The Latest From the Professionals

I wanted to let you know that my dermatologist called me personally and told me that my biopsy came back as highly probable for psoriasis. I’ll be honest, I would have prefered–it is or it isn’t psoriasis. Highly probable? Good enough, I suppose. Doc sounded pretty excited on the phone. “This is great! You actually have a diagnosis now that is pretty certain!” Yay for me. I’m sorry if I don’t sound as thrilled. I felt really phony in my response to her and said, “Yeah!” And that’s all I said. What was I supposed to say? “I know this is great! And now you can tell all your doctor friends that I am no longer a strange mysterious rash case with swollen joints.”

Discovering that what has been going on with me has a different name recently was quite a moment for me. I was anxious to share with family and my blogging friends (who are undoubtedly the most amazing group of people on the planet!). But I really didn’t like my dermatologist sounding so excited about the fact that something about me finally came back highly probable just because everything else I have presented her with has completely stumped her, her colleagues and the labs.

I also saw my rheumatologist for a follow up last month. It was an uneventful visit for the most part. Which in essence is a good thing. “How does my latest blood work look, Dr. H?” I asked. Anxious to know whether the antibiotics had affected my liver. To which he replied, “It still looks great.” “How do you feel?” he asked. “Similar to the last visit. Improvements have remained steady and feet are still very painful,” I replied. This means three more months on azithromycin and rifampin to go before I decide on the next step. (I already know what I’d like to try next and doc is on board. Love him!) Since I have seen some progress on AP and my liver is handling it ok thus far, it’s full steam ahead with the antibiotics.

Have you guys seen the recent press release from the American College of Rheumatology? Pretty exciting to a gal who is on AP for psoriatic arthritis. Here it is:

Press Release

THE BODY AGAINST ITSELF: BACTERIA INSIDE ONE’S OWN BODY LINKED TO RHEUMATOID ARTHRITIS AND OTHER AUTOIMMUNE DISEASES

ATLANTA – Researchers are using 21st-century technologies to investigate the century-old hypothesis that certain autoimmune diseases, including rheumatoid arthritis, are caused by bacteria living in the human body and will present their initial data this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Researchers have long associated periodontal disease, or gum inflammation, and bacteria in the gastrointestinal tract with RA, although no specific bacteria have ever been identified by researchers as the bacteria to target as possible therapy. Nevertheless, studies have suggested that bacteria or bacterial products contribute to RA and other autoimmune diseases.

Led by co-principle investigators Steven Abramson, MD, and Dan Littman, MD, PhD, researchers from New York University’s Langone Medical Center, aimed to determine whether bacteria in the human mouth and intestines can trigger RA. They used DNA amplification technology to identify what type of bacteria exist in the mouths and intestines of study participants, which included eight people with newly developed RA, three people with psoriatic arthritis, and nine people without these diseases – who were considered healthy.

Previous studies have relied on traditional bacteria cultures, which are only able to identify 20 percent of bacterial species in the human body because of the inability to find the right nutrients to grow the culture, which highlights the uniqueness of this study. “By sending our samples for a deep DNA sequencing, we’re able to identify 100 percent of the bacteria that are present,” says Jose U. Scher, MD, director of New York University’s new Microbiome Center for Rheumatology and Autoimmunity and one of the lead investigators in the study. “So we’re taking a huge step forward by not missing 80 percent of the bacteria. Taking that step will allow us to identify bacteria that are related to rheumatoid arthritis.”

Although it’s too early for this to be applied in the diagnosis of rheumatic diseases in a clinical health care setting, the research is already yielding results that distinguish people with RA from those without. Through this study, researchers were able to identify an over-abundance of the prevotellaceae family of bacteria in the intestinal fecal samples of participants who were newly diagnosed with RA—and had not been treated with drugs for the disease—when compared to those participants in the study who were identified as healthy.

Additionally, researchers found that mouth samples of participants with RA exhibited an overabundance of the porphyromonas genus compared to healthy controls. To examine bacteria in the mouth, researchers studied the gums of participants with RA or psoriatic arthritis, and healthy individuals. When examining the gums of these participants, researchers noted that 78 percent of the examined sites bled during examination in participants with RA, which was a significantly higher percentage than those with psoriatic arthritis (38 percent) and those participants identified as healthy (12 percent). Overall, 66 percent of participants with RA had moderate gum disease – compared to 25 percent of the participants with psoriatic arthritis and 12 percent of the participants in the healthy group.

Additional studies by the group have demonstrated that specific microbes induce the differentiation of Th17 cells in the intestine. There is already strong genetic and therapy-based evidence that pro-inflammatory Th17 cells and anti-inflammatory regulatory T cells (Treg) have critical roles in autoimmune diseases, including RA, psoriatic arthritis, and Crohn’s disease.

“The basic premise is that there are different oral and gut bacteria that activate Th17 cells to promote inflammation,” Dr. Scher explains. “Our hypotheses are that characterization of Th17-inducing microbes in the human intestine will provide insight into disease pathogenesis, and that directed manipulation of the gut microbiota will result in the alteration of arthritis biomarkers, including Th17/Treg balance.”

The next step for the team is a study in which 90 participants with RA will be subdivided into three arms. The first two arms will be given antibiotics for a two-month period, and the third arm will be given placebo. The researchers believe that by modifying the microbial flora with antibiotics, they can identify molecular mechanisms by which RA-associated bacteria affect Th17 and Treg homeostasis and thereby develop new strategies to diminish or even prevent the inflammatory process that leads to chronic destructive arthritis.

The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Scientific Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.rheumatology.org/education. Follow the meeting on twitter by using the official hashtag: #ACR2010.

Editor’s Notes: Jose U. Scher, MD will present this research during the ACR Annual Scientific Meeting at the Georgia World Congress Center at 3:30 PM on Tuesday, November 9 in the Room A 411. Dr. Scher will be available for media questions and briefing at 8:30 AM on Monday, November 8 in the on-site press conference room, B 212.

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13 thoughts on “The Latest From the Professionals

  1. I am surprised that this is the first time you are being diagnosed with psoriasis considering your RA diagnosis. That leaves me to question whether your symptoms are not just RA related. RA also attacks the skin and Lupus also causes psoriasis like rashes. I want to disagree and I am have been disagreeing since the first time this issue came up, how confident are you with this diagnosis? If you are 100% – please get a second opinion. If it is psoriatic arthritis, does that change your AP therapy treatment plan?

    I read a second press release recently with similar information and the researchers noted that if they could unlock certain clues, they could find a way to put people with autoimmune disease into remission much quicker and keep them there for a long time. Sounds hopeful but the estimates are least ten years in the future and people with advanced autoimmune disease may not be able to a part of this.

    • I’m pretty confident. I have never had a peace about the RA diagnosis. Can’t explain it–just haven’t. But when I read the symptom list for psoriatic arthritis and began researching the disease, I almost fell out of bed. I was beside myself–I was like–that’s me, that is so me. But to be honest, at this point, I feel kind of detached from the whole diagnosis gig. I figure my body is acting wacky regardless and at this point it really doesn’t matter too much since AP therapy is the same for both diseases. There is also the possibility that I have both. But I’m not going there right now. 🙂

  2. If you are like me, I need time after a diagnosis to let it all soak in. This is a lot. Sending you healing thoughts as you make your way through this new diagnosis.

    • Thanks so much, Cathy. I’ve been processing since I made the connection while researching online. It did catch me off guard. It was a mixture of excitement and then–sadness. Now it’s business as usual. 🙂

  3. Hi there… what a phone call, huh? How are you feeling now since it’s been a few days since your conversation with your derm?

    I’m sorry. *sigh* Our symptoms are so similar (down to the joints) that I would have to say we are two of a kind. Sister PsA’ers… we deserve matching necklaces or something. LOL!

    Do you happen to have Raynaud’s too?

    About your psoriasis patches… my daughter has a patch in one of the areas you had biopsied. Not something I really like to talk about, but I think it’s important to tell you so you don’t feel like you’re alone in that neck of the woods… 😦

    My rashes were misdiagnosed as eczema for years (even by the derm). It wasn’t until I saw my Rheumatologist that I was actually diagnosed with psoriasis. I think he only knew because of his experience. He’s maybe 70 and way past retirement… he’s definitely been around the block a few times.

    Hope you’re doing okay. Hugs and prayers.

    • Your comment about the matching necklaces made me laugh! Love it! Great way to start my day this morning.

      Thanks for asking me how I’m doing. 🙂 Since I already “knew” that I had PsA, her phone call didn’t phase me too much. I guess since I last saw my derm. I’ve had time to process. Now it’s like–oh, whatever. OK, so that’s what it is. I do not have Raynaud’s though. Girl, that has to be a killer in Alaska! I don’t know how you handle it. And thank you for letting me know about your daughter so I don’t feel a bit freakish. It broke my heart for her when I read that though. 😦 That stinks that it took you so long to get diagnosed. I really don’t have much confidence in dermatologists. I’ve been dealing with them since my youth and not one has really helped me or known what to do with me. My new rheumatologist is a lot older than the spring chicken straight out of med school doc I used to have. I like that he has some experience under his belt. 70 though–that’s crazy.

  4. Highly probable would not get me excited either. Life is a school of probability, but not very fun when you are the experiment in question.

    It’s great that you have a rheumatologist that is willing to work with you outside the routine treatment path. Mine does also, however the antibiotics would not work for me.

    • You said it! Who wants to be the experiment in question.

      That’s great that you have a doctor that thinks outside the box. Found my doc through the Road Back Foundation. He was only one listed for my city. I’ve talked with a few of his patients in the waiting room and they sing his praises. So disappointing to know that you gave the antibiotics a go and they were a no go for you. I know for a lot of people it can take a year or more to see any signs of progress. Fortunately, I am not in a place physically that leaves me no choice but to use a biologic. I plan to stick with antibiotics for as long as I can get away with it.

  5. Interesting! I have also been trying to self diagnose for quite some time. I have had stomach and digestive problems since I was a baby and so this theory hits home and I think they are onto something. Should I say congrats on your diagnosis or good luck and hang in there?!?! Each step (forward or backward) is one step closer to feeling better…right?

    • I’m so sorry to hear that you’ve had to deal with GI issues since you were a baby. Wow, girl. Aren’t you glad we have such a wealth of knowledge at our fingertips? I feel so blessed to be able to research so extensively on so many reputable sites and be connected to such a great group of people also searching for answers. I wish you the best in your quest for answers. I’m still researching. I still have a lot of questions…I guess we all will until there are more answers.

  6. Arthritis and related diseases are also known as rheumatic diseases. This term describes diseases of the joints, muscles and connective tissues, each having different causes. There are some very serious forms of arthritis that are called autoimmune diseases. In these diseases, the body’s immune system malfunctions.

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