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Psoriatic Arthritis

For you or a loved one with psoriatic Arthritis, this section goes into the medical treatment methods and alternative therapies available. Perhaps most importantly, though, it emphasizes the importance of a support network and empowers people with practical things they can do to make it easier to live with the condition. 

WHAT IS PSORIATIC ARTHRITIS?

Psoriatic Arthritis (PsA) is a long-term disease that affects both the Joints and the skin. People with psoriasis may develop psoriatic Arthritis. Most will have had psoriasis for about 10 years before PsA develops

PsA in Joints: psoriatic Arthritis causes pain and Swelling in the membranes that hold together and protect the bones in your Joints. This can bend and stretch the tendons and Ligaments, and eventually harm the bone and Cartilage in your Joints as well. PsA can also affect other body organs and Tissues.

PsA in skin: psoriatic Arthritis causes skin Lesions or plaques –patches of dead skin – that can appear to be rough, dry and thick as dead skin builds up, red and irritated with silvery scales and a distinct border between the plaque and normal skin. Sometimes the Lesions itch, burn or bleed. Patches are most often seen on the elbows, knees and torso, but can appear anywhere, including the scalp. Fingernails and toenails can also be affected – nails become thickened, lift up from the skin or become pitted (small holes form in them).

Psoriatic Arthritis is a Chronic disease, meaning once it starts, it likely persists life-long. Symptoms usually come and go in waves, and though scientists don't yet know what triggers PsA or how to cure it, they do know about the types of psoriatic Arthritis symptoms, how to treat symptoms and how the disease progresses.

WHAT CAUSES PSORIATIC ARTHRITIS?

Psoriatic Arthritis is caused by a malfunction of the Immune system, in which your Immune system mistakenly attack healthy Cells in your own body, in this case your Joints and skin. Scientists are not sure why this happens, but the nature of PsA puts it in the category of Autoimmune diseases.

Scientists are studying the potential causes:

  • Genetics: some people have Genes that pre-dispose them to develop psoriatic Arthritis – although carrying these Genes is not enough to develop the disease

  • Triggering event: the condition is set off when the body reacts to a stressful period in life, an Infection, or something else in the environment

  • Family link: someone who has a relative with PsA is at higher risk of developing the disease


WHAT ARE THE EFFECTS OF PSORIATIC ARTHRITIS?

Joints or areas of skin affected by psoriatic Arthritis may become red, swollen and painful, and feel hot or warm to the touch: this is called inflammation. The Joints of people with PsA also get stiff, especially in the first hours after waking up.

The symptoms of psoriatic Arthritis tend to change over time, and appear differently in each person. People with PsA often suffer from a cycle of very painful periods of time – Flares – followed by periods when the symptoms disappear, called Remissions.

Pain can be mild or extreme, the period when symptoms appear can be short or very long, and the length of time between Flares can range from weeks to years.

If inflammation from psoriatic Arthritis is left untreated, it can eventually lead to Joint deformities and severe Stiffness that make daily activities difficult. PsA is a form of Arthritis in which Joint damage can appear particularly quickly.

Fortunately, there are many ways to treat psoriatic Arthritis and prevent damage before it happens.

WHICH BODY PARTS ARE AFFECTED?

Psoriatic Arthritis usually begins slowly, in one or a few Joints, and spreads to other Joints over weeks or months. Skin and Joint symptoms often appear at the same time.

PsA psoriasis can appear anywhere on the body, but is most often seen on:

  1. Elbows

  2. Knees

  3. The lower back

  4. The scalp

Psoriatic Arthritis truly can look very different from person to person. It is impossible to predict how it will affect you — some people have skin problems worse than the Arthritis; in others, it may be the opposite.

It is common in psoriatic Arthritis to see nails become rough, ridged, and thick, and for fingers to become swollen and "sausage-looking" — called Dactylitis. Nail changes like pitting, splitting, cracking and separating from the skin are also common. Over time, Joints in the hands may change shape, lock, or fuse together. The toes can be similarly affected.

In addition to the Joints, PsA can cause Swelling in Tissues around them, like muscles, skin, or tendons and Ligaments. This is called enthesitis. It occurs in about one in five people with psoriatic Arthritis, most often in the elbows, heels, the bottom of feet and the outer hip area.

In some people with PsA, Swelling of eye muscles and Tissues, called Uveitis, also occurs. Conjunctivitis, or red eye, is also common.

SUPPORT MEANS EVERYTHING

Living with any Chronic disease can make you feel isolated – especially when you have to adapt or change your daily routine, see many healthcare practitioners and learn medical terms. But you don't need to do it alone.

How can your family and friends help

When you have psoriatic Arthritis, it's invaluable to keep the lines of communication open with your family, friends and coworkers: they can't understand what it's like to live with PsA if you don't talk openly about it.

Here are some tips and helpful insights we've learned from PsA patients:

  • Ask those closest to you to learn about your condition. This way they'll understand your symptoms, or even go with you to your appointments. They can read this or other websites, or consult reliable sources like libraries or the Arthritis Society in the country.

  • Let them know you need their support. This could be just a sympathetic ear when you need to talk. Be sure to tell them that Inflammatory diseases always have good and bad days.

  • Be open and honest about your PsA. It's the only way people can help you. Remember, if you've ever told a friend or family member, "You don't know what it's like," that's maybe because you haven't told them.

Make enjoying life a priority

When we stop doing the things we love, our mood drops, symptoms seem worse and it becomes even harder to get motivated. Keeping fun in your life is absolutely essential – make it a top priority. It boosts your mood, your relationships, and your energy level. Find one activity you love – even a small one – which you can add to each week without fail, and one you can add to each day. Once they become routine, you'll start feeling better and will want to add more.

Talk to your doctor

Psoriatic Arthritis is different for every patient, and treatment must be tailored for each individual case. The key is to communicate regularly with your doctor about your progress and the effects of your treatment, and to follow your treatment instructions every day, as medication can take time to work. If you feel there's a problem with your regimen, or are experiencing any side effects, talk to your doctor right away about trying alternative methods. Don't hesitate to ask questions and get involved in decision-making regarding your health. And keep in mind there are many options available to you, so if one approach isn't working, another one just might.

LIFESTYLE OPTIONS

If you have psoriatic Arthritis, there are many things you can do to ease your symptoms. Moderate Exercise, soothing skin care routines, healthy eating and relaxation techniques are all important factors in caring for your skin and Joints.

Please be sure to consult with your physician.

Exercise to ease pain and Stiffness

Exercise doesn't make stiff and painful Joints feel worse. In fact, a bit of moderate Exercise may be just the trick to relieving Joint tension. And physical activity strengthens muscles and Tissues, so weakened or damaged Joints are better supported.

To keep exercising fun:

  • Know your limits and trust your instincts on the amount of Exercise your Joints can handle

  • Start slowly if you haven't been active for a while

  • Don't overwork your muscles

  • Try smooth, low-impact activities like stretching, swimming, tai chi or light yoga

Always make sure that you don't overdo it. For extra motivation, you can ask a professional to design a fitness regimen. Be sure to tell them about your condition, so the routine will be right for you.

Care for your skin

Proper skincare will help you manage some psoriasis symptoms.

To soothe your skin:

  • Soak up a little sun: moderate exposure to sunlight usually helps by slowing the growth of skin Cells. However, too much sun damages your skin, so always use sunscreen. Be aware that in rare cases, UV exposure makes some types of psoriasis worse.

  • Control air humidity: use a humidifier to prevent dry air, which can aggravate psoriasis, especially in winter

  • Moisturize: keep your skin moist with topical creams and lotions that contain cocoa butter, lanolin, petroleum jelly, light mineral oil or baby oil

    Avoid irritating products: don't use strong soaps and moisturizers that contain perfumes or chemicals

  • Take daily baths: gently washing your skin every day helps to remove dead skin and calm

    inflammation

  • Use medicated creams and ointments: your pharmacy has non-prescription products that can help reduce itching and scaling. For scalp psoriasis, try a medicated shampoo. Always follow label directions and your doctor's advice

Eat Healthily

Imagine the extra strain it would put on your Joints to carry around a heavy backpack and suitcases all day long. Extra body weight can have the same damaging effect.

If you have psoriatic Arthritis, maintaining a healthy weight is the main reason to watch what you eat. Losing just a few pounds can mean big stress relief on your knees and other Joints. Choose nutrient-packed foods for optimal health and energy.

Be good to your Joints

Protect your Joints from damage by making a few changes to daily activities:

Protect your knuckles – use gadgets to twist open lids, enlarge the grip on tools and kitchen utensils and Push doors open using your body instead of just your fingers

  • Lift big pans and other heavy objects with two hands, and carry them close to your body

  • Use a reacher to pick up items from the ground, or a cane to decrease pressure on a knee or hip

  • Use a computer wisely: make sure your neck, wrists and lower back are in relaxed and neutral positions. Take a break and stand up every half hour or so

  • Balance periods of activity and rest: neither sitting nor standing all day is good for you

  • Pick a raised seat to decrease stress on hip and knee Joints

Pace yourself

One of the symptoms of psoriatic Arthritis is extreme tiredness, and dealing with pain can be exhausting. Even so, it's important to keep up some level of activity and movement. Prevent strain by alternating between demanding activities and easier ones. The key is to rest and take breaks, and listen to what your body is telling you.

Relax to handle stress

Stress can lead to an increase in blood pressure, interrupt sleep, and play a role in the intensity of psoriatic Arthritis symptoms. The first step is identifying stress triggers – then developing relaxation and coping skills to improve your overall well-being and give you a greater sense of control over your psoriatic Arthritis.

COMPLEMENTARY THERAPY OPTIONS

For some people, complementary and alternative therapies – treatments that fall outside the scope of traditional western medicine – can sometimes work very well for relief of Arthritis and psoriasis symptoms. Ask your healthcare professional about alternative therapies.

Temperature therapy

Both heat and cold can help reduce pain associated with psoriatic Arthritis but there are instances when it's better to avoid them.

Heat: Stiff Joints can benefit from a bit of heat, including first thing in the morning. Take a warm shower or hot bath, or apply warm compresses to help relax the muscles and relieve Joint Stiffness and pain. However, heat should never be applied directly to Joints that are swollen or already warm. This will make symptoms worse.

Cold: Applying a cold compress (or a plastic bag of ice cubes wrapped in a towel) to hot and inflamed Joints for about 15 minutes can help constrict blood flow and decrease the pain and Swelling. Cold can make a Joint feel stiffer, however, so don't use it on already stiff Joints.

Feed your skin with supplements

Omega-3 fatty acids (fish oil) supplements may reduce inflammation associated with psoriasis. Vitamin E is also thought to benefit skin and nails. Talk to your healthcare professional for more guidance.

Alternative therapies

Some people add natural relief therapies to their medical treatments for psoriatic Arthritis, such as acupuncture, acupressure, Swedish, or classic, massage therapy, vitamin or mineral supplementation (eg, glucosamine), or biofeedback (with or without hypnosis). Always first discuss these treatment options with your physician, and be sure to tell any alternative health specialist about your condition in order to avoid injury.

SURGERY

You and your doctor may consider surgery if medical therapies are not working well enough for you. In severe or advanced cases of psoriatic Arthritis, it can return function to a badly damaged Joint or restore posture in the Spine and neck. Back surgery is reserved for only the most severe cases, where deformities prevent almost all normal movement.

The decision usually depends on the amount of pain and disability in the affected Joint. Surgery can sometimes improve the appearance of deformed Joints. Or, doctors may perform surgery to get a closer look at the damaged Joint to better understand how to treat it.

Please be sure to consult with your physician.

MEDICAL TREATMENT

The General approach to treating psoriatic Arthritis is to reduce Joint inflammation and prevent long-term damage to the Joints, as well as to manage outbreaks of psoriasis. Psoriatic Arthritis medications are divided into two General categories: those that relieve symptoms and inflammation, and those that can relieve symptoms and modify progression of the disease. Psoriasis medications relieve symptoms and inflammation, and interrupt the cycle of increased production of skin Cells. Some medications can have a positive effect on both Arthritis and psoriasis.

Your doctor can explain the differences, benefits and side effects of each medication. You will likely try different therapies or combinations before finding the best prolonged pain relief.

Please be sure to consult with your physician.

Four types of medication are used to treat the symptoms of Arthritis in PsA:

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications that can be used to treat the pain and inflammation of PsA. NSAIDs do not control the disease, they only treat symptoms. Therefore, they are only taken on an as-needed basis.
Your doctor may recommend an NSAID to reduce Swelling and relieve Joint pain, tenderness, and Stiffness. You may start to see benefits within a few weeks.

There are many NSAIDs available, including prescription and nonprescription types. All NSAIDs have an anti-inflammatory effect. Each person reacts differently to different drugs, so you may find that one NSAID brings you more relief than another.

The most common side effects associated with NSAID use are indigestion, heartburn, and stomach and abdominal pain. They can also alter the protective lining of the stomach and gut, making you susceptible to Ulcers and bleeding, so you should avoid taking more than two different kinds of NSAIDs together. COX-2 inhibitors are custom-designed types of NSAIDs that minimize the risk of Ulcers and bleeding. People with heart disease, or a history of stroke or chest pain, should not take NSAIDs. Discuss the use of NSAIDs with your doctor if you have kidney, stomach or heart problems.

Corticosteroids

The body naturally produces Cortisone and other steroids to regulate inflammation in the body. Physicians use Corticosteroids as fast-working medication for particularly severe and painful symptoms of psoriatic Arthritis. They provide the same type of relief as NSAIDs, but are stronger, and not meant for Chronic or long-term use. They can have severe side effects, so they are usually taken for limited periods of time, or used to provide relief while waiting for slower acting medications to take effect.

Corticosteroids can be injected directly into a Joint or taken orally. Some of the side effects of oral Corticosteroids include facial rounding, fluid retention, fatty deposits in arms, legs or back, increased appetite and weight gain, difficulty sleeping, Acne, hair growth, blurry vision, increase in blood pressure, increase in blood sugar levels and mood swings. As dosage is decreased or stopped, these side effects disappear.

DMARDs

Disease-modifying anti-rheumatic drugs (DMARDs) are prescription medications that relieve psoriatic Arthritis symptoms and limit Joint damage. While they cannot reverse damage that has already happened, early treatment with DMARDs can prevent damage that may occur with psoriatic Arthritis over time, and slow or even stop the progression of the disease. With DMARDs, it can take time – sometimes weeks or months before there is a noticeable difference in pain and Joint Swelling. During this time, you might also be prescribed a steroid or NSAID, to help control symptoms.

In addition to their effects on Arthritis, DMARDs can be prescribed to relieve the psoriasis symptoms of skin inflammation and decrease the production of skin Cells.

DMARDs are meant for long-term management of psoriatic Arthritis and may be taken consistently for months or years in order to keep PsA in Remission. They can be taken alone, but are sometimes prescribed with NSAIDs, other DMARDs or biologic medications. Your doctor will recommend a therapy that is best suited to your type and stage of Arthritis, other medical problems and medications.

Common side effects of DMARDs include nausea, diarrhea, upset stomach, dizziness, increased risk of Infection and liver problems. Regular blood work is needed to monitor blood cell counts and liver function.

Biologics

Biologic response modifiers, or Biologics for short, are medications specifically designed to target your body's Immune system. Like DMARDs, Biologics are used to slow the progression of psoriatic Arthritis, help prevent Joint damage and ease Joint Swelling, tenderness and pain. And like DMARDs, they are also used to slow the production of skin Cells, and ease the pain and Swelling of psoriasis plaques and scales.

Biologics can take time to work. Some people notice the effects of the medication quickly (within a week), while others take months to feel the effects. Biologics are often combined with other medications to treat PsA, such as DMARDs. They are also prescribed to people who fail to respond to other PsA therapies.

Common side effects with Biologics include mild skin reactions at the injection site, nausea, abdominal pain and headaches. Rarely, people who take Biologics may develop serious Infections, __luPus-like reaction__s, nervous system diseases, and cancer. You should not take a biologic if you are pregnant or nursing, or have a history of multiple sclerosis or cancer. Tell your doctor if you have a history of Tuberculosis, hepatitis B or recurrent Infections.

Biologics are administered in two ways: infusion or injection. Your doctor can provide you with information and help make the right choice for you.

TREATMENTS THAT CAN BE USED FOR SYMPTOMS OF PSORIASIS IN PSORIATIC ARTHRITIS:

Topical therapy

Applied directly to the affected area, topical Corticosteroids are the most frequently prescribed for treating mild-to-moderate psoriasis . They slow cell turnover, which reduces inflammation and relieves itching. They should only be used for limited periods, because long-term use or overuse of strong Corticosteroids can cause thinning of the skin and resistance to the treatment's benefits.

Retinoids

If your psoriasis is severe and doesn't respond to other treatments, your doctor may recommend using a drug from the Retinoid family. It's not known exactly how Retinoids work, but they reduce skin cell production and the speed at which they grow and shed.

With Retinoids, symptoms usually return once the therapy is stopped. Common side effects are dry skin and mucous membranes, itching, and hair loss. Women must avoid pregnancy for at least three years after taking Retinoids since they can cause severe birth defects.

Photo (light) therapy

Brief exposure to small amounts of sunlight, or to controlled doses of UVB light from an artificial source, may improve mild-to-moderate psoriasis symptoms. During UVB treatment, psoriasis may worsen temporarily before improving, and light therapy can cause short-term side effects such as redness, itching and dry skin. Moisturizers help lessen these side effects.

Combining UVB with other therapies may increase efficacy dramatically and allow for lower doses of medication.

Reserved for moderate-to-severe cases, PUVA (psoralen plus long-wave ultraviolet A light) can be used to clear psoriasis. PUVA uses a light-sensitive compound in addition to light therapy, and usually works in most people with Chronic psoriasis Lesions.

The short-term side effects with PUVA include nausea, headache, burning and itching. The long-term side effects can include dry and wrinkled skin, freckles, and increased risk of skin cancer (including melanoma, the most serious form of skin cancer).

 

Source: National Psoriasis Foundation - www.psoriasis.org

A localized collection of pus surrounded by inflamed tissue.
A disorder of the skin caused by inflammation of the skin glands and hair follicles; specifically, a form found mainly in adolescents and marked by pimples especially on the face.
A research study that compares the investigational drug or treatment to standard-of-care therapy (compared to placebo).
AIDS (acquired immunodeficiency syndrome) is the most advanced stage of infection with human immunodeficiency virus (HIV). HIV/AIDs can be spread through unprotected sex with an infected person or by sharing drug needles or through contact with the blood of an infected person.
A surgical connection made between two structures (usually tubular ones) such as blood vessels or loops of the bowel.
Male hormones used to control the production of estrogen.
A type of arthritis of the spine that causes inflammation between the vertebrae (bones that make up the spine) and in the joints between the spine and pelvis. In some people, ankylosing spondylitis can affect other joints.
Chemical substances that stop the growth of or kill bacteria, parasites and fungus. Antibiotics do not treat viral infections – antiviral drugs may treat some viruses.
Medications that block cholinergic neurotransmitter systems.
Apocrine glands are special sweat glands found in hairy areas of the body such as the armpits and groin.
The practice of using essential oils (generally plant-based) to improve health or a person’s mood.
The use of art that helps people manage physical and emotional problems by expressing themselves creatively.
A condition that causes pain and inflammation within a joint.
A rare childhood disease that affects the brain as well as other parts of the body.
Ophthalmic atropine may be used before eye examinations to dilate (open) the pupil (the black part of the eye). This medication can also be used to relieve pain caused by swelling and inflammation of the eye.
An illness that occurs when the body tissues are attacked by its own immune system. The immune system is designed to “seek and destroy” disease in the body, including infectious agents. Patients with autoimmune diseases frequently have unusual antibodies circulating in their blood that target their own body tissues.
In a a trial protocol, an explanation of what is known so far about the medical product being studied.
Relating to or caused by bacteria. Often used to describe the origin of an infection.
A disease involving inflammation of the blood vessels; it may affect many parts of the body.
An antibacterial ingredient often used in acne medications. It is a flammable white granular solid used as a bleaching agent for flour, fats, waxes and oils, and in pharmaceuticals.
When a point of view prevents objective judgment on issues relating to the patient. In clinical studies, bias is controlled through blinding and randomization.
A yellow or greenish liquid made by the liver that helps the body digest fats.
Therapy involving natural or manufactured substances that change the way cells behave. Biological therapies can cause certain cells to stop growing, block the release of hormones or strengthen the body’s immune system.
The removal of samples of tissue, cells or fluids from the living body. Biopsies can be taken using a biopsy instrument that is passed through the skin or through an endoscope into the organ in question, or is collect by open surgery. A trained specialist (pathologist) examines the tissue under a microscope to establish a precise diagnosis such as cancer.
A clinical trial is called blinded or “masked” when patients don’t know whether they are in the experimental or control arm of the study.
An anticoagulant agent used to prevent blood clots. In heart or blood vessel disease, or poor blood flow to your brain, doctors may recommend a blood thinner. Blood thinners can decrease the risk of heart attack and stroke by reducing the formation of blood clots in arteries and veins.
A localized swelling and inflammation of the skin usually resulting from bacterial infection of a hair follicle and adjacent tissue, having a hard central core, and forming pus.
A bone scan is a procedure that checks for abnormal areas or damage in the bones. Prior to the scan, a very small amount of radioactive material is injected into a vein. This collects in the bones and is detected by a scanner (a special camera that takes pictures of the inside of the body).
Another name for the intestines: the small bowel (duodenum, jejunum and ileum), and the large bowel (colon and rectum).
BRCA 1 is a gene on the human chromosome 17 and BRCA 2 is a gene on chromosome 13. These genes normally help to control cell growth. A person who inherits certain mutations (changes) in one or both of these genes has a higher risk of getting breast, ovarian, prostate, and other types of cancer.
Medication used to block an enzyme responsible for breaking down levodopa before it reaches the brain; carbidopa is always given in combination with levodopa
A cancer that starts in the skin or in tissues that line or cover internal organs.
A strong but flexible, somewhat elastic tissue found in some parts of the body (such as the nose, the outer ear, and some joints).
A clouding of the lens in the eye which may affect vision. Cataracts commonly occur in older people.
A non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, tenderness, swelling and stiffness associated with osteoarthritis (arthritis due to a breakdown of the lining of the joints), rheumatoid arthritis, and ankylosing spondylitis.
The basic building blocks of the body's tissues. The human body is made up of many different types of cells. Human cells vary in size, but all can only be seen with a microscope.
Aclear, colorless body fluid found in the brain and spine that acts as a cushion or buffer for the brain's cortex, providing basic mechanical and immunological protection to the brain inside the skull. It also constitutes the content of the ventricles, cisterns, and sulci of the brain, as well as the central canal of the spinal cord.
The layer of blood vessels and connective tissue that rests between the white of the eye and retina (at the back of the eye). The choroid is part of the uvea and supplies nutrients to the inner parts of the eye.
Persisting over a long period of time. Relating to disease, one that is slow in progressing and long lasting.
A structure in the eye that releases a transparent liquid (aqueous humor) inside the eye.
A medical condition in which hard scar tissue largely replaces soft, healthy tissue in the liver. Severe scarring of the liver can prevent it from functioning well. It is important to know that cirrhosis is the end result of many kinds of injury to the liver, such as alcohol, hepatitis C, autoimmune liver disease and others (alone or in combination). Therefore, any chronic liver disease that is severe and progressive can result in cirrhosis.
Eye disease with symptoms that include blind spots, blurred vision and other vision problems as well as floaters. Most people are exposed to CMV in their lifetime but typically only those with weakened immune systems become ill from CMV infection.
Can spread from one person or organism to another by direct or indirect contact.
Corticosteroids are a group of natural and synthetic analogs of the hormones secreted by the pituitary gland. They are prescribed on a short-term basis as fast-working medication for particularly severe and painful symptoms.
Corticosteroids are a group of natural and synthetic analogs of the hormones secreted by the pituitary gland. They are prescribed on a short-term basis as fast-working medication for particularly severe and painful symptoms.
Also known as Cowden disease, involves a mutation in the tumor suppressor gene phosphatase and tensin homolog (PTEN).
A type of inflammatory bowel disease that causes irritation of the digestive, or gastrointestinal (GI) tract.
Treatments used to diminish some side effects of cancer treatments, particularly bone marrow suppression. CSFs stimulate the bone marrow so that it increases its production of blood cells. With more blood cells the risk of infection, anemia and bleeding is reduced.
Also known as intermediate uveitis, it affects the ciliary body.
A medication used to treat cancer of the ovaries, breast, blood and lymph system, and nerves (mainly in children). Cyclophosphamide is also used for retinoblastoma (a type of eye cancer that occurs mainly in children), multiple myeloma (cancer in the bone marrow), and mycosis fungoides (tumors on the skin). Cyclophosphamide belongs to a group of cancer medicines called alkylating agents.
A noncancerous, closed pocket of tissue that can be filled with fluid, pus, or other substance. Cysts feel like large peas under the surface of the skin.
Inflammation of an entire digit (a finger or toe), which can sometimes be painful. Dactylitis can occur in psoriatic arthritis and ankylosing spondylitis.
A medical condition that causes a persistent feeling of sadness, loss of interest, and hopelessness.
A dermatologist is a medical doctor specializing in the skin, the diseases of the skin, and the relationship of skin lesions to overall disease.
If a person has diabetes, their body is not able to properly use the sugar that is released from the food they eat. These sugars build up in the body and can make them feel nauseated, very hungry, very thirsty or very sick, with frequent urination.
Diagnostic examination used to x-ray the breast in patients who have signs or symptoms of disease, such as pain, a lump or nipple discharge. Doctors may use diagnostic mammography to look for tumors or other abnormalities.
A neurotransmitter that regulates movement and emotions.
Medications that work in a similar way to dopamine.
Ductography is an x-ray of the breast ducts (tubes that carry milk from the lobules to the nipple).
The point at which a tendon or ligament or muscle inserts into bone, where the collagen fibers are mineralized and integrated into bone tissue. Enthesitis is inflammation of the entheses, the sites where tendons or ligaments insert into the bone, points where recurring stress or inflammatory autoimmune disease can cause inflammation or occasionally fibrosis and calcification. One of the primary entheses involved in inflammatory autoimmune disease is at the heel, particularly the Achilles tendon.
A chemical substance in animals and plants that aids natural biological processes (such as digestion).
Estrogen is a hormone made by the body that helps develop and maintain female sex characteristics and plays a role in the growth of long bones. Estrogen can also be made in the laboratory. Estrogen may be used for birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.
An estrogen receptor is a protein found inside the cells of the female reproductive tissue, some other types of tissue, as well as some cancer cells. The hormone estrogen will bind (attach to) the receptors inside the cells and may cause the cells to grow.
Activity requiring physical effort, carried out especially to sustain or improve health and fitness.
Extreme tiredness, exhaustion that doesn’t get better with rest.
An episode when the symptoms of a disease or condition break out or intensify rapidly, become suddenly worse or more painful.
Small spots occasionally seen in the field of vision. Floaters may appear as dots, threads or cobwebs.
A doctor who specializes in the study of digestive organs including the liver.
Carries the information inside each cell of the body that determines biological traits, which are features or characteristics that are passed on by parents.
Relating to, caused by, or controlled by genes.
The genetic makeup of an organism or group of organisms with reference to a single trait, set of traits, or an entire complex of traits; the sum total of genes transmitted from parent to offspring.
A group of diseases associated with damage the eye's optic nerve. Glaucoma occurs when the fluid pressure inside the eyes slowly rises, damaging the optic nerve. Without treatment, people with glaucoma may slowly lose their peripheral (side vision). Over time, blindness may result.
A sugar occurring in many fruits, animal tissues and fluids, etc., and having a sweetness about half that of ordinary sugar.
The GCP defines international quality standards that governments can incorporate into regulations for clinical trials involving human subjects. Good Clinical Practice guidelines include standards on how clinical trials should be conducted. These also define the roles and responsibilities of clinical trial sponsors, investigators, and monitors. Monitors are hired by the sponsor to verify that the data/information at the site (hospital, clinic) is accurate.
A deep narrow pit that is formed by the tubular infolding of the epidermis and that encloses the root of the hair and into which oil glands often secrete.
Hemodialysis is a process where a machine filters wastes, salts and fluid from the blood when the kidneys are no longer healthy enough to do this on their own.
A liver disease caused by the hepatitis A virus (HAV). HAV causes the liver to swell and prevents it from working well. HAV is passed from person to person through fecal matter. Most often it is transmitted because of poor hand-washing after using the bathroom or changing a diaper, or before preparing and eating food. Unlike Hepatitis B and hepatitis C, it does not become chronic (long-term).
A liver disease caused by the hepatitis B virus (HBV). HBV causes the liver to swell and prevents it from working well. HBV is passed from person to person through bodily fluids such as blood, semen or vaginal secretions. Most often it is transmitted through sexual contact or from an infected mother to her infant during birth.
A doctor who specializes in the study of the liver.
HER2 is a type of protien(made with instructions from the HER2 gene) that helps to control cell growth. When the HER2 protein is made in larger than normal amounts by cancer cells, the cells may grow more quickly and can spread to other parts of the body.
There are two approved forms of testing that utilizes a biopsy of breast tissue and/or breast tumor cells to observe either how much of the HER2 protein is present in the tumor or how many copies of the HER2 gene that instruct the rapid development of that protein are present.The tests look for abnormal amounts of each and the results can help inform treatment options.
A virus that affects the skin or the nervous system, often causing blisters.
A condition that occurs when too much hair to grow on a woman’s face or body.
A disease caused by a fungus called Histoplasma. This fungus grows in soil and material contaminated with bat or bird droppings. Breathing the fungal spores can cause infection; it is not contagious between people.
HIV (short for human immunodeficiency virus) weakens the immune system by destroying important cells that fight disease and infection. A deficient immune system can’t protect from illness as it normally would. It is sometimes referred to as the AIDS virus.
Tests that measure the amount of certain proteins, called hormone receptors, in cancer tissue. Hormones can attach to these receptors. Having a lot of hormone receptors means that hormones can help the cancer grow.
Hormones (estrogen, progesterone, or both) are used to treat women after menopause to replace the hormones no longer produced by the ovaries.
A surgical operation for ulcerative colitis (UC) after removal of the bowel. An internal pouch is made from the ileum and attached to the anus. This means stools are passed through the anus in the usual way. Sometimes referred to as restorative proctocolectomy.
The network of cells, tissues and organs that work together to protect the body and defend it against infectious organisms (bacteria, viruses, etc.) and other harmful substances. Through a series of steps called the immune response, the immune system attacks these organisms and substances.
Suppression of the immune system and its ability to fight infection. Immunosuppression may be due to drugs or diseases.
Infections are caused by germs inside the body. Different types of infections include colds, sore throats, rashes, and cuts or wounds that become infected. How they are treated depends on what type of germ caused the infection.
A term to describe disease that can be transmitted through the environment, and can spread infection.
A natural process that the body normally uses to protect itself from harm, such as an injury or infection. Affected areas may become red, swollen and painful and feel hot or warm to the touch.
A type of breast cancer that begins in the breast ducts. The cancer cells spread from the ducts to the lymph vessels in the skin of the breast.
A disease characterized by inflammation, where the body’s immune system thinks its own cells are threats, attacking them as they would typically target external threats like foreign bacteria or a virus.
See PRINCIPAL INVESTIGATOR.
Ionizing radiation is made (or given off) by X-ray procedures, radioactive substances, rays that enter the Earth's atmosphere from outer space, as well as other sources. At high doses, ionizing radiation increases the chemical activity inside cells and can lead to health problems, such as cancer.
The colored portion of the eye containing a circular opening, the pupil, in its center.
A condition involving inflammation of the eye's iris. The iris is a part of the middle layer of the eye (uvea), so iritis is sometimes called anterior uveitis.
Yellowing of the skin and the whites of the eyes. It is caused by accumulation of bilirubin in the body when the liver is not working well.
The point of contact between elements of a skeleton whether movable or rigidly fixed together with the surrounding and supporting parts (as membranes, tendons or ligaments).
A rare childhood disease that makes the walls of the blood vessels in the body become inflamed; this disease can affect any type of blood vessel, including the arteries, veins and capillaries.
Kinesiologists are medical specialists who are leaders in the prevention and management of injury and chronic disease through movement. Using exercise, they are devoted to improving performance, health and overall quality of life.
An abnormal change in structure of an organ or body part due to injury or disease.
A hereditary cancer predisposition syndrome reported in 1969 by Drs. Frederick Li and Joseph Fraumeni from the National Cancer Institute.
The tough bands of tissue that serves to connect the articular extremities of bones or to support or keep an organ in place. Ligaments are usually composed of coarse bundles of dense white fibrous tissue parallel or closely interlaced – they are pliant and flexible, but not extensible.
The growth and spread of unhealthy cells in the liver. Also known as hepatocellular carcinoma.
A liver transplant is the process of replacing a diseased liver with a donated, healthy liver.
A reaction that looks like Lupus, defined as an inflammatory connective tissue disease often held to be an autoimmune disease. Occurring chiefly in women, Lupus is characterized by fever, skin rash and arthritis, often by acute hemolytic anemia, and by small hemorrhages in the skin and mucous membranes.
A lymph node is a rounded mass of lymphatic tissue surrounded by a capsule of connective tissue. Located in the lymphatic system, these nodes filter lymph (lymphatic fluid), and they store white blood cells. Lymph is a clear fluid that carries cells that help fight infections and other diseases. The lymphatic system is made up of the tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. Lymphatic vessels extend to all tissues of the body.
A cancer of a part of the immune system known as the lymph system.
An MRI is a procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of the body’s interior. These pictures can distinguish between normal and diseased tissue.
Malignant is the description of a type of tumor that can invade and destroy tissues and spread to other parts of the body.
When cancer cells spread (metastasize) from one part of the body to another where they can grow into new tumors.
An approach based on the belief that the body can be stimulated to heal itself.
Chemical (such as dopamine, acetylcholine, or norepinephrine) which transmits or relays information or signals from one nerve cell (neuron) to other nerve cells or muscle cells.
A lymph node is a rounded mass of lymphatic tissue surrounded by a capsule of connective tissue. Located in the lymphatic system, these nodes filter lymph (lymphatic fluid), and they store white blood cells. Lymph is a clear fluid that carries cells that help fight infections and other diseases. The lymphatic system is made up of the tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. Lymphatic vessels extend to all tissues of the body.
A small mass of rounded or irregular shape.
See OBSERVATIONAL MODEL and OBSERVATIONAL STUDY
The general design and strategy as to identifying and following up with participants during observational research studies. Types of observational study models include cohort, case-control, case-only, case-crossover, ecologic or community studies and family-based.
A research study whereby patients identified as belonging to study groups are assessed for biomedical or health outcomes. Patients may receive diagnostic, therapeutic, or other types of treatments, but the investigator does not assign participants to specific interventions (as in an interventional study).
A doctor who specializes in treating patients with cancer.
A medical doctor specializing in the branch of medical science dealing with the anatomy, functions and diseases of the eye.
A licensed professional who examines the eyes (using suitable instruments or appliances) for defects in vision and eye disorders in order to prescribe corrective lenses or other appropriate treatment.
The bones of a person with osteoporosis are weak and more likely to break. Anyone can develop osteoporosis; however, it is common in older women.
In biology, “overexpression” means to make too many copies of a protein or other substance. Overexpression of certain proteins or other substances can play a role in cancer development.
A rare form of breast cancer that begins in the breast ducts and spreads to the skin of the nipple and areola. The affected skin may appear to be crusted, scaly, red, or oozing.
A condition that occurs when all layers of the uvea are inflamed.
People with this condition have a mutation in the STK11 (also called LKB1) tumor suppressor gene.
The processes (in a living organism) of absorption, distribution (in the body), metabolism (process by which the body breaks down and converts medication into active chemical substances to treat a disease), and excretion of a drug or vaccine (usually via feces, urine and even respiration).
An inactive pill, liquid, or powder that has no treatment value. In clinical trials, experimental treatments are often compared with placebos to assess the treatment's effectiveness.
The study method whereby an inactive substance (the placebo) is given to one group of patients while another group receives the drug being tested. The results are then compared to see if the test treatment is more effective than the placebo in treating the condition.
Inflammation of the ileal pouch (an artificial rectum surgically created out of ileal gastrointestinal tissue in patients who have undergone a colectomy).
In drug and medical product/device development, a study that is classified as “preclinical” means it is at the stage of research where it has yet to be cleared for testing in humans and is still being tested in animals to gather important feasibility, and drug safety data.
The clinical trial doctor - a highly qualified physician who carries out the research and interacts with the patients. All clinical trial doctors also have additional training in clinical trials and research.
Progesterone is a hormone made by the body that plays a role in the menstrual cycle and pregnancy. The hormone progesterone can also be made in the laboratory. It is used for birth control and as a treatment for menstrual disorders, infertility, symptoms of menopause, and other conditions.
A protein found inside the cells of the female reproductive tissue, some other types of tissue, as well as some cancer cells. The hormone progesterone will bind (attaches) to the receptors inside the cells and may cause the cells to grow.
The probable outcome or course of a disease; can also refer to the chance of recovery or recurrence.
A Protocol is the study plan on which the clinical trial is based. All plans are carefully designed to safeguard the volunteers, as well as answer specific research questions. A protocol describes who may participate in the clinical trial, the schedule of tests, procedures, medications, and regular follow-ups by the principal investigator and team to monitor the health and safety of research study participants, and effectiveness of the treatment.
Thick, yellowish-white fluid formed at the site of inflammation during infection.
A treatment that uses high-energy particles or waves to destroy cancer cells.
A clinical trial method in which the subjects are randomly distributed into groups which are either given the test drug or which serve as the control group.
Often expressed in terms of a number that confirms that the act of randomization – subjects being assigned by chance into separate groups that are then used to compare different treatments—has occurred. The number is indicative of the total number of times this process has successfully taken place. There is often a total number of randomized subjects that is the goal for a study to meet in order to be considered complete.
In a clinical trial protocol the rationale is the reason why a clinical trial is being conducted.
Reactive arthritis is a type of arthritis, or joint inflammation that occurs as a “reaction” to an infection somewhere else in the body.
The last part of the colon.
Recurrence means cancer that has recurred or come back. This usually happens after a period of time during which the cancer could not be detected. The cancer recur in the same place as the original (primary) tumor or to another place in the body.
A period free of active disease with few or no symptoms.
Carefully planned studies (also called a clinical trial or clinical study) that observe or treat patients in order to develop or discover new treatments or medications. Researchers want to see how well a drug works, how it can be used safely, and learn how to prevent, screen for, better diagnose and treat health issues
When the retina has been lifted or pulled from its normal position. It can occur at any age, but is more likely in people over age 40.
Any of various synthetic or naturally occurring analogs of vitamin A.
A form of arthritis that causes pain, swelling, stiffness and loss of function in the joints. It can affect any joint but is common in the wrist and fingers.
A disease involving inflammation, usually in the lungs, skin or lymph nodes. Sarcoidosis starts as tiny, grain-like lumps, called granulomas and can affect any organ in the body.
A type of breast imaging test used to detect cancer cells in the breasts of some individuals who have already had abnormal mammograms or who have dense breast tissue. This is not used for screening or in place of a mammogram.
The first visit to the site of a clinical trial, that evaluates whether the person can participate or not. The volunteer meets the specialist and study coordinator, reviews the informed consent form, undergoes a physical exam and tests, reviews their medical history, etc. If they qualify, a baseline visit is scheduled.
A hormone, such as estrogen or testosterone, affecting sexual development or reproduction.
A narrow, elongated channel in the body that allows the escape of fluid.
The backbone. Vertebrae are any of the bony or cartilaginous segments that make up the spinal column.
A means of describing or classifying cancer based on the extent of the cancer in the body.
To destroy microorganisms which adhere to surfaces, usually by bringing objects to a high temperature with steam, dry heat, or boiling liquid.
Its the sensation of dfficulty in moving a joint or apparant loss of range of motion of a joint.
The investigative methods found in the protocol that are used in a clinical trial.
see PLACEBO
A doctor who manages the treatment of cancer by excision (surgery).
A tubular gland of the skin that excretes perspiration.
Abnormal enlargement of a body part, typically due to an accumulation of fluid.
A sexually transmitted disease that can affect the genital area, lips, mouth, or anus of both men and women. Syphilis can be transmitted from sexual contact with someone who has it. It can also pass from mother to baby during pregnancy.
A group of cells that work together to carry out a specific function.
Toxoplasmosis is a disease caused by the parasite Toxoplasma gondii. The infection can cause damage to the brain, eyes, and other organs.
Traditional Chinese medicine is based on the belief that disease is caused by problems with the flow of energy in the body. Herbal remedies as well as other procedures such as acupuncture and massage are used to restore the flow of energy in the body.
The act of transfusing donated blood, blood products or other fluid into the circulatory system of a person or animal.
Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may spread to other organs.
Can also be called a neoplasm. A tumor is an abnormal mass of tissue that occurs when cells divide more than healthy cells or do not die when they are supposed to. Tumors can be benign ( non cancerous), or malignant (cancerous).
Diabetes means a person’s blood sugar (glucose) level is too high. Type 2 diabetes, the more common type, means the body does not make or use the hormone insulin properly. Insulin helps glucose get into the cells to give them energy. Without insulin, too much glucose stays in the blood, and over time this can lead to serious problems of the heart, eyes, kidneys, nerves, and gums and teeth.
An ulcer is an area of tissue erosion (loss of surface tissue), for example, of the lining of the gastrointestinal (GI) tract or skin. Due to the erosion, an ulcer is concave like a crater and depressed below the level of the surrounding tissue.
A procedure that uses high-energy sound waves to look at tissues and organs inside the body. These sound waves make echoes that form images of the tissues and organs on a computer screen (sonogram). Ultrasound can be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures.
Inflammation of the uvea, the pigmented, vascular structure in the eye consisting of the iris, ciliary body, and choroid.
A substance that is usually injected into a person or animal to protect against a particular disease.
The amount of a virus(such as hepatitis B or hepatitis C virus) in the blood.
An extremely small living thing that causes a disease and that spreads from one person or animal to another. It can only reproduce itself by taking over a cell in the body of its host.
A disease associated with chronic inflammation of melanocytes (specialized cells that produce a pigment called melanin). Melanin gives skin, hair, and eyes their color.
A disease spread by infected mosquitoes. Although many infected people experience no symptoms, the infection may be associated with fever, headache, body aches, skin rash, and swollen lymph glands. These symptoms can last a few days to several weeks, and usually go away on their own. If West Nile virus enters the brain, it can be life-threatening.

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