advice the doctor Whether its a health niggle, emotional problem or youre just looking for guidance, Inspire magazines Dr Sarah Jarvis gets straight to the point my mother has psoriasis and, while the skin condition is distressing, the arthritis shes suffered as a result is even more debilitating. im 21 and have just been diagnosed with psoriasis. How likely am i to get arthritis, and what can i do about it? Katie evans, via email i have had shoulder pain for several months, but recently it has become more intense. a scan has revealed a tear in my rotator cuff, and my doctor has been talking about several treatments, from physiotherapy to surgery. Which should i go for, and how has it happened? Paul hudson, via email Do you a probl have like an em youd s so, wri wered? If Inspire te to us at: magaz 275 Ne wmark ine, Cambr e idge CB t Road, 5 8JE, or ema arthrit il inspire@ iscare. org.uk dr sarah Jarvis answers: Psoriasis is a chronic, non-infectious, incurable skin condition that affects up to 1.8m people in the UK. It can run in families and, most commonly, starts in a persons late teens or 20s, although there is another peak among people in their 40s and 50s. Like rheumatoid arthritis, psoriasis is an auto-immune condition; your immune system which normally protects you against infection turns on part of your body. In the case of psoriasis, the skin is usually affected first. In normal skin, the top layer is constantly being shed from the surface and replaced by new cells from the basement layer, which work their way to the surface. This usually takes about four weeks, but is accelerated in psoriasis, leading to inflamed, red, scaly plaques on the skin. These, classically, affect elbows, knees and the scalp, but can occur anywhere. Estimates for the proportion of psoriasis sufferers who get arthritis vary widely, but it may be up to one in five. Arthritis most commonly develops within 10 years of skin symptoms, and is more likely in people with more severe psoriasis. About one in five people with psoriasis develop joint problems before they notice skin changes. There are several patterns of joint problems in psoriatic arthritis. In symmetrical polyarthritis (more common in women), wrists, hands, feet and ankles, on both sides, are affected. In the spondylitic type (more common in men) the spine and sacroiliac joints are targeted. The good news is that treating psoriatic arthritis early and intensively can slow progression of the disease. This is usually done with disease modifying drugs, similar to those used in rheumatoid arthritis. However, this requires a specialist referral at an early stage. If you notice any persistent or severe joint pains, see your doctor. dr sarah Jarvis answers: Shoulder pain is common, partly because the shoulder is so complicated that theres a lot to go wrong. The rotator cuff is a collection of four muscles, around the shoulder joint, which work together to allow the wide range of movement your shoulder performs, as well as stabilising it. Their tendons merge to attach to the head of the humerus (upper arm bone), passing under a bony protuberance of the shoulder blade on the way. Here, the rotator cuff tendon can get caught, leading to inflammation, and sometimes fraying or tearing. In older and middle-aged people, this is the most common cause of rotatorcuff tears; in younger people, its more commonly caused by acute trauma. The most common symptom is pain, which tends to be worst when you raise your arm away from your body, between about 70 and 120 degrees from your side. The pain can be worse at night, and your shoulder and arm may feel weak. If the tendon is torn through, pain is usually severe and some movements are impossible. Minor tears can often be treated with physiotherapy to improve strength and movement in your shoulder plus painkillers or antiinflammatory tablets. If this doesnt relieve your symptoms, a steroid injection into the affected area, often carried out under ultrasound control, can reduce inflammation and pain. Surgery tends to be reserved for larger tears. Arthroscopy (keyhole surgery) or open surgery may be recommended. As well as repairing the rotator-cuff tendon, if needed, the space under the bony outcrop of the shoulder blade is usually opened up to prevent catching and squashing of the tendon in future. Arthritis Cares helpline is staffed by qualified counsellors who can give you emotional support, and its free and confidential. Call 0808 800 4050 the line is open Monday to Friday, 10am to 4pm. Arthritis Care also has a number of free booklets about arthritis that you can download from their website. "