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New Therapies for Treating Psoriatic Arthritis

Posted Aug 24 2008 1:49pm
ANNOUNCER: Psoriatic arthritis is caused by the immune system attacking joints. New therapies are helping to fight back. Drugs called TNF inhibitors slow the development of joint damage by blocking the attack. And the earlier that patients start on the treatment, the better.

SOUMYA REDDY, MD: The reason that they should begin these medications earlier is to prevent some of the radiologic damage that can be occurring even without the patient being aware of the damage happening. And that's something that may not even show up on X-rays for another six months or one year, but is something that's happening and that's the reason to begin treatment early.

ANNOUNCER: Available TNF inhibitors include Enbrel, Humira and Remicade. Remicade is given by intravenous injection in the doctor's office every one to two months. Enbrel and Humira are given by intramuscular injection every one to two weeks. Patients can be taught to administer these injections to themselves.

SOUMYA REDDY, MD: The subcutaneous injections, Enbrel and Humira, we teach patients how to take the medication in the doctor's office and then we tell them that some people can develop a mild injection-site reaction, which is just a little bit of swelling and redness, and maybe slight amount of pain in the first 24 hours after the injection.

ANNOUNCER: Research shows that patients on TNF inhibitors usually show improvement in both their skin and joint problems.

PHILIP MEASE, MD: We not only were able to improve pain, physical function, quality of life and inhibit the joint destruction, but we also were able to significantly clear the unsightly skin lesions that were so embarrassing for people. So this has led to all three of these drugs being approved for the treatment of psoriatic arthritis, and this has been a big advance in our treatment paradigm.

ANNOUNCER: Common side effects of the TNF inhibitors include swelling at the injection site and infection. Patients are also warned about rare complications of the therapy, including heart failure. Studies suggest there also may be a slight increase in cancer risk.

BRUCE STROBER, MD: Some of these studies indicate that the risk of developing types of malignancies while on these medications isn't any greater than it would be if you weren't on the medication. But I think this is a concept that will develop over time.

ANNOUNCER: Doctors note that patients on TNF inhibitor therapy usually enjoy an improved quality of life.

SOUMYA REDDY, MD: These patients are often young and otherwise working and quite functional before they become disabled with this condition. So these medications help them return close to a level that they were before, depending on when they start these medications. So many of them are able to return to work, return to doing some of the activities that they enjoy doing, such as dancing or painting, that they previously were unable to do because of their joint pain and damage.

NARRATOR: A new drug for psoriasis called Alefacept is also being studied as a possible treatment for psoriatic arthritis. Like TNF inhibitors, Alefacept works by suppressing the immune system.

PHILIP MEASE, MD: This was first developed for the treatment of psoriasis and approved for that condition. And then we have also tried it in the treatment of the arthritis, and we have some preliminary information that it may be helpful for treatment of the arthritis, but it's not yet approved for that indication.

ANNOUNCER: Genetics plays an important role in the risk for psoriasis. Identifying the genes that cause psoriasis may lead to new ways to treat the disease.

DAFNA GLADMAN, MD: Today that sounds like a dream but in the next five to 10 years this may become a reality because we've identified a gene that is associated with susceptibility to psoriasis that's called a corneodesmosin gene and it turns out that gene actually leads to a protein that is important in the function of the keratinocytes. Those are the cells that cause the scaling in psoriasis. So interfering with whatever the abnormality is might prevent that from happening.

BRUCE STROBER, MD: I think it's a trend in all fields in medicine that we're increasingly getting more sophisticated and therefore there will be fewer and fewer patients that don't have a good treatment option.

PHILIP MEASE, MD: So there are some exciting new drugs coming along to increase the choices that we have for treating patients. So it's a very exciting time for us as physicians to be treating patients with psoriatic arthritis and psoriasis.

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