol
from AJS

Hey!  I've had P since I was 7 and I'm now 25.  At 10 I was diagnosed with psoriatic arthritis.  This mail is to the girl who was worried about getting arthritis.  I think it is heredity BUT nobody in my family has had either of these before, only me, so I don't know really how I got it.  It has something to do with blood cells.  I personally think it has a lot to do with stress.  I find everything gets worse when I'm stressed AND unfortunately, if I've been drinking, my P flares up hugely! -AJS


Ed’s Response:  I’m not sure about the particular correspondent you are referring to, the girl who was worried about getting arthritis, but that doesn’t matter because the archives here are full of emails from people who worry about PA compounding their struggles with P.

I think you’re right about the heredity and blood angles on PA (and P).  Scientists believe they have isolated some genes that enable psoriasis, and one of the new ways health researchers are combating it is through biologics — a new class of medicines — that, in the case of P, target the behavior of very specific cells in our blood.

This doesn’t resolve the issue of why there is no history in your family, yet you’ve been afflicted since the age of 7.  How does heredity work in your case?  Well, what you and the rest of us flakers actually inherit is probably the potential to flake.  P may or may not be something that just happens.  Many of us suspect it must be triggered.  It’s kind of like a pistol and a bullet.  Under a certain set of circumstances a pistol can be made to discharge a missile (bullet).  The hammer must be cocked and the trigger squeezed.  Of course, there must already be a primed bullet in the chamber.  The genetic proclivity we flaker’s probably share is the bullet in the chamber.  Something else cocks the hammer and squeezes the trigger. 

You and a few million of the rest of us think the “something else” is stress.  There’s lots of anecdotal evidence to suggest this.  Also, alcohol-related stress is evidenced.  Anecdotally, there are hundreds of possible/probable P-triggers.  Is it possible that your parents, grand parents and siblings, cousins, et. al. possessed the bullet but never fired it?  Well, here we scratch our heads.  We’ve just come into possession of this wonderfully complex map of the human genome and we’re a long way from “connecting all the dots” (no pun intended).  If the proclivity to flake is a certain combination of genes, it may be possible for two genetically un-inclined non-flakers to produce a very-much-inclined flaker.  It may also be that the inclined gene combination goes un-triggered in generations or certain individuals.

It will probably be several more years before we can explain psoriasis genetically.  (Time gets added to that prognosis every time another gene becomes suspected of involvement.)  But we should be thankful the subject is being explored.

In the meantime, we continue to focus on ways to inhibit the symptoms of psoriasis.  Those biologics I mentioned are an exciting new development.  There are more.

And no, none of this relieves the anxiety and worry about P evolving into PA.  I commend us not to worry because worry can be stressful, but I know we’re going to do it anyway.  < Sigh >  -Ed

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