When Jack Gaskin first noticed a patch of dry skin on his scalp, he thought little of it. But soon itchy, flaky lesions also started to appear on his face, armpits, legs, backside and even behind his ears.
“Eventually, there was almost no part of my body that was unaffected,” says Jack, 39, who lives in Wallington in South London.
His GP diagnosed psoriasis, a common skin condition that causes angry, inflamed lesions and affects an estimated 1.3 million in the UK.
But there was worse to come. Within months, the problem had morphed into psoriatic arthritis, a painful, exhausting and incurable condition where it’s not just the skin that is affected but joints too. It can lead to agonising inflammation and fatigue so severe that sufferers barely have the energy to get out of bed.
In the very worst cases, it can mean damaged joints eventually needing to be replaced with prosthetic ones.
“I’d never heard of psoriatic arthritis,” says Jack, who works for a tea marketing company.
“When the doctor gave me the diagnosis I thought ‘what the hell is that?’ I had severe inflammation and pain in my knees, feet and ankles.
“Then there were the bouts of sheer exhaustion. If I went for a five-minute walk, I’d have to lie down for 90 minutes to recover.”
Now it seems Jack’s descent into severe illness may have been brought on by stress.
Both psoriasis and psoriatic arthritis are autoimmune conditions, where the immune system – as well as guarding against illness by attacking foreign organisms such as viruses and bacteria – also starts to destroy the body’s own cells.
Quite why this happens is not clear but it’s thought a whole host of factors may trigger it, from stress and poor diet to smoking and a family history of autoimmune disease.
“There is no doubt stress is a factor and many people with psoriatic arthritis say they were stressed at the time they developed it,” says Dr Wendy Holden, consultant rheumatologist at North Hampshire NHS Foundation Trust and medical adviser to the charity Arthritis Action.
Studies suggest stress is at least partly to blame for pushing some psoriasis patients over the edge into full-blown arthritis. That’s because it releases hormones, such as cortisol, which cause inflammation throughout the body, especially in the joints. It’s not clear, says Dr Holden, why some psoriasis patients go on to get arthritis and others don’t.
“Some estimate one in 20 people with psoriasis get it, others put it as high as one in five,” she adds.
In fact, she says, some people who develop the arthritic form of the illness don’t appear to have skin problems at all. Instead, it seems they get psoriatic arthritis because a first-degree relative – such as a parent or sibling – had psoriasis themselves.
In September 2019, reality TV star Kim Kardashian, 41, revealed she had been diagnosed with the condition, which she described as “painful and scary”. In her case it began with a rash on her stomach and legs and led to severe pain in her hands that meant she was unable “even to pick up a toothbrush”.
Jack was in his early 30s and working long hours when his body started to give up on him.
“In a week, I lost my job after the crowdfunding business I had created folded and I split up with my girlfriend,” he says.
“I didn’t see either of these things coming and they really affected my mental health and stress levels.
“I had psoriasis at the time but in six months it began to get worse across my body, even in my privates. My hair started falling out in clumps.”
It was only when a specialist noticed Jack’s fingernails had developed ridges – a tell-tale sign – that he learned this was much more than a skin complaint.
Despite treatment with steroids to dampen down the inflammation, his condition rapidly worsened.
“I soon developed swelling in my toes and fingers and my fingernails started falling out. It made me really self-conscious and anxious. If I was in a meeting and leant forward to show something, I felt everyone would notice my broken fingernails and flaking scalp. This led to more stress.”
Jack’s condition was eventually stabilised with powerful drugs to reduce levels of inflammatory proteins.
Keeping his stress under control has also reduced flare-ups. “The drugs have stabilised my illness but I can’t do many things I used to love – such as hiking and wild camping with friends. That’s out of the question as hiking puts too much strain on the knees.
“I’m still in pain and discomfort but I’ve learnt to accept it. The fact that it’s not getting worse for the first time in years is a huge relief. My advice to any sufferers would be that arthritis may take a lot but it can’t take everything.
“Be gentle and compassionate with yourself and you’ll get through it.”
How to protect your joints
Dr Wendy Holden, medical adviser to the charity Arthritis Action, says there are things those at risk can do to reduce the risk of psoriasis developing into arthritis.
Watch your weight – obesity can raise the risk of autoimmune conditions such as this because it drives inflammation inside the body.
Quit smoking – toxins contained within cigarettes are known to play havoc with the immune system.
Chill out – chronic, long-lasting stress drives up levels of harmful hormones which may turn psoriasis into something much more serious.