Case #3: A 29-year-old male with psoriasis and joint symptoms has been referred to physical therapy for pain management and an exercise program. He has a 7-year history of plaque psoriasis, a 7-year history of psoriatic arthritis, particularly in the hands, and 15% body surface area involving scalp, trunk, and limbs. He is obese with a BMI of 31 and is being followed closely due to being at risk of metabolic syndrome. He is on 15 mg/week of methotrexate.
Answer:
The patient’s diagnoses of psoriatic arthritis and metabolic syndrome:
Etiology:
Psoriatic arthritis:
It is autoimmune disorder which occurs when our body immune system begins to attack healthy cells and tissue. This abnormal immune response causes overproduction of cells and inflammation
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They are common causes and risks factors for cardiovascular system. 5, 8
Genetics: Family history of type 2 diabetes, hypertension, hyperlipidemia, obesity. They are more inclined to develop insulin resistance which causes metabolic syndrome. Some people like African-Caribbean, Asian, Hispanic (Latin American) have a higher risk of developing metabolic syndrome. 4, 6
Obesity: sedentary life style, lack of exercises lead to obesity which is known factor to promote insulin resistance. Fat deposition also takes main part in insulin resistance and etiology of metabolic syndrome. High lipid concentration in the muscles of upper body-obesity is more strongly correlated to insulin resistance. Visceral obesity is a common example in obesity patient. 5, 6, 8
Diet: High fat (carbohydrate foods) foods, atherogenic and cold drinks are main factors of increasing fat and obesity. Cold drinks have more sugar concentration which leads to insulin resistance.
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But some people have high blood glucose level or high blood pressure. But some sign and symptoms of metabolic syndrome should have present in the patient.
Obesity: If patient have large waist circumference or apple shape body, it’s called “central or abdominal obesity”. Waist circumference can vary in gender, height and weight in individual patient. In men, waist circumference should be at least 40 inches and 35 inches in women.
High blood pressure: High blood pressure at least 130/85mmhg usually but it has no sign and symptoms except in early stage. Patient may have dull headache, more nosebleeds or dizzy spells. 6, 11
High blood glucose levels: Patient’s body is unable to control insulin resistance. But fasting sugar level should be at least 5.6mmol/L. high blood glucose level’s symptoms include increased thirst, weakness, fatigue, blurred vision, increased urination in night. 6, 11
Abnormal cholesterol: Hypo density lipoprotein level less than 40 mg/dL and women less than 50 mg/dL. 6
High blood triglycerides: They are form of circulating fats and levels of triglyceride should be at least 150mg/dL or 1.7mmol/L. 11
Medical treatment:
Psoriatic
Good evening Mr. Brown your test results came in and we found out that your Triglycerides are 145 mg/dL, Cholesterol 210 mg/dL, HDL 33 mg/dL, and LDL 160 mg/dL. Normal triglycerides means there are less than 150 milligrams per deciliter (mg/dL) which you do have which is great. A desirable level of cholesterol would be Below 200 mg/dL, and borderline high would be 200-239 mg/dL so because your cholesterol level is 210 mg/dL you are at borderline high. Ideal LDL level for people at very high risk of heart disease would be below 70 and a high level would be 160-189 mg/dL your LDL level is 160 mg/dL therefore it’s high. The best HDL
Martina, your overall cholesterol measurement of 172 mg/dL is below the recommend upper limit of 200 [1]. Additionally, your HDL (high-density lipoprotein)-cholesterol measurement of fifty-six mg/dL is also within the normal limits, which are defined as a reading greater than 40 but less than or equal to 60 mg/dL [1]. Your LDL (low-density lipoprotein)-cholesterol reading is extremely close to being below the recommended limit of 100 mg/dL: your reading was 101 mg/dL [1]. The recommended levels are the values at which your risk for several diseases is minimized. Your triglyceride reading of 78 mg/dL was well within the normal limit of less than 150 mg/dL, but your glucose reading was indicative of prediabetes.
Obesity is a condition where an individual’s weight is disproportionate to their height. There are many factors
In addition to obesity leading to other health problems, obesity stems from numerous causes such as genetic, environmental, and sociological factors. Other
Obesity is the net result of an excess of energy consumption over expenditure. Factors that must be considered as contributing to causation are: heredity, and altered metabolism of adipose tissue, the list goes on and on. Overeating is clearly a prominent contributor to obesity. Feeding behavior occurs in response to hunger and to appetite induced by the presence of food.
Obesity can be caused by any number of things including genetics, physical inactivity, and overeating.
Hi Mr. Brown how are you today? On today`s visit we will be going over your cholesterol panel we receive back all your test results for your cholesterol levels. Your triglycerides levels are at 145 milligrams per deciliter. Your levels are under the normal range of 145 milligrams per deciliter, which is good because your levels are under the high borderline which is between 150 to 199 milligrams per deciliter. This is great that your levels are normal Mr. Brown because Triglycerides are a type of fat known as lipid that’s found in your blood. When you eat food, your body converts any calories it doesn 't need to use right away into triglycerides. The triglycerides are stored in your fat cells. After the hormones are released into triglycerides for energy between meals. If you eat more calories than you burn, then the calories like fats and carbohydrates, can cause you to have a high triglycerides result. So basically, Triglycerides help in the digesting process and breaking down the fats in the food we eat. The results for your cholesterol level are 210 milligrams per deciliter which is borderline high considering, the normal range for cholesterol levels are less than 180 milligrams per deciliter. Since your body has to have cholesterol to make Vitamin D, your hormones, and it also helps with the digestion of the meals you eat. See cholesterol is like a wax, fat like substance that is found in the cells in our bodies.
Causes of obesity include lifestyle choices such as diets, lack of physical activity, psychological, environmental, genetics, medical conditions, effects of medication, lack of awareness and its implications as well as lack of education in the community. According to Sethi & Vidal-Puig (2007) there is a high risk of developing a wide range of health problems including type 2 diabetes, high blood pressure, infertility and osteoarthritis when obese and puts
Psoriasis is regarded as an autoimmune disease in which genetic and environmental factors have a significant role. The name of the disease is derived from Greek word „psora‟ which means „itch‟. Psoriasis is a non-contagious, dry, inflammatory and ugly skin disorder, which can involve entire system of person1. It is mostly inherited and mainly characterized by sharply marginated scaly, erythematous plaques that develop in a relatively symmetrical distribution. The most commonly affected sites are the scalp, tips of fingers and toes, palms, soles, umbilicus, gluteus, under the breasts and genitals, elbows, knees, shins and sacrum2. This disease is chronic in nature with a tendency to relapse. In this disease, the skin keeps scaling as flakes
Psoriasis is defined as an autoimmune disease. People have myth that this disease is a contagious disease but this disease is not contagious as such. It is a non-contagious disease. Because of hyperactivity, skin starts showing reaction and results in rashes. On the other side, some studies show that psoriasis occurs due to the genetic cause and genetic susceptibility. In this, alteration carried out in specific genes which cause vascular development which will lead to psoriasis susceptibility. Psoriasis may result into chronic and severe changes in the body.
Psoriasis is a disease of chronic systemic inflammation that involves not only the skin, but also internal organs. The frequency of Non-alcoholic fatty liver disease was found to be significantly greater in psoriasis patients with increased risk of atherosclerosis and cardiovascular disease. A large number of immunes is found in Psoriatic skin and this immune produce chemokine’s, cytokine and inflammatory molecules. The exact role of genetics in psoriasis is still unclear and an overlap between some psoriasis loci and those identified in other autoimmune or inflammatory diseases has been reported.
Psoriasis is a constant immune system infection that for the most part influences the integumentary framework. In the United States, psoriasis is the most common immune system sicknesses, affecting around 7.5 million Americans, or 2 – 3% of the populace. Despite the fact that psoriasis can happen at any age, the mean period of onset for the first event is between 15 – 20 years, with a second crest at 55 – 60 years. While the definite reasons for psoriasis are obscure, the illness happens when a strange insusceptible reaction prompts hyperproliferation of youthful cells of the dermis and epidermis, changed cell separation, and aggravation. The invulnerable reaction connected with psoriasis is T-cell intervened. Lymphocytes will be lymphocytes, or
People with diabetes have high blood sugar. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both.
Psoriasis is estimated to affect 2-4% of the population. The rate of occurrence varies according to age, ethnicity, gender and the region. A combination of genetic and environmental factors are thought to be responsible for these differences (Parisi et al., 2013).
Lupus is a chronic inflammatory disease marked by its effect on various parts of the body, including the joints, skin, blood, and kidneys. It is a condition in which the body's immune system attacks its own cells and tissues, resulting in pain, inflammation, and often damage to organs. Lupus involves the immune system. The immune system makes antibodies that work to protect the body against foreign substances like viruses and bacteria. Such foreign bodies are called antigens. When a person has lupus, his or her body is unable to determine the difference between antigens and the individual's cells and body tissues. As such, the immune system creates antibodies against the individual's own tissues. These antibodies are called autoantibodies. Depending on the type of lupus, a wide range of symptoms may be experienced, from rashes, hair loss, and achy, swollen joints to fever, anemia, and abnormal blood clotting. Though the disease can affect many parts of the body, individuals usually experience symptoms in only a few organs. There is no known cure for lupus. However,