How Do You Treat Psoriatic Arthritis?
By Nathan Wei
Psoriatic arthritis (PSa) is one of the most common forms of inflammatory arthritis with prevalence varying in the general population from 0.3% to 1%. It is unique in that the immune abnormality underlying the condition affects both the skin as well as the joints.
While psoriatic arthritis may begin by attacking only a few joints, over time it may begin to involve many joints and becomes very severe in at least 20% of patients.
Treatment should target the skin and joint problems of the disease simultaneously.
Successful treatment of PsA with conventional therapies is limited by a number of different factors, including failure to effectively manage skin and joint aspects of the disease, risk of potentially serious adverse effects, and poor tolerability.
The usual starting regimen given to patients with PsA is non-steroidal-anti-inflammatory drugs (NSAIDS).
While initial treatment with NSAIDs may control PsA, some patients may experience a worsening of psoriasis and others may not respond well enough.
In addition, NSAIDs do not slow down the course of the disease or prevent development or progression of erosions (joint damage).
Psoralen plus ultraviolet light (PUVA) and other medications may be effective therapies for psoriasis, but they do not halt progressive joint damage and deterioration in patients with PsA.
Usually, patients with severe PsA are placed on disease-modifying anti-rheumatic drugs (DMARDS). These drugs work slowly to retard the progression of disease.
Data from clinical trials support the use of sulfasalazine for PsA. However, a large percentage of patients (approximately 40 % or higher) either do not tolerate the drug or develop side effects.
Methotrexate (MTX) may be a useful drug in PsA patients. The major concern with this drug is potential liver toxicity.
In addition to periodic (monthly) liver function tests, a complete blood cell count and kidney function tests should be obtained during therapy.
Patients with psoriasis receiving MTX appear to be at slightly higher risk for liver disease compared with patients with RA who take the drug. The role of liver biopsy in monitoring is still undecided.
Another drug that has been used is cyclosporine A. While effective, it has many serious toxicities including kidney damage and hypertension.
All of these drugs, in addition to their toxicities, have limited effectiveness in patients who have spinal involvement from their psoriatic arthritis.
Currently, it is felt that institution of drugs that inhibit tumor necrosis factor (TNF) is the recommended course of action to follow. TNF is a chemical messenger that initiates and perpetuates inflammation and destruction in arthritis.
There are three TNF inhibitors that are currently used for psoriatic arthritis. They include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira). All three drugs work well for both the rash as well as the joints. Enbrel and Humira are self-administered while Remicade is given by intravenous infusion. These drugs also appear to be effective for the spinal manifestations of psoriatic arthritis.
Other drugs such as rituximab (Rituxan) and abatacept (Orencia) are also being studied for use in psoriatic arthritis.
Patients with painful swollen joints may require intraarticular joint injections with glucocorticoids (“cortisone”)
I am not 55 yet but I have been doing fitness instruction for several years. You have to loose that weight it is just not healthy. Do it now while you are still young enough. My father who is 60 and has broken his back in two places managed to loose 35 pounds last year. Already he is more mobile and feels better about how his body reacts. I suggest for you start doing water aerobics, it is very very low impact and because of the resistance can burn calories very fast. I have taught many people with arthritis water aerobics and they claim that it is the only thing that keeps them moving thought the day. Also i believe in the super veggy diet, I dont know about going totally vegan but the veggy juices works wonders!
55 yr male confused with rheumatoid arthritis no progress with enbrel humera and now thinking n ffeelingdown?
first i thank all those willing to help me . im a successfull buisnessman irish american ,who every aspect of my life is affected.my blood work does nt show true ra but ive gone to the # 1 doctor in manhattan who many times told me , i have the disease..now he suggest rituxan but my readings on it ,freighten me . another man whom i never knew asked me at a closing this week do i have lupus . i was schocked he knew i had a condition. he happened to be a doctor from romania and said today is my lucky day and suggested i go to the gerson institute,an intensified treatment of coffee enemas and 20 lbs of vegetables squeezed into juices. its readings is all positive but i cant see myself being a vegitarian but i will loose weight being 260 and 5 feet 10 incheswith humera i was nt much better but im worse now and feel so unique. my stiffness and body locking during sleep is terrible .when in florida for 8 weeks i was much better and played golf 5 days a week with pain but i was active