In the Kitchen

Wouldn’t it be nice to have hands that worked without aching?  Unfortunately, meds to treat autoimmune arthritis only slow the disease; they don’t halt progression or provide a cure.  In the kitchen, achy hands make meal prep a challenge.

CanOpenerAlthough I try to cook with fresh ingredients, sometimes it is necessary to open cans.  My preferred method of opening a can has been to hand the can and opener to someone and raise my eyebrows in a silent plea for help.  Unfortunately, my kids are growing up and either playing sports or heading to college, which throws a wrench in my can-opening options.  Everyone in the house recognized the problem, so my kids did some research in an attempt to find me the best electric can opener on the market.  I have great kids!  They gave me a Hamilton Beach 76606Z for Christmas, which means I’ve had it long enough to know that it is a very good can opener.  I can now open cans even if there’s nobody else in the house and my hands and wrists prevent use of a traditional-style can opener.

MandolineThe other kitchen acquisition that has helped tremendously is a good-quality mandoline.  Note the “good quality” modifier. I used to have an inexpensive model, and cutting things with it was an exercise in frustration.  The one I replaced it with is fabulous.  I first saw it demonstrated at a fair, then did some research before buying.  The price on Amazon has come down in the past year and beats the fair price by a good bit.  This mandoline will slice tomatoes, pickles, mushrooms, potatoes, and probably anything else you might want to slice (except avocados — it gets jammed on the pit when slicing so effortlessly you don’t realize you’re already that far into the fruit).  I like the fact that the slice thickness is determined by a fixed bed.  You choose the thickness you want and easily insert the appropriate cutting bed. My old mandoline had a knob that I turned to adjust the cut-depth and it had a tendency to slip while in use.  With this setup, there is nothing that can slip and inadvertently change the slice-size.  I also like the V-blade, because it will slice soft things like tomatoes just as perfectly as it slices firm foods like potatoes.  I also like that it’s mostly stainless steel instead of plastic. The Borner V6 comes with a holder that can be mounted on the kitchen wall.  Since there’s no space on my walls to mount anything, I just leave it sitting on the counter beside my KA.

My favorite cooking tool is a crockpot.  Any kind, every kind.  Start oatmeal at bedtime and it’s ready in the morning when you get up.  Start supper in the morning, and it will be ready to eat when you get home in the evening.  Everyone should own at least one crockpot (IMHO).

If your budget is like mine, you can’t afford a personal chef. A few good kitchen tools will make a world of difference.

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Disclaimer:  while I’m not opposed to people sending me gadgets or money, that didn’t happen here.  I bought my mandoline and crockpots, and my kids bought my can opener.

Types of Psoriatic Arthritis

There are different types of psoriatic arthritis.  Classification varies, depending on the source:

  • Asymmetric Oligoarticular PsA affects fewer than four joints, and (unlike RA) does not affect the same joint on both sides of the body.  This type of PsA is generally considered mild due to the small number of joints affected.  “Mild” is a comparative word that does not necessarily take into account the impact of the disease on a person’s life.  Approximately 70% of people with psoriatic arthritis have this type.
  • Symmetric Polyarticular PsA affects four or more joints, and (like RA) can affect the same joint on both sides of the body.  This type of PsA is more severe since more joints are involved.  Approximately 25% of people with psoriatic arthritis have this type.
  • DIP Predominant affects mainly the distal interphalangeal joints of the fingers and toes.  Inflammation of the DIPs is a clue that the autoimmune disease involved is PsA instead of RA.  Approximately 5% of people with psoriatic arthritis have this type.
  • Arthritis Mutilans, aka chronic absorptive arthritis, affects fewer than 5% of PsA and RA patients.  This type is severe and causes deformity.
  • Enthesitis is inflammation of the tendon/ligament insertion sites (where tendons/ligaments attach to bone). Over time, fibrosis or calcification can occur.
  • Spondylitis includes inflammation of the cervical spine (neck) and sacral spine (lower back), as well as hands, feet, hips, knees, elbows, and other joints as in RA and symmetric PsA.
  • Dactylitis affects fingers and toes, and indicates swelling of the entire digit.  This is in contrast to RA, wherein joints will swell, but not entire fingers/toes.

ClASsification criteria for Psoriatic ARthritis (CASPAR) requires inflammatory articular disease, but not necessarily visible swelling or symmetry.  Spine pain, enthesitis, or tendonitis are sufficient.  If that criteria is met, then at least three points from the following five categories qualify a person for a diagnosis of psoriatic arthritis:

  1. Psoriasis — either
    1. current psoriatic skin or scalp disease diagnosed by a rheumatologist or dermatologist (2 points), or
    2. personal history of psoriasis (1 point), or
    3. 1st degree (parent, child, sibling) or 2nd degree (grandparent, grandchild, aunt, uncle, nieces, nephews, half-siblings) blood relative with psoriasis (1 point)
  2. Psoriatic nails (1 point)
  3. Negative RF blood test (1 point)
  4. Dactylitis (swollen “sausage” fingers/toes)– current or history (1 point)
  5. New bone formation near joints visible on x-ray (1 point)

Psoriatic Arthritis – often misdiagnosed

Doctors know that over time, tendinitis and bursitis can lead to pain in the muscles surrounding an affected joint/tendon/bursa.  It’s just a consequence of long-term inflammation.

This pain can interfere with sleep.  That seems obvious, but it’s amazing how many people don’t realize there’s a connection.  If your shoulder hurts, even if you manage to fall asleep, every time you roll over on it, the pain can awaken you.  Likewise if the pain is in your hip.  In fact, regardless of pain’s cause, it’s not at all unusual for pain to lead to sleep loss.  To make matters worse, loss of sleep magnifies pain.

This is why it is so important for tendonitis and bursitis to be diagnosed quickly.  The diagnosis leads to treatment:  physical therapy & anti-inflammatories (and sometimes muscle relaxants).  If you get a good physical therapist and do your prescribed exercises religiously, the problem can usually be well-managed and the pain will go away.

Unfortunately, sometimes doctors miss a tendonitis/bursitis diagnosis.  If the patient had no injury causing the problem, the doctors might miss the diagnosis.

PainCycle

Undiagnosed tendonitis in both shoulders eventually leads to muscle aches in the upper back and both arms.  Undiagnosed tendonitis in both Achilles tendons leads to muscle aches in the lower legs.  Undiagnosed bursitis in the hips leads to muscles aches in the thighs.  At this point, many doctors give up and call it “fibromyalgia” (unexplained muscle aches in all four quadrants, and move on to patients they can help. This, despite the fact that a diagnosis of bursitis and/or tendonitis would perfectly explain all the symptoms1.

Or maybe it isn’t tendonitis/bursitis.  Maybe it’s vague back pain.  Maybe it comes and goes — flaring up for a while, then disappearing.  Maybe it’s not symmetric (only one shoulder/hip/knee instead of both).

All of these situations call for a closer investigation of family history for symptoms of psoriasis.  Note, however, that at least 15% of people with psoriatic arthritis do not have skin psoriasis.

The diagnosis of psoriatic arthritis (PsA) often is missed, partly because patients may present with inflammatory spinal pain, tendinitis, enthesitis, or dactylitis rather than a “true arthritis.”
Jaya Philipose, MD and Atul Deodhar, MD

Many doctors won’t make a PsA diagnosis without seeing visible evidence of psoriasis.  They might not realize the criteria for diagnosis.  ClASsification criteria for Psoriatic ARthritis (CASPAR) requires inflammatory articular disease.  Spine pain, enthesitis, or tendonitis are sufficient; visible swelling is not required; neither is symmetry.  If that criteria is met, then at least three points from the following five categories are sufficient for a diagnosis of psoriatic arthritis:

  1. Psoriasis — either
    1. current psoriatic skin or scalp disease diagnosed by a rheumatologist or dermatologist (2 points), or
    2. personal history of psoriasis (1 point), or
    3. 1st degree (parent, child, sibling) or 2nd degree (grandparent, grandchild, aunt, uncle, nieces, nephews, half-siblings) blood relative with psoriasis (1 point)
  2. Psoriatic nails (1 point)
  3. Negative RF blood test (1 point)
  4. Dactylitis (swollen “sausage” fingers/toes)– current or history (1 point)
  5. New bone formation near joints visible on x-ray (1 point)

Under this criteria:

  • a person with enthesitis, a negative RF test (1 pt), and mild scalp psoriasis (2 pt) should be diagnosed with PsA.
  • a person with mild inflammatory spine pain, a first or second-degree relative with psoriasis (1 pt), evidence of new bone formation on x-rays (1 pt), and negative RF (1 pt)  should be diagnosed with PsA
  • a person with tendinitis, psoriatic skin disease (2 pt), psoriatic nails (1 pt), and a positive RF (0 pt) meets the criteria for PsA.

Although doctors used to consider psoriatic arthritis as a sub-type of rheumatoid arthritis, that is no longer the case.  Psoriatic arthritis is a separate condition with distinct diagnostic criteria.

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1There is a reason that many “fibromyalgia” patients thrive with physical therapy.  They do not actually have unexplained muscle pain.  Their muscle pain is caused by tendonitis and bursitis.  Treating the tendonitis/bursitis cures the muscle pain.  This in turn makes it possible for the patient to get restful sleep.

Note this is not the only possibility for a “fibro” diagnosis.  Another common missed diagnosis is heart disease.  Cardiologists have been known to tell patients that they do not have fibro; all their symptoms are due to heart disease, and the symptoms resolve if the heart disease is well-treated.