Treatments for psoriasis can be a guessing game. No one
remedy seems to work for everyone afflicted. But for those with psoriatic
arthritis, an advanced stage of the auto-immune disease, the game is a balancing
act. Several new drugs promise relief from the potentially crippling condition,
but not without risks that include infection and cancer.
Psoriatic arthritis affects about 30% of people with psoriasis. Those with
psoriatic arthritis experience tenderness, redness and pain in joints such as
the hip, knee, wrist and fingers. The pain can range from irritating to
excruciating. For less than 5% of individuals with psoriatic arthritis, the
disease can damage bones in the fingers and hands. For this group, psoriatic
arthritis can mean permanent deformities and intense pain.
Psoriatic arthritis generally occurs among those with poorly treated psoriasis
symptoms. So, the first step in treating psoriatic arthritis is to catch it
before it starts. Once the condition has been diagnosed, however, new treatment
methods are promising more symptom-free days and a greater chance of halting the
progression of the disease. But these medications are not without the potential
for serious side effects, and you must talk with your physician about the
benefits and risks of taking them.
A Variety of Treatments
Although none of the many new medications are a cure for the disease, most offer
symptom relief for a majority of patients. These drugs are in a class of
medications called tumor necrosis factor (TNF)-alpha inhibitors; however, they
are more commonly referred to as biologics. TNF-alpha is a protein released into
the body during an immune response. It works like the general of the white blood
cells, sending them off to fight infection. The cluster of white blood cells
creates a pocket of inflammation.
In a normal immune response, the TNF-alpha dissipates after dealing with the
infection. But in those with autoimmune disorders, such as psoriasis and
psoriatic arthritis, TNF-alpha remains in the bloodstream at higher than normal
levels. This can then cause inflammation, in places like finger and hip joints,
where there is no infection. The buildup of inflammation results in pain and
damage to tissues, such as cartilage and bone.
TNF-alpha inhibitors work by limiting the impact of TNF-alpha on the body. They
reduce the amount of inflammation and resulting pain by stopping it before it
starts. Examples of these medications include Remicade (infliximab), Humira (adalimumab)
and Enbrel (etanercept).
In addition to these medications, Golimumab, a new TNF-alpha inhibitor, may hold
additional promise for those with psoriatic arthritis. Centocor Inc. and
Schering-Plough Corp., the companies that developed Golimumab, say their
clinical trials indicate that more than half of patients experience a 20%
improvement in symptoms after 14 weeks. The drug, which has not yet been
submitted for FDA approval, has not yet been evaluated by an independent study.
All TNF-alpha treatments are delivered either intravenously or by injection.
Because they suppress the immune system, the risk of infection while using these
drugs increases. As a precaution, a doctor will give a patient a tuberculosis
test beforehand to determine if the individual has been exposed. Patients should
also avoid exposure to any infectious disease while using these drugs.
A Variety of Side Effects
According to the National Institutes of Health, Humira can cause nausea, back
pain, headache, stomach discomfort and redness or swelling at the injection
side. More serious, but rare, side effects include muscle weakness, itchiness,
fever, shortness of breath, vision problems and swelling of the feet, hands or
Remicade has a higher risk of allergic reaction because it is injected directly
into the bloodstream through an IV. Reactions, such as itching and swelling of
the face, feet or hands, typically appear within 2 hours of treatment. In most
cases, a nurse will observe those receiving treatment for about 2 hours.
Those taking Enbrel are also at risk for side effects. These include redness at
the injection site, sneezing, nausea or vomiting, cough or sore throat and runny
nose. More serious side effects include seizures, fever, breathing difficulties
An increased risk of infection is also among the serious potential side effects
of these drugs. These serious side effects are rare, but should be reported to a
physician immediately if they occur.
Possible Cancer Risk
There is some evidence to suggest that biologics may increase a patient's risk
of lymphoma, melanoma and non-melanoma skin cancer. However, the data is
inconclusive. The increased risk that has been observed in some studies is
slight, but worth discussing with a physician. Those with a history of these
cancers should especially have a conversation with a doctor about these
potential risks prior to starting a biologic therapy.
In an analysis, published in 2006 in the Journal of the American Medical
Association, a group of 3,493 patients taking Humira and Remicade reported 29
malignant cancer diagnoses within 56 weeks of their trial period. The patients
took various doses of the biologics to treat rheumatoid arthritis. In a control
group using a placebo, three malignancies were reported. The study also found
that those taking higher doses were more likely to have a malignant diagnosis.