Around 7.5 million Americans, which is about 2.2% of the population, suffer from psoriaris, an autoimmune disease causing red, flaky skin. A new review in the Journal of the American Academy of Orthopedic Surgeons (JAAOS) reveals that patients with psoriatic arthritis (PsA), a type of arthritis that affects nearly 48% of patients with the skin disease psoriasis, gain substantial benefits from medications or biologic agents that target T-cells, white blood cells involved in the body’s immune system.
Lead study author Michael S. Day, M.D., MPhil, a resident orthopedic surgeon with the Department of Orthopedic Surgery at NYU Hospital for Joint Diseases explains:
“Although these new immunosuppressive agents are expensive, they are the only agents that have demonstrated a decrease in radiologic progression of peripheral arthritis, and can be used to manage associated types of inflammation, as well as skin and nail disease.”
PsA can occur in all intensities, ranging from mild symptoms that involve only a few joints, to severe symptoms, which affect more joints and cause substantial pain. Dr. Day states that even though skin lesions appear before arthritic symptoms in approximately 15% of patients, those with more severe psoriasis are not necessarily at greater risk for developing PsA.
Study co-author, Dr. Susan M. Goodman, an assisting attending rheumatologist and internist at Hospital for Special Surgery explains:
“When patients in dermatology clinics are screened for evidence of inflammatory arthritis, many have evidence of joint inflammation that they did not report, suggesting that many of these patients are undiagnosed and untreated.”
Initial treatments for PsA currently include nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce inflammation, pain and fever, however Goodman adds that in the near future, patients will be able to avoid progressing to end-stage arthritis and joint destruction through drugs designed to provide a more targeted therapy.
The fact that PsA and rheumatoid arthritis (RA) are very similar has encouraged PsA researchers to consider treating patients early and aggressively, a strategy that has shown to be successful in RA patients.
Patients with joint deformities as a result of PsA can also be considered for surgery, however few large-scale, high-quality clinical trials exist says Dr. Day, adding that:
“The disease typically follows a moderate course, but up to 48 percent of cases develop into destructive arthritis in which the inflammatory process leads to bone erosion and loss of joint architecture.”
Dr. Goodman said: “Initially, it was believed that PsA had a more benign course than does RA, but this belief has been disproven.”
Even though orthopedic surgeons play an important part on the PsA treatment team, the basis for a successful surgery of PSA patients is the collaboration between dermatologists, rheumatologists, internists and family physicians.
Dr. Day states: “PsA is a systemic inflammatory disease with multi-organ system effects. As such it should be treated with a multi-disciplinary approach.”
“Those who do progress to joint destruction may benefit from surgery, and may provide researchers with insights and further data regarding outcomes as well as the risks of surgery in this population,” adds Dr. Goodman.
Written by Petra Rattue