This August is Psoriasis Awareness Month, and a good time to become more familiar with this diagnosis which affects millions of Americans. Despite being a relatively common condition, many of us hold onto the false assumption that it is only skin deep. Psoriasis, in all of its forms, actually goes much deeper, to the level of the immune system. Interested in knowing more? Read on for an introduction to this autoimmune disorder, related health concerns, and how it can be treated.
Psoriasis – An Immune System in Distress
Like other Autoimmune (AI) diseases, Psoriasis is a chronic inflammatory condition caused by a dysfunctional immune system. Though psoriatic presentations may differ, they are caused by the same underlying imbalances that exist within all AI diseases.
Our immune systems are designed to create antibodies which tag harmful foreigners such as viruses & bacteria so that our white blood cells know where to attack. In AI disease, the body loses the ability to differentiate between a true foreigner, and our own tissues. As a result, antibodies toward our own cells are produced, directing our immune system to target tissues and organs. Inflammation develops, followed by tissue destruction and dysfunction within the body.
While there is no single cause for AI disease, there are suspected triggers that may lead to development of auto(self)-antibodies. Additionally, there can be a genetic predisposition to developing an AI disease. Common triggers that may increase the risk for autoimmune disease include: Chronic Infections (viral, bacterial, fungal & parasitic) Continuous Allergen Exposure (including food sensitivities) Chronic Heavy Metal Toxicity
It is especially important to limit these potential triggers in your daily life if you have a known family history of autoimmune diseases.
Psoriasis In Its Many Forms Plaque Psoriasis The most common form – Plaque psoriasis occurs when overactive inflammatory immune cells create cytokines (proteins that act as immune cell signals) which target keratinocytes in the skin. The result is an inflammatory, raised plaque which appears red and exhibits a silvery build up of dead cells. When removed, pinpoint bleeding known as Auspitz’s Sign is seen. Plaques tend to arise on the outer aspects of joints (knees, elbows) but can occur anywhere on the body. They may also arise in areas of recent skin trauma.
Psoriatic Arthritis
Approximately 30% of patients with Psoriasis will develop a type of Psoriatic Arthritis. This painful and debilitating condition is categorized as a spondyloarthropathy, meaning it is similar in symptoms and presentation to arthritis disorders such as Ankylosing Spondylitis, & Reactive Arthritis. The joints may become very swollen, red & extremely tender to palpate. The arthritis may develop on one or both sides of the body, and may affect the spine. Types of psoriatic arthritis include Symmetric, Asymmetric, Distal Interphalangeal predominant (joints closest to the fingertips), Spodylitis (affecting the spine) and Arthritis Mutilans (rare, but severely debilitating).
Additional Forms
Though plaque psoriasis is more commonly seen, individuals may also be diagnosed with:
Guttate Psoriasis (thinner, smaller lesions that are greater in number)
Inverse Psoriasis (red, smooth lesions that arise in body folds)
Pustular Psoriasis (red, non-infectious pustules develop on the skin)
Erythrodermic Psoriais (widespread, poorly defined red lesions with pain & peeling)
How is Psoriasis Diagnosed?
Diagnosis of psoriatic skin lesions can be based on appearance, and may include biopsy for confirmation. Additional testing for other psoriatic presentations may include X-rays or synovial fluid testing for joint symptoms, and blood tests to assess for inflammation (ESR, CRP) or a genetic component (HLA-B27). Further testing may be recommended to effectively rule out other potential causes.
Treatment – Conventional & Alternative Approaches Conventional treatments for psoriasis are primarily suppressive, meaning they cover symptoms by blocking the activity of the inflammatory cells without addressing the underlying causes for immune dysfunction. For skin changes, these treatments usually consist of topical creams, whereas systemic immunosuppressive drugs are more commonly prescribed for arthritic symptoms. These medications can be of great value for symptom relief and interruption of tissue destruction, but it is equally important to treat the underlying imbalance.
An in-depth investigation of potential triggers is often indicated, followed by avoidance of those which are found to be significant. Even the basic removal of dietary and environmental allergens can help to decrease symptoms and decrease the number and duration of treatments needed. In addition to the chronic infections, allergens and heavy metals noted above, you should also speak with your healthcare provider about mental & emotional stressors, gastrointestinal dysbiosis, medications, and nutrient deficiencies. Each of these may contribute to auto-immune activity and aggravation of your psoriatic symptoms.
Potential treatments worth investigating for longer-lasting relief and healing include: Heavy metal testing & Chelation therapy (when indicated) Food allergy elimination diets (based on diagnostic test findings) Anti-inflammatory protocols Essential macro & micro nutrient supplementation (to reverse deficiencies) Diagnosis & treatment for chronic infections Gastrointestinal support (including diagnostic testing for SIBO, leaky gut syndrome, & more) Ozonotherapy IV’s & topicals (to modulate inflammation & decrease immune dysfunction) Low Dose Naltrexone (to modulate inflammation & decrease autoimmune activity)
Questions about treatments for Psoriasis and other autoimmune disorders? Contact Dr. Kaley at Restorative Health Clinic (503) 747-2021.
Dr. Kaley Bourgeois
References:
National psoriasis foundation. (n.d.). Retrieved from https://www.psoriasis.org/
Blauvelt, MD, A. (July). Pathophysiology of psoriasis. Retrieved from http://www.uptodate.com/contents/pathophysiology-of-psoriasis
The negative impact lead has on our children is becoming more and more dangerous. All recent studies are suggesting that lead is much more of a problem at lower levels, than was previously thought. This will make us rethink the lead pipes in many of our homes. Especially for sensitive children, lead and other toxic metals can threaten their ability to grow and thrive normally.
By Nancy Walsh, Staff Writer, MedPage Today
Published: May 13, 2013: Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Young children exposed to lead — even at low levels — are at risk for not meeting reading readiness benchmarks in kindergarten, a large study of urban children found.
On tests of reading readiness, children with blood lead levels between 5 and 9 mcg/dL scored 4.5 points (95% CI −2.9 to −6.2) lower than those with levels below 5 mcg/dL, according to Pat McLaine, DPH, of the University of Maryland in Baltimore, and colleagues.
And those with lead levels of 10 mcg/dL and higher had scores 10.1 points (95% CI −7 to −13.3) lower, the researchers reported online in Pediatrics.
Almost 25 years ago the CDC established 10 mcg/dL as a “level of concern” for blood lead levels in children, and more recently determined that children whose levels are 5 mcg/dL should be targeted for intervention.
“Learning to read is critical to the entire process of formal education,” McLaine and colleagues stated.
This requires “proficiency in phonologic processing skills (using the sounds of one’s language to process written and oral language) and in the ability to decode new words,” they explained.
A possible association between lead exposure and reading readiness has not previously been examined, but cooperation between school and public health authorities in Providence, R.I., provided an opportunity to consider this.
Using linked data from the Rhode Island Department of Health and Providence’s public school district records, McLaine’s group compared results among 3,406 children who had been tested for blood lead levels an average of three times before entering kindergarten.
Reading readiness was assessed on the Phonological Awareness Literacy Screening-Kindergarten (PALS-K) instrument, which measures reading-relevant cognitive abilities.
The test is given in the fall of kindergarten, and children who score lower than 28 out of a total of 102 are given additional classroom instruction throughout the year, the researchers explained.
The goal is for children to score 81 or higher by the time the test is repeated in the spring.
The study population was diverse and largely low income, with almost 60% being Hispanic and more than 90% qualifying for federal school lunch assistance.
The median blood level of lead in the entire group was 4.2 mcg/dL.
One in five children had had at least one blood level reading of 10 mcg/dL or higher, and more than two-thirds had at least one level of 5 mcg/dL or above.
“These results are markedly higher than [National Health and Nutrition Examination Survey] estimates from the same time and suggest that national population estimates may seriously underestimate the lead problem in urban schools,” the researchers observed.
The highest levels were seen in blacks and children whose first language was not English or Spanish, such as those of Asian descent.
About 35% of the children tested below the cutoff score on the PALS-K in the fall. These low scores were most commonly among boys, Hispanics, those receiving free lunches, and those with blood lead levels of 10 mcg/dL or higher.
Low scores also were seen in children whose mothers hadn’t completed high school or had public insurance at birth.
More than two-thirds of children whose blood levels were below 5 mcg/dL passed the cutoff PALS-K score, compared with only half of those whose levels exceeded 10 mcg/dL.
The prevalence ratio for not meeting the PALS-K benchmark score on the fall test was 1.21 (95% CI 1.19 to 1.23) among children whose blood lead levels fell between 5 and 9 mcg/dL and 1.56 (95% CI 1.51 to 1.60) for those with levels of 10 mcg/dL or higher.
This analysis found a “clear dose-response relationship” between early-life lead exposure and kindergarten reading readiness, even after adjustment for socioeconomic status, language spoken, and other demographic factors.
“Our results suggest the need to evaluate current screening approaches for early reading intervention and to determine whether adding a history of elevated [blood lead levels] could improve targeting of children who are at risk of school failure and are not presently being captured in that system,” the researchers stated.
They plan to follow these children during elementary school “to better understand the long-term impacts of both kindergarten reading readiness and childhood lead exposure on school success.”
These findings offer a caution about children who are exposed to fairly low levels of lead, according to Kevin Chatham-Stephens, MD, of Mount Sinai Medical Center in New York, who was not involved in the study.
“This study reinforces the fact that levels we used to think were safe — up to 5 mcg/dL — actually can impact children’s growth and neurodevelopment,” Chatham-Stephens told MedPage Today.
Limitations of the study included unclear reliability of measures of lead levels and possible residual confounding.
The study was supported by the National Institute for Occupational Safety and Health Education and Research Center for Occupational Safety and Health, the CDC, and the U.S. Department of Health and Human Services.
Below is an excellent excerpt from Medpage Today – chelation that removes undesirable elements like calcium, lead, mercury etc from the heart and blood vessels [thus allowing it to have better autonomous vasodilatory control, less inflammation] in conjunction with nutrients [vitamins, minerals] to support biochemistry, decreases risk for heart attack in patients who have had a heart attack in the past. Important concepts from this paper: Giving the appropriate nutrients through IV, plusRemoving substances that inhibits normal function of the Nitric oxide mediated [NOS] vasodilatory system and normal blood vessel function yielded significantly better outcomes than the control group in patients with heart disease. This is concurrent with our observations and practice. When done correctly and conservatively, chelation with focused nutrients for the cardiovascular and energy production system is a very appropriate treatment, with consistent patient satisfaction feedback.
ACC: Is Chelation Plus Vitamins a Winning Combo?
By Kristina Fiore, Staff Writer, MedPage Today
Published: March 10, 2013
SAN FRANCISCO — Vitamins alone won’t improve outcomes for patients who’ve had a heart attack, but they do appear to have additive benefits when given in conjunction with chelation therapy, researchers reported here.
In further analyses of the Trial to Assess Chelation Therapy (TACT), MI patients who had both high-dose vitamins and chelation therapy were significantly less likely to reach a combined cardiovascular endpoint over 5 years than those who had placebo in both instances, Gervasio Lamas, MD, of Mount Sinai Medical Center in Miami Beach, Fla., reported during a late-breaking clinical trials session at the American College of Cardiology meeting here.
“The message here, I think, is a cautious one,” Lamas said. “We’ve moved something that has been an alternative medicine into perhaps the realm of scientific inquiry, and found some unexpected results that merit further research.”
But he warned that he doesn’t think the “results of any single trial are enough to carry this novel hypothesis into daily use for patients who’ve had acute MI.”
However, Magnus Ohman, MD, of Duke University Medical Center, noted that the trial was well-designed and had a clear outcome: “We have a 2-by-2 factorial design, we have a significant reduction with vitamins and chelation versus placebo-placebo, yet your conclusion is, ‘maybe not.'”
“So I’m wondering,” he continued, “if we do a trial and we have an endpoint that is unusual and is a statistically significant finding, why are you holding back?”
Ohman told MedPage Today he wouldn’t necessarily recommend chelation therapy to his patients at Duke University, but if they told him they were going to try it, he wouldn’t discourage them.
When it was presented at the American Heart Association meeting last fall, the TACT trial showed that chelation therapy reduced a composite cardiovascular endpoint in patients who’ve had an MI — a finding that was surprising to all and unsettling to many cardiologists, who had been dismissive of chelation.
But most chelation practitioners will use concurrent high doses of anti-oxidant vitamins and minerals in conjunction with chelation. To rule out this potential confounding, the trial was conducted in a 2-by-2 factorial fashion, in which once patients were randomized to either the therapy or placebo, they were also randomized to either vitamins (3 high-dose capsules per day) or placebo.
The TACT Vitamin trial enrolled the full 1,708 patients and assessed the same primary composite endpoint of time to first occurrence of either death, MI, stroke, coronary revascularization, or hospitalization for angina.
Overall, Lamas and colleagues found no difference between those on vitamins or those on placebo in terms of the primary endpoint (37% in placebo group versus 34% in high-dose vitamin group), and there were no significant differences in any individual components of the primary endpoint.
But when looking at all four groups, they found that those who had chelation and vitamins had a significantly reduced risk of the primary endpoint compared with those who had placebo in both instances (HR 0.74, 95% CI 0.57 to 0.95, P=0.016).
Lamas said the mechanisms by which a combination of high-dose vitamins and chelation therapy might benefit these patients are unclear, but are deserving of further research.
During the session, he equated the results to those from a phase I or II randomized controlled trial, and that the idea of chelation therapy and vitamins “has now become, I think based on TACT, a novel hypothesis.”
“It might give us a little window into a mechanism that we have not previously thought of,” Lamas said, cautioning, however, that “we are far from carrying this novel hypothesis and applying it to patients.”
The study was supported by the National Heart, Lung, and Blood Institute and the National Center for Complementary and Alternative Medicine.
The researchers reported relationships with Janssen, Medtronic, Eli Lilly, Gilead, and AstraZeneca.
Primary source: American College of Cardiology
Source reference:
Lamas GA, et al “Randomized comparison of high-dose oral vitamins versus placebo in the Trial to Assess Chelation Therapy (TACT)” ACC 2013.
