Published in the May issue of the Journal of the American Academy of Dermatology, the new psoriasis and psoriatic guidelines present the latest recommendations for treating patients with mild to severe cases of these conditions. "As a result of the impartial analysis of the most current research, physicians now have evidence-based guidelines which will help enhance the quality of care for patients and ultimately their safety," said dermatologist, C. William Hanke, MD, FAAD, president of the Academy. "The guidelines for psoriasis and psoriatic arthritis, which focus on the use of biologics, are the first phase of the Academy's efforts. The Academy is currently working on the second phase of these guidelines which will provide evidence-based advice for the management of psoriasis with topical therapies, ultraviolet light therapy, and systemic non-biologic therapies for psoriasis."
A related condition, psoriatic arthritis is a chronic disease characterized by stiffness, pain, swelling and tenderness of the joints, surrounding ligaments and tendons. Nearly 85 percent of psoriatic arthritis patients develop psoriasis before psoriatic arthritis. It generally takes about seven to 10 years for psoriasis patients to develop psoriatic arthritis. Although it can develop at any time, psoriatic arthritis most commonly strikes patients between the ages of 30 and 50.
Based on a comprehensive examination of the most recent studies on therapies for psoriasis, the Academy's guidelines outline the benefits and limitations of topical and systemic therapies currently available to treat psoriasis.
According to the guidelines, topical treatments are appropriate for patients who are good candidates for localized therapy, but in many cases they should not be used exclusively to treat psoriasis if patients could benefit from a combination of systemic and/or phototherapy treatments. When evaluating a patient, a dermatologist will determine if traditional systemic treatments, [methotrexate, cyclosporine (CyA) and oral retinoids] phototherapy, or the newer biologic agents are safe and effective for each individual.
Recommendations for Biologics
With the recent introduction of biologic therapies to treat psoriasis and psoriatic arthritis, dermatologists have more options available to find an appropriate treatment regimen to manage these conditions. Given by injection or infusion, biologics are systemic medications that pinpoint precise immune responses involved with psoriasis and psoriatic arthritis. They work, in part, by acting as a tumor necrosis factor (TNF) inhibitor to slow the inflammatory response. Studies confirm that the chronic physical symptoms that plague patients with moderate to severe psoriasis can be successfully alleviated with biologics, and they also are credited with helping improve a patient's quality of life.
Research shows that the activation of T-cells, a type of white blood cell, is the key immune system trigger in the development of psoriasis. Once activated, these cells release cytokines - chemicals used by the immune system to communicate messages. In psoriasis patients, these cytokines signal skin cells to reproduce and mature at an accelerated rate, which cause other reactions that lead to the formation of psoriatic lesions. Biologics are designed to target the precise immune responses involved with psoriasis, thereby controlling the condition and reducing the risk of future flare-ups.
Currently, five biologic agents are approved by the U.S. Food and Drug Administration (FDA) for the treatment of psoriasis and three of these five are approved for psoriatic arthritis. Because biologic therapies target the immune system, the guidelines stress that it is important to use all approaches to prevent infection, including vaccinations. However, once biologic therapy has begun, patients should avoid vaccinations with live vaccines under all circumstances, including live-attenuated vaccines - such as intra-nasal influenza and the herpes zoster vaccine and consult their dermatologist before receiving a vaccination of any kind. Patients also need to be periodically re-evaluated by their dermatologist for the development of new symptoms, including infections and potential cancers.
"Regardless of the therapy that is used to treat psoriasis or psoriatic arthritis, patients need to be in constant contact with their dermatologists to report any unusual side effects or fluctuations in their condition that may require an adjustment in their medications or indicate the onset of psoriatic arthritis or another secondary medical condition," said Dr. Hanke. "These guidelines should help further the understanding of the current psoriasis therapies and help enhance the overall health and quality of life of patients."