First Data For Ustekinumab
There certainly doesnt appear to be any added benefit from using methotrexate on a group level in patients getting ustekinumab and TNF inhibitors, Dr. Siebert said. Weve looked at everything, he emphasized, and none of the single domains or composite measures were improved by the addition of methotrexate. I think we knew that for TNF inhibitors, but the key thing is weve never known that for ustekinumab, and this is the first study to show that.
Indeed, the findings match up with those from the SEAM-PsA study in which patients who were treated with the TNFi etanercept as monotherapy did much better than those given the TNFi in combination with methotrexate or methotrexate alone. While not a randomized trial, PsABio now shows that the same is true for ustekinumab.
Obviously, there are some clear differences between a clinical trial and an observational study such as PsABio. For one thing, there was no randomization and patients taking methotrexate were presumably doing so for good reason, Dr. Siebert said. Secondly, there was no methotrexate-only arm.
Conventional Or Traditional Disease
DMARDs are indicated for the treatment of moderate to severe or refractory cases of PsA. Patients with active disease, defined globally as one or more tender and swollen joints and poor prognostic factors, particularly those with elevated acute phase reactants, radiographical damage or clinically relevant extra-articular manifestations, who have failed to respond to NSAIDs within 3 months, should be treated with DMARDs.
Delay in the start of DMARDs may lead to worse outcome. MTX, sulfasalazine and leflunomide can be effective for peripheral but not for axial disease, enthesitis or dactylitis. Observational controlled studies with sulfasalazine have shown no reduction in long-term joint damage. Similarly, the use of antimalarials and gold salts is not recommended, and there is little convincing evidence regarding the efficacy of cyclosporine in PsA. It has been shown that the probability of continuing to take cyclosporine is significantly lower and the rate of adverse events is higher when compared with MTX or antimalarials .
Before starting DMARD therapy patients should be screened and have regular blood monitoring, usually every 3 months, including blood counts, liver function tests and serum creatinine .
What Are Psoriatic Arthritis Symptoms
Psoriatic Arthritis develops either slowly, with mild symptoms, or rapidly and severely. How severe the disease is varies from person to person.1
Common symptoms include:1
- Tenderness, pain and swelling over tendons
- Swollen fingers and toes
- Stiffness, pain, throbbing, swelling and tenderness in one or more joints
- Reduced range of motion
- Nail changes, such as pitting or separation from the nail bed
- Redness and pain of the eye
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Who Will Be Responsible For My Healthcare
Youre likely to see a team of healthcare professionals.
Your doctor, usually a rheumatologist, will be responsible for your overall care. And a specialist nurse may help monitor your condition and treatments. A skin specialist called a dermatologist may be responsible for the treatment of your psoriasis.
You may also see:
- a physiotherapist, who can advise on exercises to help maintain your mobility
- an occupational therapist, who can help you protect your joints, for example, by using splints for the wrist or knee braces. You may be advised to change the way you do some tasks to reduce the strain on your joints.
- a podiatrist, who can assess your footcare needs and offer advice on special insoles and good supportive footwear.
What Are Biologic Dmards
Biologic DMARDs are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. This process creates drugs that can prevent, treat, and cure disease. In people with PsA, they work by interfering with specific substances in the immune system to reduce or better regulate the inflammatory responses that cause PsA and psoriasis symptoms. Common proteins targeted include tumor necrosis factor and various interleukins . Biologic DMARDs include:2,5
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What Is A Subcutaneous Injection
Many PsA medications are administered through subcutaneous injection. These medications are injected through a needle and into a layer of fat underneath the skin that is called subcutaneous fat. Injecting the medication into this layer of fat allows the body to absorb the medication slowly and gently.
Subcutaneous injections are usually administered into areas of the body that have wide layers of fat, such as the upper arm, the thigh, or the abdomen. You may be able to perform subcutaneous injections at home, or you can book an appointment with your health care provider to receive an in-office injection.
Alternative And Complementary Therapies
PsA and psoriasis are long-term conditions, so its common for people to seek alternative or complementary therapies to improve their physical and emotional well-being.
Stress often triggers psoriasis flares. Using mind-body techniques such as meditation, yoga, and tai chi may assist with overall health and potentially improve your symptoms.
> Nutrition, diet, and exercise can also help keep PsA symptoms under control. Keeping a healthy weight reduces pressure on the joints and lowers systemic inflammation. In general, exercising releases feel-good endorphins, which may improve your overall mood.
Lastly, physical or occupational therapies are recommended for PsA patients to maintain joint health and improve their quality of life.
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In A Time Of Biologic Overload New Guidelines Provide Direction While Head
Although choosing a biologic therapy for psoriatic arthritis can be complex, recent guidelines and head-to-head trial data provide some indications of which agent to use first and second, Kristina Callis Duffin, MD, said in a presentation at the 2019 annual meeting of the American Academy of Dermatology in Washington, D.C.
The most recent published guidelines call use of TNF inhibitors as first- and second-line therapy, but include caveats that would steer certain patients toward other biologics or even to oral therapies such as methotrexate, said Callis Duffin, co-chair of the department of dermatology at the University of Utah, Salt Lake City, and President of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis .
Which biologic should we choose first? is a common question asked by patients and physicians alike, Callis Duffin told attendees in a presentation that addressed treatment decision making in a time of biologic overload due to a plethora of approved systemic therapies.
Choosing a Biologic for Psoriatic Arthritis
What do the Guidelines Say?
Until recently, there have been few published recommendations to guide treatment choice in psoriatic arthritis. In 2015, GRAPPA issued treatment recommendations for psoriatic arthritis that are somewhat complex and hard to negotiate, in the speakers estimation.
TNFs in First and Second Line, With Caveats
Head to Head Data Are Coming
Exceptions to the Rule
What Are The Risks Of Biosimilars
The risks and side effects of biosimilars are the same as those associated with their biologic reference product. Anyone considering taking a biosimilar should talk with their health care provider about the short- and long-term side effects and risks. It is important to weigh the risks against the benefits.
Biologics and biosimilars act on cytokines, which are specific proteins released by the immune system that can cause inflammation. Biologics suppress the function of the overactive immune system. When on a biologic or biosimilar, you may have a higher risk of infection. If you develop any signs of an infection, contact your health care provider right away.
Signs of infection include:
- Damp, sticky feeling or sweating
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Psoriatic Arthritis Medication: Pain Relief And Natural Alternatives
Psoriasis, a skin condition caused by an autoimmune issue, can actually affect more than your skin. According to the National Psoriasis Foundation, about 30 percent of people with psoriasis also develop a painful joint condition called psoriatic arthritis.
In the same way that your immune system attacks your skin to produce a scaly rash with psoriasis, it can also attack your joints, leaving them swollen and inflamed.
The pain of psoriatic arthritis is usually centered in the fingers and toes, but you might also notice soreness in your:
- lower back
The pain can get worse when youre under stress or have a flare-up of psoriasis. Between these flare-ups are pain-free periods called remissions.
Psoriatic arthritis does more than just cause aches and pains. Over time, it can damage your joints. Without treatment, it can cause you to lose the use of certain affected joints. If you and your regular doctor think you may be dealing with psoriatic arthritis, make an appointment with a rheumatologist to discuss treatment options.
Psoriatic arthritis medication is one way to treat the pain from this autoimmune issue, but there are many other nondrug options available.
Theyre Administered By Injection Or Infusion
Biologics differ from other psoriatic arthritis treatments because they are not available as a pill. Instead, biologics are often given at home by self-injection, which a doctor can show you how to do. Most self-injections are administered every one to four weeks, Zashin says.
Other biologics are given through an intravenous infusion, which is done in a doctors office every four to eight weeks.
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Work And Psoriatic Arthritis
Having psoriatic arthritis may make some aspects of working life more challenging. But, if youre on the right treatment, its certainly possible to continue working.
Help and support is available, and you have rights and options.
The Government scheme Access to Work is a grant that can pay for equipment to help you with activities such as answering the phone, going to meetings, and getting to and from work.
The 2010 Equality Act, and the Disability Discrimination Act in Northern Ireland makes it unlawful for employers to treat anyone with a disability less favourably than anyone else. Psoriatic arthritis can be classed as a disability if its making every-day tasks difficult.
Your employer may need to make adjustments to your working environment, so you can do your job comfortably and safely.
You might be able to change some aspects of your job or working arrangements, or train for a different role.
In order to get the support youre entitled to, youll need to tell your employer about your condition. Your manager or HR department might be a good place to start.
Other available support might include:
- your workplace occupational health department, if there is one
- an occupational therapist. You could be referred to one by your GP or you could see one privately
- disability employment advisors, or other staff, at your local JobCentre Plus
- a Citizens Advice bureau particularly if you feel youre not getting the support youre entitled to.
Reducing Signs And Symptoms
Both of these drugs reduce the signs and symptoms of psoriatic arthritis and most exciting they also can slow down damage to your joints, Dr. Smith says
DMARDs slow down psoriatic arthritis and improve quality of life for most people, Dr. Smith says. Some patients will even achieve a remission while taking them. But more typically, disease activity continues, but at a slower, less intense rate.
If your doctor prescribes DMARDs, here, according to Dr. Smith, are three things you should know about these powerful medicines.
1. All DMARDs may have side effects
Because DMARDs are a systemic treatment, they may have side effects, such as stomach upset, liver problems or blood issues, Dr. Smith says. It may take some tinkering for your physician to find the right regimen for you.
Possible long-term complications include liver damage with methotrexate and leflunomide. Some dormant long-term infections such as tuberculosis, can be re-activated by DMARDs.
DMARDs change your immune system, so you may get more intense viral or bacterial infections. Make sure to let your doctor know about any serious infections, Dr. Smith says.
You also should check with your doctor before getting any vaccines, Dr. Smith says. Live vaccines, like the shingles vaccine, may be dangerous with certain of medications, he says.
Some biologics also have been linked to a very small increased risk of cancer. You should ask your doctor about it, Dr. Smith says.
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Disease Modifying Antirheumatic Drugs
DMARDs are long term medications that can relieve more severe symptoms of PsA and help protect joints from damage. DMARDS may be pills or injections.
There are many different types of DMARDs, but doctors only use some of them to treat PsA. Many DMARDs treat other autoimmune diseases, such as rheumatoid arthritis or inflammatory bowel disease .
Doctors use some DMARDs to treat PsA as an off label use. This means that the FDA has not approved the drug to treat PsA, but it may work for this purpose.
How To Ask Your Doctor For A New Treatment
You might already see your doctor every 3 to 4 months if you take medication. During those visits, the doctor can examine your joints, do imaging tests, and check your lab test results to see whether your PsA is under good control.
But tests donât always tell the whole story. Your point of view is important, too. Let the doctor know if you’re having any problems with your medications, including side effects or breakthrough symptoms.
If you’re not due for a visit yet, call the office or send your doctor an email about your concerns through the patient portal.
Donât be afraid to speak up. “A lot of patients are hesitant. They don’t want to take up the doctor’s time,” Craig says. “It’s helpful for us if they come in. I hate to see someone suffer for months. And it’s often easier to intervene earlier in the course of the disease, when things are less active.”
If your doctor isn’t on board with you switching medications, don’t be afraid to push back to get on the right treatment. “Sometimes it’s a matter of miscommunication,” he adds. “We need to be on the same page as to what the expectations are, what we’re treating, and what effect we expect.”
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Efficacy And Safety Of Biologics
Although approved biologic agents differ by countries, biologic agents commonly used for the treatment of psoriasis are categorized into three groups, tumor necrosis factor inhibitors, interleukin -23 inhibitors, and IL-17 inhibitors, as shown in . Infliximab, adalimumab, etanercept, certolizumab-pegol, and golimumab are TNF- inhibitors. Golimumab is used only for PsA. Ustekinumab is an anti-IL-12/23p40 antibody. Guselkumab, risankizumab, tildrakizumab, and mirikizumab are anti-IL-23p19 antibodies. Secukinumab, and ixekizumab are anti-IL-17A antibodies. Brodalumab is an anti-IL-17RA antibody. Bimekizumab is an anti-IL-17A/F antibody, which blocks both IL-17A and IL-17F. Many randomized controlled trials were conducted, and they demonstrated that the drugs are efficacious for moderate-to-severe plaque psoriasis. Recently, network meta-analyses enabled indirect comparison among those agents.
Signs Of Psoriatic Arthritis
Here are the most Early Signs of Psoriatic Arthritis Symptoms and Signs that you will notice and feel if you are being affected with PA:
- Pain and Swelling in one or more joints
- Stiffness of a joint, Particularly in the morning or after rest
- Tenderness and Swollen Joints
- General Fever
- General Fatigue
If you are noticing any of the above symptoms of psoriatic arthritis then you should use the treatment and natural remedies for psoriatic arthritis at the bottom of this page. The earlier you get it stopped and healing the greater your chances to reverse it for good.
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Psoriatic Arthritis Flares: Tips For Treatment
Psoriatic arthritis is an autoimmune disease and a chronic form of inflammatory arthritis that commonly affects people who have already been diagnosed with psoriasis. The main symptoms of psoriatic arthritis are similar to those of rheumatoid arthritis, including joint pain, swelling, and stiffness. These symptoms can become progressively worse over time. However, most people diagnosed with psoriatic arthritis go through periods when their symptoms improve or resolve and return or worsen. A period of worsened symptoms is called a flare or a flare-up.
When you feel psoriatic arthritis symptoms returning, its important to get a handle on the condition quickly. Treating a flare as early as possible may prevent symptoms from becoming severe or interfering with daily life. Heres what you need to know about living with psoriatic arthritis flares so you can work with your doctor to treat them effectively.
What Do Psoriatic Arthritis Flares Feel Like
When psoriatic arthritis flares, some people experience not only painful, swollen joints, but also less characteristic symptoms, such as extreme fatigue and skin rashes. Some individuals experience flare-ups as a general feeling of discomfort before more acute joint pain sets in.
Sometimes, comorbidities can trigger or signal a psoriatic arthritis flare. As one MyCrohnsAndColitisTeam member shared, My makes my psoriasis flare, which, in turn, flares psoriatic arthritis. Other times, psoriatic arthritis seems to flare on its own. One member who experienced this wrote, I have plaque psoriasis, psoriatic arthritis, and psoriatic nails. At the present time, my psoriasis is under control, but my arthritis flares. I just never know when its going to happen.
Because flares can come up at any time, they can disrupt life significantly. One member told others that their feet started burning and stinging after doing just a little shopping. Thats all it takes! Another said, Psoriatic arthritis makes you feel so tired and drained that you feel like every step is so heavy and tiring.
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Treatments From A Rheumatologist
A Rheumatologist is a hospital Consultant who is specialised in musculoskeletal conditions – including types of arthritis. They will be able to confirm the diagnosis and prescribe appropriate treatments, which may include the treatments that have been available from a GP.
Psoriatic arthritis needs to be treated with ‘disease modifying’ treatments to prevent or stop further damage being done to the joints. A Rheumatologist will assess a person’s psoriatic arthritis and make a decision as to whether ‘disease modifying’ treatment is appropriate or not. Click on the links below to find out more about treatments available from a Rheumatologist