Scholarships

Last week I received a request to let my readers know about AbbVie’s Rheumatology Scholarship.  To be honest, I’ve struggled with this.  My daughter was already working on the application.  She has a better shot at a scholarship that has few applicants than if there are zillions of applicants.  Do I really want everyone to know about this opportunity?  Since you’re reading this post, you realize that I decided to go ahead and help spread the news.

There are fifteen $15,000 scholarships available to students seeking degrees from either college or trade school.  To be eligible, the student’s doctor must confirm diagnosis of either RA, JIA, PsA, or AS.  More details can be found in the message AbbVie sent:

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Did you know students living with a rheumatologic disease like rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA) face unique challenges as they pursue their higher education goals? These students have a higher prevalence of short-term school absences when experiencing symptoms. According to one study, over 90% of students with rheumatologic disease seeking treatment at a rheumatology center reported missing school an average of 3.9 days during a two month period compared to the national average of 1.1 days.1

AbbVie recently launched the AbbVie Rheumatology Scholarship, which is designed to provide financial support for exceptional students living with RA, JIA, psoriatic arthritis (PsA) or ankylosing spondylitis (AS), as they pursue their higher education goals. Our hope is that this scholarship will further empower patients to reach their educational goals.

Below is a brief overview of the scholarship for your reference.

AbbVie Rheumatology Scholarship Overview

  • The scholarship is available to students living with RA, JIA, PsA or AS, who are seeking an undergraduate or graduate degree from an accredited United States (U.S.) university/college or trade school, and who plan to enroll for the 2016-2017 school year.
  • Fifteen Rheumatology Scholars will be selected. The award value will be $15,000 for each recipient.
  • Applicants will be judged based on academic excellence, community involvement, written response to an essay question and ability to serve as a positive role model for the rheumatology community.
  • Key dates and deadlines include:
    • Applications are available on RheumScholarship.com.
    • Applications must be submitted by April 4, 2016.
    • Winners will be notified by April 29, 2016.
  • More information on the AbbVie Rheumatology Scholarship, the application process and eligibility criteria can be found at RheumScholarship.com.

 

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.