Interview: Rheumatologist on Psoriatic Arthritis Symptoms and Treatment
Psoriatic arthritis or PSA, is a painful and debilitating chronic condition that affects up to one million Americans.
Up to 30% of patients with psoriasis may have a disease called psoriatic arthritis (PsA).1 You might be familiar with psoriasis and its symptoms, but maybe haven’t heard of PsA, which causes pain, and swelling in and around the joints and tendons.2
Nearly one in four people with psoriasis may have undiagnosed PsA, in addition to the up to 2 million people currently diagnosed with the disease,2 including celebrities like LaLa Antony.
RheumatologistDr. Grace Wright is joining Novartis in shining a light on this often overlooked condition and what you should look out for if you think you may be suffering from the disease.
Dr. Wright joined me to discuss the disease state, signs and symptoms, and treatment options of Psoriatic arthritis. One option approved to treat active psoriatic arthritis in adults is Cosentyx® (secukinumab). Dr. Wright will address the benefits associated with Cosentyx along with important safety information.
Read our discussion below.
MLS: First Doctor Wright, tell us more about psoriatic arthritis and how it affects those who have the condition.
DW: The psoriatic arthritis or PSA, as you said, is a chronic inflammatory disease. It’s actually an auto-immune disease that involves the immune system, generating a variety of inflammatory molecules, inflaming the cells that then target tendons and skin and joints, as well as other structures within the body. So, many people will first notice that they have stiffness in their joints or they may have swelling. And in the case of psoriatic arthritis, it maybe just one or two joints when this starts. There can be pain associated with that swelling and stiffness and as well as you can feel pain when you start movement, because there is inflammation in the tendons at the site that they attach to bones, and that’s called enthesitis.
DW: It’s a painful condition with fatigue, swelling and stiffness and pain when you begin movement. When you have involvement of the skin, you’ll also see these inflammatory skin lesions which are called, the psoriatic plaques. These are large patches of red, scaly, itchy skin. In the very early stages, they can sometimes be misdiagnosed as eczema because people think, “Well, it’s a scaly rash,” so it has to be an allergic-type reaction, but this is really a very thickened inflammatory plaque that can cause a lot of discomfort for people.
MLS: Thank you for sharing those. Especially, the signs and symptoms of the condition. Now doctor, once the person has been diagnosed with psoriatic arthritis, what are some of the treatment options that are available to them?
DW: Well, we have many treatment options and that’s a really important message for people to understand that we actually can make a difference. We can treat people. We encourage people to be diagnosed and to seek treatment early. We have pills or oral agents that target the general inflammation. We have also more targeted pills, and then we can move to the biologics which are administered by either injection, patient injecting themselves or by infusion from the physician. And these targeted biologics are complex proteins that target the inflammatory cells and those molecules within the body that are really sort of driving this inflammation in both skin, joints, and tendons. So it’s very important to be under the care of a specialist, like a rheumatologist, who can manage these symptoms and manage these drugs. Now, as I am joining you today, talking on behalf of Novartis, one such biologic is Cosentyx, which is a biologic that targets a specific molecule within the inflammatory pathway, that is involved in both the inflammation in the skin, at joints and tendons.
MLS: That’s good information to know for people to take with their doctor to have a hand in hand relationship with them for treatment. Now, how can caregivers and family members and friends support their loved ones who have the condition?
DW: Well support, we find, is essential when you have conditions that may make patients feel very socially isolated, because sometimes the stiffness and fatigue go unrecognized and people drop out of social engagements, they don’t connect with family. So, it’s important to have family and friends understand that at times, “Yes, they’re too tired. Yes, at times they’re too stiff”, but exercise is important, a healthy diet is important, and having that emotional support actually does help to improve the lives of the people suffering with this disease.
MLS: Absolutely. Now, you just touched upon this very lightly with your previous statement, tell us, as a rheumatologist, you’ve seen lots of people with this condition. Have you noticed any lifestyle changes that a person can make, who has psoriatic arthritis, that they can do to better manage their condition?
DW: Yes. It’s important for all patients with inflammatory arthritis, “Exercise, exercise, exercise.” It’s a mantra. It’s important to keep our muscles and joints strong, and a healthy diet is also beneficial. It helps your immune system work better, and it helps your body function. It’s one of the two old fashioned mantras of, “We are what we eat.” So, it’s important to have a healthy balanced diet and to always exercise.
MLS: Thank you for sharing that. And lastly doctor, where can people go to find more information on the condition?
DW: The American College of Rheumatology, the Psoriasis Foundation and a variety of other patient-doc groups would be able to share information on this.
MLS: Thank you so much and what are some of your last tips and advice or takeaways that you would like for people to get for today regarding psoriatic arthritis?
DW: It’s important to remember that we can treat this condition, that if you have symptoms not to wait, the longer we wait, the greater the potential for damage and we’re not that good at reversing damage, we’re much better at preventing damage. So early intervention is critical to discuss these symptoms with your healthcare provider and to seek medical care.
COSENTYX® (secukinumab) is a prescription medicine used to treat adults:
· with moderate to severe plaque psoriasis that involves large areas or many areas of the body, and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet or UV light, alone or with systemic therapy)
· with active psoriatic arthritis
IMPORTANT SAFETY INFORMATION
Do not use COSENTYX if you have had a severe allergic reaction to secukinumab or any of the other ingredients in COSENTYX. See the Medication Guide for a complete list of ingredients.
COSENTYX is a medicine that affects your immune system. COSENTYX may increase your risk of having serious side effects such as:
COSENTYX may lower the ability of your immune system to fight infections and may increase your risk of infections.
· Your doctor should check you for tuberculosis (TB) before starting treatment with COSENTYX.
· If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with COSENTYX and during treatment with COSENTYX.
· Your doctor should watch you closely for signs and symptoms of TB during treatment with COSENTYX. Do not take COSENTYX if you have an active TB infection.
Before starting COSENTYX, tell your doctor if you:
· are being treated for an infection
· have an infection that does not go away or that keeps coming back
· have TB or have been in close contact with someone with TB
· think you have an infection or have symptoms of an infection such as:
o fevers, sweats, or chills
o muscle aches
o shortness of breath
o blood in your phlegm
o weight loss
o warm, red, or painful skin or sores on your body
o diarrhea or stomach pain
o burning when you urinate or urinate more often than normal