PsA, Diabetes, Hyperlipidemia, Hypertension... all linked together

General
1

I have been a medical mystery my entire life.

When I was 18 and a freshman in college, I went to the clinic on campus to ask the doctor why I was so insanely muscular when I didn't lift weights. He checked my blood levels and found that my testosterone levels were normal but I had really high cholesterol and triglycerides. At the time it was 440 for cholesterol and 4000 for triglyceride (I am NOT kidding!)

Lipitor, Niacin, you name it - nothing touched my lipid profile.

Fast forward 7 years later during my first pregnancy I had severe insulin resistance, high blood pressure, etc.

Fast forward another 5 years and I had psoriasis.

Two years later it was Psoriatic Arthritis.

For years the medical community thought these were all just rare symptoms independent from each other, but I kept thinking there was a connection between them - how in the world could someone relatively 'healthy' in lifestyle end up with such a catastrophe in metabolic disorders.

Now that I am in chiropractic school and learning the same things as the medical doctors, I have a little bit more credibility to my statements when I say - let's look at this, let's try that. Finally, my endocrinologist agrees with me that they must all be related. Only recently have we (the medical community) made the connection between Diabetes and chronic inflammation, now I have found an article that links Psoriasis and PsA to metabolic syndrome (MBS = insulin resistance, hyperlipidemia, hypertension, etc).

I had found an article a few weeks back that documented the use of Humira - a TNF alpha inhibitor which attempts to decrease levels of inflammation in the body - had shown some positive results with Diabetes and Insulin Resistance. When I took my first shot of Humira a few weeks ago, I noticed that it did, indeed, help to lower my blood glucose levels, but it did not sustain that effect unfortunately.

My question to this community is asking how many people have PsA AND Metabolic Syndrome? Are you on a biologic drug to suppress inflammation? IF yes, what kind and how many milligrams?

I'm on 40mg every two weeks. I'm curious if I higher dose or more frequent dosage might have better effects on MBS or not. I hate having to take so many medications, but I do what I have to in order to be here for my kids in the future.

Here is the article if anyone is interested in reading it.

http://www.springerlink.com/content/b72631x7177103h8/fulltext.pdf

Please let me know your thoughts.

Thanks,

Cynth

724-PsAIRSHLDetc.pdf (284 KB)
2

Interesting! I'll definitely read the article. Sorry you're going through all this - I hope the new-found information is a good starting point for finding an overall treatment for your PsA/MBS!!!

3

Hi Cynth,

Thts what i was thinking also, when u have one auto-immune, easy to get another one.

I got dx with diabetes2 in 2/2012..Hi trigs 380..u had 4000?..OMG....and hi cholestral, and hi-sugar, all ripe for diabetes2

Was on Lovaza, for trigs, am on simvistatin, low dose...been going to diabetes educators, dietician...i am now trying fish oil, 2 a day, replacing Lovaza..trigs are 75 or something now

For me, i guess my rheummy was right, the prednisone, high doses, caused the type2..well, i need to loose 30 lbs also...

My A1C was 7.3 in 2/2012, it's now 6.0....and i stopped Metformin meds for diabetes2

it takes, as rheummy said 3 months at least for prefnisone to get outta my sytem

I kinda think, when i had a bad case of mononucleosis, as a teen, it effected my spleen, was in hospital..And it may have been the cause of some things..I have read some reports about this, but not enough scientific proof for rheummy

Have the RA dx first,, and the PSA, 3 yrs ago, because of peelings...Funny, Humira for 5 yrs didnt help the peelings, either did Enbrel ( pustular psoriasis on feet/palms)..but remicade helps it..And it's hard to diagnose PSA, as we all know

Maybe i have always had it, but peelings came later

take care, and hope it gets better for you

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25% of the population at age 40 have Metabolic Syndrome. (higher below 40 if over weight or a smoker) psoriasis has been recognized since 1938 as has Type II Diabetes as a Rheumatic disease.... Its a great term paper and wonderful that it has been turned into an open access document. Much of Metabolic Syndrome can be controlled by lifestyle changes. We hear it MOST OFTEN refereed to as "prediabetes." Increased insulin raises your triglyceride level and other blood fat levels. It also interferes with how your kidneys work, leading to higher blood pressure. These combined effects of insulin resistance put you at risk of heart disease, stroke, diabetes and other conditions.


Insulin resistance probably involves a variety of genetic and environmental factors. Some people may be genetically prone to insulin resistance, inheriting the tendency from their parents. But being overweight and inactive are major contributors.

Now whether PsA is intrinsically liked, or the Metabolic Syndrome comes from the inactivity from PsA is probably irrelevent. All the drug treatment in the world wont change our diets, or make us lose weight. We can exercise more if the disease is under control though.

Depending on the Doctor (MD) you talk to metabollic syndrome is either a euphemism, cop out, or simply a collection of risk factors. But it IS one that is almost entirely controllable by environmental changes despite the cause. If only that were true with PsA

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That is SO interesting to me. I've had some form of arthritis since I was a kid, I have insulin resistance (gestational diabetes) and struggled with infertility. I've always felt that my doctors work too independently and the medical community in general doesn't look at the entire body. Currently, I avoid gluten and that is keeping my inflammation levels down at a livable level (or my problems are caused by gluten?). Thank you for sharing this. I look forward to reading the article and other responses.

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I watched a webinar on the psoriasis website today and they linked PsA to hypertension, diabetes( 62% higher probability), high cholesterol, and liver inflammation, oh and inflammation on the aorta. The good news is that we can participate in increasing our odds. Healthy diet, exercise, rest, decrease stress, and keep PsA under control. Basically what you said, lamb.

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Lamb, you always make such good points. How to manage the inflammation is the key, but as Psa sufferers know there are many things that seem to trigger the inflammatory process. Its such a balancing act.

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Its amazing what you can piece together when you look into your medical history, I only started to join the dots when I was doing physiological and pathophysiological studies in training. Then it was just linking my hyperlipidemia, insulin resistance and polycystic ovary symdrome (PCOS)
It really surprised me that the docs don’t tell you of the link…never really got an answer from any of the docs why they don’t suggest there might be a link between conditions, most said that there’s no point in informing people!? I can understand not telling people what they MIGHT experience, but if there are pre exsisting conditions that could be linked why not say…it certainly explains things better than thinking your unfortunate enough to have loads of illnesses/conditions.

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Oh for sure! I’d read some articles about this, but the one you have posted is the most comprehensive. My history looks like this:
Age 40 – toenail “fungus” (treated unsuccessfully, then ignored)
My 40’s – mystery aches and pains, weight gain (blamed myself, of course)
Age 50 – hypertension dx
50’s – insulin resistance, knee joint damage, double knee replacement, foot pain, metabolic syndrome
Age 60 – erosions found in feet, nail “fungus” diagnosed as psoriasis, PsA diagnosis.
Connecting the dots, the toenail fungus was the tip of the auto-immune iceberg. The hypertension and the insulin resistance were symptoms of the undiagnosed PsA. Switching to a low-carb diet got me out of the metabolic syndrome zone.
I am not on a biologic, but wish I were because I have a feeling that a tnf inhibitor may also quell some of the symptoms besides joint issues. Or maybe not.

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Are we sure if all of the different docs know how it MIGHT be related? Some seem to get stuck in doing their thing and not really exploring other ideas.



Louise Hoy said:

Its amazing what you can piece together when you look into your medical history, I only started to join the dots when I was doing physiological and pathophysiological studies in training. Then it was just linking my hyperlipidemia, insulin resistance and polycystic ovary symdrome (PCOS)
It really surprised me that the docs don't tell you of the link..........never really got an answer from any of the docs why they don't suggest there might be a link between conditions, most said that there's no point in informing people!? I can understand not telling people what they MIGHT experience, but if there are pre exsisting conditions that could be linked why not say.......it certainly explains things better than thinking your unfortunate enough to have loads of illnesses/conditions.
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Yeah they do know HOW it MIGHT be related. From a purley statistical stand point its all anecdotal. I could write several pages why the statistical analysis in the original article COULD prove there is NO relationship..... They identify (or fail to identify) depending on how you read it a common link (it seems its psoriais??)

We know what one of the common denominatos is though (and have since about 1975) Its TNF-A excess is present in all of these issues. The following if you feel up to some neck deep wading explains it pretty well

http://www.bio.davidson.edu/courses/immunology/students/spring2000/...

But there is a problem.... A TNF inhibitor (biologic) should cure ALL of these issues and should work for everyone.IF excess TNF A is the cause. it doesn't. So there is something else at play........ What is it? And thats where it gets crazy.

Thats why it is anecdotal....... IT LOOKS TO BE TRUE but isn't. If losing weight cutting out sugar and getting more exercise will fix metabolic syndrome, why won't it fix my shoulder or Seenies feet???

So to detach this thing we are surrounded by Anecdotal evidence:

The Sun rises in the east and Sets in the west - it doesn't

The Sky is Blue - its not

Eating at McDonalds makes folks fat - it doesn't (food does)

Any way I could go on. At some point we have to accept that SCIENCE, real science, is of a far narrower scope. It has to be repeatable and verifiable. Raw numbers are never enough. There is NOT a big conspiracy to keep the truth from folks to make profits.

However HUGE and very profitable industries have been formed around anecdotal evidence. Its anecdotal because sometimes it works.... Chiropractic is the first that comes to mind. The bases of chiropractic is that spinal sublexation causes all manner of problems so they treat it and it gets better. problem is over half of folks with spinal sublexation have NO symptoms. Same with the spinal centers doing surgeries on "bulging discs" Add to that dietary supplements, special diets, etc etc. and NOBODY should have a problem.

My first career was as a speech therapist. I did essentially stuttering therapy (The famous Dorvan Breitenfeld was my mentor) Now stuttering is pretty easy to fix. But before you can the hard part is getting past all the stuff that happened first (Fear etc etc) The MOST difficult was the secondary behaviors all of which are anecdotal evidence caused) Kid gets stuck (block) stamps his foot and out comes the word. next time he gets stuck he stomps his foot and out comes the word. Aha he has the cure! Until it doesn't work and he stomps his foot twice.... You can imagine where this is going. I had one kid in our residential program who would Stomp his foot (we counted sixty times once) scream sueee, jerk his head and blink his eyes and was still getting stuck.

Connected? Linked? Does it matter??? I used to frequent another form (for spondylitis) It got to the point there were folks complaining that they had ingrown toenails from spondylitis and needed help to get their Rheumy to DO SOMETHING. (how about stuffing cotton underneath it and soaking it in hot water till you can cut it off?)



Wheeler said:

Are we sure if all of the different docs know how it MIGHT be related? Some seem to get stuck in doing their thing and not really exploring other ideas.




12

In a nutshell, it seems that inflammation and an immune response is the connection between all of these seemingly unrelated issues.

I'd like to find out how much is genetic and how much is environmental.

My 16 year old daughter has psoriasis on her fingernails only. Unfortunately, I need to take her to get tested for Insulin Resistance. I definitely don't want to see her go down the same path as I did. However, no one else in my family has psoriasis or insulin resistance. There is a family history of diabetes, but since the medical community didn't know about insulin resistance or very much about hyperlipidemia, it's difficult to know if my grandparents had this or not.

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Question: Can "hyperlipidemia" be that your good cholesterol is high even if your bad fats are low? When I was reading this previously I thought I didn't have it because when I've had my cholesterol tested before, my bad fats were low but my good were very high. Is that a form of "hyperlipidemia"?

14

Thanks for the posting...I have polycystic ovarian syndrome and PSA, tried a biologic, had to stop due to heart/chest pain/irritation issue that is still being checked out.

15

Is there also a connection with Thyroid problems as well? I have read that it is commom for PsA people to have both. Is this another one to add to your list? I have Hashimoto Thyroiditis (Multi Nodular Goiter). This falls into the endocrinology category. I might be getting too far off the track and this may need to be discussed separately.

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It had been a year since I started a good diet for P (no processed sugar, yes lots of veggies, fruits, brown rice, salmon, olive oil, almond, walnuts, etc). I did not have any arthritic symptoms to complain. My Blood test before arthritic symptoms: Triglycerides 49 mg/dL, Glucose 71 mg/dL, HDL 29 mg/dL, LDL 85 mg/dL.

Blood test 1.5 years after above period and after I started having some serious arthritic symptoms: Triglycerides 103.4, HDL 21, LDL 130, HBA1C 5.3% (Avg. blood glucose 104 mg/dL)

I am managing my inflammation so far with a reasonable diet. I stopped processed sugar 4 years ago. May be that is the reason for the shown sugar levels. My father is suffering from diabetes 2 for 20 years at least. So I am very cautious.

I have found many published articles too (of similar nature). All linking inflammation, dyslipidemia, hyperlipidemia, diabetes, heart attack, etc.

On these 4 years, I lost 35 pounds (190s to 160) being a 6 feet tall person. So I am thin.

One of a friend also directed me to this article for my wondering on the raising of LDL cholestrol. This links inflammation to cholestrol.

I wish more research to be done along the lines of inflammation.

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I have Hashimotos,my thyroid gland is starting to press on my windpipe,not good :frowning:

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This is a subject dear to my heart. I am a fan of a blog by a microbiologist called Cooling Inflammation, who makes the links and I have been following his advice with tremendous success- 5 months drug free, with much reduced symptoms, massive improved well being after being on serious meds for Psa and other inflammatory conditions ie endometriosis for 20 years. its called Cooling Inflammation

Cooling Inflammation

Inflammation is the foundation for cancer and degenerative/autoimmune diseases. Small changes in diet and exercise, e.g. omega-3 oils, vitamin D, low starch, plant antioxidants, and maintaining muscle mass, can dramatically alter predisposition to disease and aging, and minimize the negative impact of genetic risks. Based on my experience in biological research, I am trying to explain how the anti-inflammatory diet and lifestyle combat disease.

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Just want to say, I don't have a clue if all of this is connected or not. I am sero-negative PsA; Hypertryglyceridemia; Hypertension; FMS, CMP, OA.

I do have to say that at 4000 you have my high of 3185 beat!! It has taken my PCP 4 years to get my cholesterol values in the normal range and during all of that found out I am very very allergic to niacin.