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Treatment Options for Psoriatic Arthritis

Posted Aug 24 2008 1:49pm
ANNOUNCER: Psoriasis is known as a skin disease, but it can also cause arthritis. Treatment of Psoriatic Arthritis depends on the extent of the joint disease. Mild symptoms may respond to physical therapy and treatment with non-steroidal anti-inflammatory drugs, or NSAIDS.

BRUCE STROBER, MD: People with more mild psoriatic arthritis, and when I'm saying mild I mean really very mild -- only infrequently does the condition affect them, may only get nonsteroidal anti-inflammatory medication, ibuprofen being a good example.

ANNOUNCER: More severe disease will require treatment with disease-modifying anti-rheumatic drugs, or DMARDS. These drugs include sulfasalazine, and the immunosuppressive agents methotrexate and cyclosporine. These drugs can help, but may also lead to potentially serious side effects.

PHILIP MEASE, MD: There may be some adverse effects -- for example, methotrexate may cause liver problems. And so we are continually seeking what are better medicines that may have more enduring effects or may have fewer side effects than what we have traditionally used.

ANNOUNCER: Newer therapies for severe psoriatic arthritis include TNF-blockers, drugs that block the action of an inflammatory protein called tumor necrosis factor alpha.

PHILIP MEASE, MD: The ones that are currently available include a drug called Enbrel, or etanercept; one known as Humira, and the other way we know that drug is known as adalimumab. And then there's a drug called Remicade, which is also known as infliximab.

DAFNA GLADMAN, MD: The main reason that anti-TNF agents were developed is because TNF turns out to be a very important cytokine, that's a chemical that's produced in our body during inflammation. And it turns out that TNF is important both in the inflammation in the skin and the inflammation in the joints. And so anti-TNF agents block the activity of TNF and therefore control the inflammation or prevent the inflammation from perpetuating itself.

ANNOUNCER: The most common side effects of TNF-blockers include reactions at the injection site, headache, and an increased risk of infection, including the reactivation of latent tuberculosis.

BRUCE STROBER, MD: Infection is not unexpected because while you need TNF to create psoriasis and psoriatic arthritis, you have it for a reason in your body, which is to help you fight infection. So patients on these medications have probably a slightly greater risk of having upper respiratory tract infections and maybe some types of skin infections and other bacterial infections. It's not common but you see it a little bit more commonly than people who are not receiving those medications.

ANNOUNCER: Early diagnosis and treatment of psoriatic arthritis in important in order to prevent joint pain and deformities.

SOUMYA REDDY, MD: It's very important to begin treatment as soon as the diagnosis is confirmed and the reason is that, although you can treat the symptoms of psoriatic arthritis such as pain and swelling with other medications such as NSAIDs and painki- -- pain-relieving medications, the structural damage can only be halted or slowed using these types of medications, the DMARDs and TNF inhibitors. And that's been shown in studies and that's why it's important to begin treatment early.

DAFNA GLADMAN, MD: What happens to people with psoriatic arthritis over time, if they are left untreated, unfortunately we do have examples of those, they go on to damage their joints. They damage their joints in one of two ways: the joints either totally get destroyed and become what we call flail joints, which are totally useless, or they become totally fused and closed so that they can't move at all, which again makes them useless.

ANNOUNCER: Treating both the skin and joint problems of psoriasis can result in dramatic improvement in both.

BRUCE STROBER, MD: It's remarkable how the improvement in the joint symptoms are as -- is as important as the improvement in the skin symptoms from a perspective of how much that person's daily activities of living have been improved. Right down to they don't wake up in the morning feeling really stiff and rigid in their joints; they can kind of bounce out of bed.

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