DEAR DR. DONOHUE: I have had psoriasis for about 10 years. The skin is under control, but a new symptom has appeared. I have pain in my back and fingers. My doctor, after seeing my X-rays, says I have psoriatic arthritis. Can that be so? I never heard of psoriasis becoming arthritis. – W.L.

ANSWER:
Arthritis occurs in as many as 7 percent (some would put the figure at 23 percent) of those who have psoriasis. The arthritis can happen before or simultaneously with the skin outbreak, but most psoriasis patients, if they are destined to develop arthritis, do so after the skin disease has been present for some time.

Any joint can be a target. The most commonly involved joints are the knees, the ankles, the finger joints adjacent to the fingernails, and the spine.

Severity of joint disease cannot always be equated with severity of skin disease. A person with only a few patches of skin psoriasis might have extensive joint involvement.

Take a look at your fingernails. Are there small pits in them? Pitted fingernails can be a sign that joints are going to become arthritic.

Treatment of psoriatic arthritis can often be attained with anti-inflammatory medicines like Motrin, Advil, Aleve, Indocin, Naprosyn and many others. If these drugs cannot suppress the arthritis, then doctors turn to drugs like sulfasalazine, methotrexate and cyclosporine.

Newer medicines like etanercept come to the rescue for arthritis that resists all other treatment.

The last four mentioned drugs keep the lid on an immune system that has gone astray. A misfiring immune system is believed to be the cause of psoriatic arthritis.

The National Psoriasis Foundation, which you can reach at 1-800-723-9166 or www.psoriasis.org, provides information on all aspects of this troublesome condition. Give the people there a call.

DEAR DR. DONOHUE: I have just come from my doctor’s, and I am writing you immediately so I don’t forget what he told me. He says I have Bowen’s disease. He wants to be sure, so he took a biopsy and should have the results next week. I am frightened to death. What is this all about? – S.T.

ANSWER:
Bowen’s disease is skin cancer in situ. “In situ” means that cancer cells are only in the uppermost skin cells. They have not burrowed deeply into tissues under the skin, nor have they spread to lymph nodes or distant places. You can say it is a precancer.

Bowen’s skin is a red, scaly patch that grows very slowly.

Even if the biopsy confirms the doctor’s impression, you can stop worrying. You have a large menu of choices for treatment. The doctor can freeze the patch, dry it with electric current or cut it off. The worst is over for you. The worst is not knowing what the funny-looking patch of skin is.

Your doctor will watch for any recurrence.

DEAR DR. DONOHUE: What is sleeping sickness? I find myself dozing off at my desk and during conferences. It is mortifying, and a number of people have remarked on it. One suggested I had sleeping sickness. Is it possible? – K.J.

ANSWER:
Anything is possible. The sleeping sickness referred to is narcolepsy. People with narcolepsy suffer from irresistible sleep attacks during the day. Nothing can stop them from dozing off. Along with sleep attacks are other important signs. One is called cataplexy. It’s a loss of muscle tone. The jaw might droop, the head sag or the knees buckle. Cataplexy is brought on by emotionally charged situations. A hearty laugh, a fit of anger or a moment of fear can trigger an attack.

Sleep paralysis is another sign of narcolepsy. The person finds it impossible to move just before falling asleep or just upon wakening.

Hallucinations can occur in the transition from wakefulness to sleep or from sleep to wakefulness. The hallucinations are quite vivid and can be quite terrifying.

People need not have all of the above to earn the diagnosis of narcolepsy. Tell your doctor what’s going on and let the doctor decide whether you have narcolepsy. There is treatment for it.

DEAR DR. DONOHUE: My doctor has me worried sick. He looked in my eyes and said I have a cataract. He offered no suggestions about treating it. I am 69 and will do anything to stop from going blind. Help. – Q.T.

ANSWER:
If your doctor looked into the eyes of a hundred 69-year-olds, he could tell most of them that they have a cataract. Cataracts are an all-but-inevitable consequence of aging, and they almost never result in blindness.

A cataract forms in the eye’s lens. The lens is an oval-shaped structure about the size of a small marble. It sits behind the pupil, and it focuses light onto the retina to produce a visual image. Cataracts are nothing more than a clouding of the lens.

Although everyone who lives long enough is likely to have the beginnings of a cataract, not everyone needs cataract surgery. It is the patient who tells the doctor when surgery is necessary, and not vice versa. When the eye lens becomes so opaque that a person cannot carry on with the normal activities of life, that is the time for cataract removal.

The clouded lens is extracted, and an artificial lens is inserted in its place. Cataract operations are often done as an outpatient procedure, with no overnight stay in a hospital. In bygone years, cataract surgery kept a person out of commission for a considerable amount of time. Patients spent much of that time flat on their backs with sandbags alongside the head, keeping it immobile. Postoperatively, they had to wear extremely thick glasses to take the place of the removed lens. The good old days, when it comes to cataract surgery, were not so good.

You are not going to go blind. You might never have to have cataract surgery. Many cataracts progress so slowly that they never cause significant impairment of vision.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.


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