Environmental Factors

I have continually seen “other environmental factors” seen as causes in multiple information regarding how PSA is caused. It is often listed along side family history, history of P, previous injusy, etc. I can not find any reliable info as to what those factors are. The internet sources are all over the place and I have not found any studies regarding this. Are they prior disease exposure, chemicals, molds…? This is a curious subject to me and was hoping others could shed light on this. Anyone? Moderators, Tlamb, smart people?

That's a flipping good question Rachael! There is a section on exactly this in the latest 'Psoriatic Arthritis' book by Gladman, Rosen and Chandran. It is very much speculation I'd say but they list the following as factors that have been associated with PsA and reported: Rubella vaccination, injury sufficient to require a medical consultation, recurrent oral ulcers, moving house, bone fractures, lifting heavy loads, infections that require treatment with antibiotics, HIV infection and corticosteroid use. They note that smoking is less prevalent in PsA patients compared to those who have psoriasis without PsA.

In conclusion, if you don't already have PsA it might be unwise to single-handedly manhandle your grand piano while moving house with your leg in plaster, especially if you've got a mouth full of ulcers and have recently been vaccinated against Rubella. But if you have PsA already, well, what's stopping you?

My understanding is that a person starts off with a propensity towards an autoimmune disease and then what influences the timing of the development, if at all, is all of those stresses, including environmental factors, childbearing, etc.

For example, I used to smoke, and I worked on farms and around chemicals. My mom did not have these factors. She developed an autoimmune disease in her late fifties. I developed my first in my mid thirties. Not that it’s always that neat, but it’s a good example.

Too funny !!!!!!!!!!!!!!!!!!!!!!

On a serious note, I typed a long reply and then hit the wrong key on my tablet keyboard and lost the lot .... it's these PsA ridden fingers don't always respond correctly to mind control. Will re-compose tomorrow.

Sorry we've not had a pow-wow for ages Rachael ... I've been helping out for BF's on other communities so I've been pretty much AWOL here.

Sybil said:

That's a flipping good question Rachael! There is a section on exactly this in the latest 'Psoriatic Arthritis' book by Gladman, Rosen and Chandran. It is very much speculation I'd say but they list the following as factors that have been associated with PsA and reported: Rubella vaccination, injury sufficient to require a medical consultation, recurrent oral ulcers, moving house, bone fractures, lifting heavy loads, infections that require treatment with antibiotics, HIV infection and corticosteroid use. They note that smoking is less prevalent in PsA patients compared to those who have psoriasis without PsA.

In conclusion, if you don't already have PsA it might be unwise to single-handedly manhandle your grand piano while moving house with your leg in plaster, especially if you've got a mouth full of ulcers and have recently been vaccinated against Rubella. But if you have PsA already, well, what's stopping you?

Thanks to all of you. I guess I always consider environmental factor as being things or situation that are not directly in our control but that we try to control. I guess my book is an outdated version as it was very vague in that area or like I said my interpretation of what was wrong. Lol, Sybil “moving” wasn’t that a very recently discussed interest of yours? I suppose if we already have it then you are right in saying it shouldn’t stop you. I am starting to think after your mission I remember well to get a haircut (now my brain fog is not posative and it was over a year ago) that you are plain unstoppable!

I think that earlier book is much more accessible than the update. Yes, I am going to move when someone actually decides to buy my house, could be a long wait. I should be okay 'cos like you say, the PsA's a done deal. And I don't get mouth ulcers.

I think there are 2 types of people with PsA, those who wonder why they got it and those who don't. I do wonder, which is not the same as fretting about it. They say it affects men and women equally and the age group I've seen mentioned most often is 30 - 50. But because new members seem to be predominantly women in their 50s or older I can't help thinking that the menopause is in the frame big time. And one thing that doesn't seem to be discussed in the research or discussions very often is whether it is a disease that can lurk before it becomes more full-on. I'm convinced mine did for many years and I therefore wonder whether the severe presentation could have been prevented. I'd like to see research into that.

Am I right in thinking that you work in heavy industry Rachael? Because in such an area environmental hazards in the more familiar sense of the words must be something you're very aware of. Although when I was teaching I used to cringe every time they put a new carpet down because the fumes from the glue used would hang around for ages. I reckon as a species we need to wise up a bit about such things. But I can dream on!

There is a unique thing that happens with PsA called the Koebner Phenomenon or also isomorphic response. Basically injury causes a reaction. Early it was just considered as a skin reaction that happened in straight lines. A dermatologist by the name of Koebner who was also basically nuts (literature describes him as eccentric) He once proudly exhibited on his arms and chest three different fungus infections, which he self-inoculated in order to prove the phenomenon. It became a generalized term applied to his discovery that on psoriasis patients new lesions often appear on lines of trauma, which are often linear. Since then it has been applied to any trauma that gets things rocking and rolling. I had few problems until a pretty severe spinal injury from a 10,000 foot fall from a perfectly good airplane. The end result was PsA. Others call these "triggers" One of the more common is called Reiters syndrome which is arthritis caused by "infection"

I know that everyday logic doesn't necessarily apply to this stuff, but it has always seemed to make sense to me that a dysfunctional immune system would focus on areas of the body where there's trouble already.

tntlamb said:

There is a unique thing that happens with PsA called the Koebner Phenomenon or also isomorphic response. Basically injury causes a reaction. Early it was just considered as a skin reaction that happened in straight lines. A dermatologist by the name of Koebner who was also basically nuts (literature describes him as eccentric) He once proudly exhibited on his arms and chest three different fungus infections, which he self-inoculated in order to prove the phenomenon. It became a generalized term applied to his discovery that on psoriasis patients new lesions often appear on lines of trauma, which are often linear. Since then it has been applied to any trauma that gets things rocking and rolling. I had few problems until a pretty severe spinal injury from a 10,000 foot fall from a perfectly good airplane. The end result was PsA. Others call these "triggers" One of the more common is called Reiters syndrome which is arthritis caused by "infection"

Wow! Thank you for the " everyday person" responses. I do consider myself a relatively intelligent person but some of the medical terminology in my searches gets overwhelming and yes, Sybil, working in an an industrial environment puts a whole new twist in my perception of the term. I have also noticed a large increase in my colleagues in the form of autoimmune diseases. A large rash of gout, RA, Shingles, and recently discovered 2 past employees also had PSA all in a group of about 22 people with 9 people developing these problems working most often in the same area compared to others. I can’t help but wonder due to exposure to very narrow process that makes my corporation unique. I am not looking for monetary suits but this brings red flags to me.
Thank god for the many nuts in science! As crazy as there process of proving theories are we as a whole have surely benefited from their idiocracies!
I do think I can link every flare even prior to past injuries and one or two to serious infections that resulted in immune response just diagnosed as the identifiers only such as anemia, entisis, tendonitis etc.
I am past worrying so much about why or how I developed PSA but the recent enlightenment about fellow employees really brought my curiosity back.

I've long had the idea that I got from somewhere or other that people with Nordic genes are more likely to get certain autoimmune diseases. Though that may be outdated, I might be plain wrong etc. You don't happen to live in one of those states that had a big Scandi influx do you? Or Irish, they had a fair injection of Vikings. My Mum's family were largely of Irish origin as far as I know.

Lol, bingo! On mother’s side my grandmother immigatared from Ireland and my grandfather from Scotland (yes I know they were an unheard of pair). On my Father’s side all primarily Swedish or Nordic descent but several generations back. So a good 70% of me probably fits your therory. I believe my mother still has duel citizenship as Scott/American. I suppose it does make sense that if the genes are primarily a singular group of predisposed origion that would make a person much more susceptible to an inherent disease. The fact that prior injury or infection causes our immune system to return to a location that it was already well familiar with repairing as the first place it would return to when “confused” makes sense as well. Immune system confusion is how I generally describe what happens to me to others people.I explain that it goes into overdrive and confuses healthy joints tissue with something it needs to attack. Those who I bother to explain this to seem to understand that easily. No one ever wants the long version, ha-ha!

No, they never want the long version lol! And sometimes 'long' seems to equal more than about 5 words! Yet 'they' still repeatedly ask me why I'm limping like it's groundhog day.

I checked this out a wee bit online and it looks like there's no sure evidence about this gene pool thing. But what research there is suggests that psoriasis (and therefore PsA too I'd imagine) is more common the further you get from the equator. Then there's a rider about the southern hemisphere in that the higher rates of PsA there than in equatorial regions might be down to immigration from the northern hemisphere.

I was also wondering whether the apparent cluster of people with autoimmune conditions including PsA from your workplace could be due to having ancestors from the same northerly parts of the world. I've heard that some of the most northerly native american tribes get / got PsA too .... and they would have been from the same line as Inuit I should think.

I wouldn't be surprised if the same genes that predispose people to PsA also protect against other things ... that would be good!


Rachael said:

Lol, bingo! On mother's side my grandmother immigatared from Ireland and my grandfather from Scotland (yes I know they were an unheard of pair). On my Father's side all primarily Swedish or Nordic descent but several generations back. So a good 70% of me probably fits your therory. I believe my mother still has duel citizenship as Scott/American. I suppose it does make sense that if the genes are primarily a singular group of predisposed origion that would make a person much more susceptible to an inherent disease. The fact that prior injury or infection causes our immune system to return to a location that it was already well familiar with repairing as the first place it would return to when "confused" makes sense as well. Immune system confusion is how I generally describe what happens to me to others people.I explain that it goes into overdrive and confuses healthy joints tissue with something it needs to attack. Those who I bother to explain this to seem to understand that easily. No one ever wants the long version, ha-ha!

Very interesting Sybil. You could be right about the work involvement or it could be simply that some of them work longer doing this than others or harder as well. Knowing family history doesn’t come up as often as ailments especially in America with all the worry about racial correctness and “melting pot” of people. For an advanced nation we are very behind in some ways. The equator being a factor would naturally lead me to believe that sun exposure would be like natural light therapy. Even if development that would easily keep most of it possibly at bay and prevent future gene alteration. No scientific fact to back this up but just a theory, lord knows I am no doctor or scientist just a mechanic/electrician ha-ha!

Well here is an example I used with students years ago involving causation and association:

Vodka over ice causes temporary insanity

Whiskey over ice causes Heart problems

Gin over ice causes Liver problems

Rum over ice causes kidney problems

Lesson: Avoid ice.

It's interesting, too, what the time frame is from exposure to whatever environmental factors and onset of disease.? Is it always an immediate autoimmune response or can it be on hold and show up at a later time? Or does it sometimes take an accumulation of factors and there's a breaking point? I always thought quitting smoking caused my psoriasis. After that, I had occasional episodes of aches and pains, but they weren't widespread and didn't cause the fatigue and weakness PsA caused me. I agree with the menopause factor--my PsA was diagnosed 2 years after I went through menopause.

I think political correctness is the same here, I guess the UK mainland is the original melting pot which is something I love about it. But then people of African origin usually have awareness of sickle cell disease ... and that's all to the good. I don't think there's any harm in acknowledging that different ethnicities may be prone to different diseases and anyway with PsA it's obviously nowhere near as clear cut as sickle cell, there are just some possibilities.

I think mechanics and electricians probably have a lot in common with doctors! I used to work on cars. One thing I learned is that when one thing goes wrong, generally speaking other things do too. I'd like to unlearn that! It was mostly 2CVs and other citroens, usually old bangers .... a bit like me in fact.

I am dead keen on Vitamin D. Last summer was a damp squib plus I had a psoriasis flare that seemed to get worse in the sun if anything. Am now forcing down a lot of sardines, I hate the things.

I can understand your thinking about your work environment, it's really hard to know isn't it? I used to live in Southampton, apparently one of the most polluted cities in the UK at the time and a real asthma hotspot. Yet the air felt clean enough, it was a pleasant place to live in. About 30 - 40% of the kids I taught would be puffing away on inhalers.


Rachael said:

Very interesting Sybil. You could be right about the work involvement or it could be simply that some of them work longer doing this than others or harder as well. Knowing family history doesn't come up as often as ailments especially in America with all the worry about racial correctness and "melting pot" of people. For an advanced nation we are very behind in some ways. The equator being a factor would naturally lead me to believe that sun exposure would be like natural light therapy. Even if development that would easily keep most of it possibly at bay and prevent future gene alteration. No scientific fact to back this up but just a theory, lord knows I am no doctor or scientist just a mechanic/electrician ha-ha!

Ok I think the general consensus is we need more studies! Hello doctors, scientist, pharmaceutical companies we have more questions unanswered! After all the more we know the easier to treat and possibly someday cure or prevent. I find your menopause theory interesting and would love to expand that to hormonal influences. I have read it often can occur during pregnancy which during my second one was when I developed my P. I also had a pedicure ( my only pedicure, sad face here) at my 7-8 month mark. This also resulted in my psoriatic toe nails shortly after which only got worse over time. Of course I always assumed until finding this site I had contracted nail fungus but my doctors now confirm what it really is. I would guess that hormones definitely play a major role with the level of or onset of the disease.

Omg Rachael--yes, hormonal factors!!! That makes more sense. My psoriasis started a few years before having kids, but now that you mentioned hormones I realized it started not too long after I started birth control pills. My psoriasis stayed consistent through 3 of my pregnancies and completely vanished through one of them, only to return a few months later. But it was nice not having ANY psoriasis for a few months!

Wow, my fingernail involvement and also sore fingers started after I applied fake nails myself-that was 8 or 9 years ago. They were so uncomfortable I had to pry them off after a few days and that's when the problems first started!! When I had my nails done professionally for our son's wedding 2 years ago, they were gel nails to fill in the valleys so my nails were smooth. But, they were uncomfortable and I couldn't wait to get them off. That was before I started Enbrel. I had them again last year for our daughter's wedding and that's when I said never again!!!!! My nails were improving from being on Enbrel and I was afraid it would reawaken my dormant nail p and PsA in my fingers. Too scary!! Luckily it didn't!

I think you're right on about the other environmental factors, and, yes, I hope there's continued research. What a miracle if triggers could be pinpointed and people who might be predisposed to autoimmune disease could get an injection (like the flu shot!!!) to prevent it!!