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Psoriatic Disease: An Autoimmune Disease Expert’s Point of View

Reviewed by Michael W. Smith, MD on December 01, 2020

By Anca Askanase, MD, as told to Camille Noe Pagán

If you have psoriatic arthritis (PsA), odds are you’ll probably have symptoms for months and maybe years before you're told that you have it. It’s understandable because if your joint pain isn’t constant -- and PsA pain often isn’t -- you might think it’s just a sign of aging or wear and tear caused by exercise.

Like all chronic diseases, though, the earlier you start treating your PsA, the less damage you’re likely to have. So when I see someone with psoriasis who also has joint pain, fatigue, nail issues, or other signs that it could be PsA, my goal is to find out what’s going on and get them started on a treatment plan. 

Getting Diagnosed

Diagnosis isn’t always straightforward. Unlike rheumatoid arthritis, for example, psoriatic arthritis doesn’t show up on blood tests. Because of that, doctors make a diagnosis mostly based on symptoms like joint pain and stiffness that are worse in the mornings and get better after you move around a little.

I think it’s important to know that if you have psoriasis, joint pain isn’t automatically a sign that you have psoriatic arthritis. Only about 30% of people with psoriasis will get PsA. I’ve treated people who have psoriasis and lupus, for example, or inflammatory osteoarthritis. Their symptoms were similar to psoriatic arthritis, but it wasn’t that.

Work With Your Team

After you get your diagnosis, it’s important to work closely with your medical team to manage your condition. I think it’s beneficial to see a specialist like a rheumatologist. Someone who regularly sees people with PsA is more likely to understand all of your treatment options.

You also want to make sure that different members of your health care team -- for example, your rheumatologist, dermatologist, and family doctor -- work together on your treatment plan. PsA ups your chances of things like heart disease and diabetes. That’s why all members of your health care team should be monitoring you.

Continued

Unfortunately, we still don’t have a cure for psoriatic arthritis. What we do have are many good treatment options that we didn’t have even 10 years ago. There are a lot of new medications for psoriasis and psoriatic arthritis that can limit damage to your joints, which can help you feel better and stay active longer.

Continued

Biologics, which change the way your immune system works, are especially promising. But they don’t work for everyone, which is why researchers are still looking for treatments. The reality is, 50% of the treatments we have make about 50% of people better.

Not enough people are in remission, and that’s the goal.

If You Feel Something, Say Something

I wish more people knew that they don’t have to settle. If you don’t like the side effects of a treatment or aren’t seeing the results you want, you should let your doctor know. There are usually more things to try. And in some cases, you may need to combine treatments to get to a place where your skin is clear and you’re feeling good.

Module: video
inside the visit perspective video
 
Inside the Visit: Psoriatic DiseaseTom Garmon has been living with psoriasis for more than 40 years. Watch as he and Jonathan Weiss, MD, discuss his journey.330

[MUSIC PLAYING]



JONATHAN WEISS: So Tom, we've

known each other a long time.



TOM GARMON: Yes we have.



JONATHAN WEISS: What's

your recollections

about starting your journey

with psoriasis?



TOM GARMON: Well starting

the journey with psoriasis

was a long, long time ago.

1974 to be exact.

I just remember it being

frightening to hear the words,

there is no cure,

and that there's not a lot we

can do for it,

at that point in time

was devastating.



JONATHAN WEISS: How much

of your body

was covered with psoriasis

at that point, do you feel?



TOM GARMON: Ended up at 60%

to 65% covered with heavy plaque

psoriasis.



JONATHAN WEISS: Wow.



TOM GARMON: And it was bad.

You did everything you could

to try to hide.

And I hate to say I was hiding,

but that was what I was doing.



JONATHAN WEISS: Early on, what

actually worked for you first?



TOM GARMON: I don't know

that anything worked.

Some things worked

toward slowing the progression

down.

I started out with the coal

tars, light treatments,

your body being wrapped in Saran

Wrap.

And that was the science

of the day.



JONATHAN WEISS: When you and I

started out, all we really

had were the topical steroids

and emollients or moisturizers.

And going further even

with the topical treatments,

we have new topical therapies

that are coming out.

So even for people with limited

psoriasis,

or patients who

are on a biologic

but have a few small plaques

of psoriasis, there will be

new products coming out

in the topical realm that will

be great.



TOM GARMON: I remember very

vividly when you grabbed

my shoulder and said,

you can't give up now Tom.

There's a future.

Don't give up now.

There's things that are going

to be available.

It's going to take time.

I didn't know it was going

to take that long,

but it did take time.

And then the science,

the medicine caught up

with the problems.



JONATHAN WEISS: Back when I was

telling you

about the medications being

developed, the ones that I knew

about then, the biologics

weren't even a concept.

And so I wasn't even referring

to what we have now.

I think you're right.

We have to have trust that as

long as there is a true need

of a large number of people,

new treatments do get developed.

You were on several pills

for a while, and they all had

their side effects.



TOM GARMON: Methotrexate was

a drug that was used.

It helped, but the side effects

for me were awful.



JONATHAN WEISS: I remember that.

Now you were one of our earliest

patients

on the biologic medication.



TOM GARMON: Yes, I responded

real well

to the biological drugs,

or the biologics.

And I went from 65% covered

to basically clear in 12 to 16

weeks.



JONATHAN WEISS: That was probably

one of the most gratifying parts

of my career,

as someone who focused

his career on treating

psoriasis,

was seeing your response

to the initial biologics.



TOM GARMON: To me, the biologics

have been the answer

to my prayers.

And I realize that is not

the case

for every psoriasis patient.



JONATHAN WEISS: Right.

Now another issue with you

Tom that we've had

over the years

is we've had to transition

to medications.

You were on a biologic that got

taken off the market.

And quite honestly, I was very

nervous about how you would

respond.

And you did beautifully

on that medication.



TOM GARMON: I was calling

the FDA, anybody that would

listen to me, about how do we

keep this medicine out there?

And then you got me calmed down,

and said, let's find something

else that's going to work

for you.



JONATHAN WEISS: I'm going to give

you a hypothetical here.

If for some reason

the current drug stopped working

for you,

what would be

your first thought?



TOM GARMON: My response to that

is, who has guided you this far?

You contact your doctor that you

have faith in, and you say, OK,

what are my alternatives?

The pharmaceutical companies are

developing new drugs daily.

What do you recommend we try

next?

Is this a class issue,

or is it simply my body

and this medicine issue?



JONATHAN WEISS: Right.

We have so many choices now,

and it's so great.

Now we've changed our standard

to where we don't like to accept

less than 90% clearance.

And if one biologic's only

giving 50% clearance,

we will switch.

I think we are on the cusp

of precision medicine

that will allow us to know

the percentage likelihood they

are to respond

to different classes

of biologics,

using the simple skin test

or blood test

or that sort of thing.

So that's pretty exciting.



TOM GARMON: Oh yes it is.

In the game of life,

you've been dealt a poor hand.

Let's just use that term.

But you have no choice

but to play it.



JONATHAN WEISS: I think we may be

on the cusp of even greater

things for psoriasis.

Greater results

for our patients.

So--



TOM GARMON: That sounds

like a winner.

I appreciate you.



JONATHAN WEISS: Likewise Tom.

I really appreciate you.



TOM GARMON: You take care.

Jonathan Weiss, MD, Dermatologist, Snellville, GA<br>Tom Garmon, Patient/delivery/aws/ae/40/ae404ec0-2d28-417e-9e6d-25d839235480/4b7b3c51-f294-4ad7-be3d-2637c5d4ce60_305946_1_inside_the_visit_perspective_psoriatic_disease_012621_,4500k,2500k,1000k,750k,400k,.mp401/27/2021 12:00:0018001200inside the visit perspective video/webmd/consumer_assets/site_images/article_thumbnails/video/sf305946_1_inside_the_visit_perspective_psoriatic_video/1800x1200_sf305946_1_inside_the_visit_perspective_psoriatic_video.jpg091e9c5e820f0119

Just don’t wait to see your doctor. I can’t stress this enough: The earlier you start on medication, the more likely you are to get to a place with few or no symptoms.

Continued

Many times, I only have 15 to 20 minutes to spend with each person I see. There’s a lot I have to pack in during that time. But that doesn’t mean I don’t want people to ask questions and bring up concerns! Learning more about your condition and how to manage it will make things better.

Regular checkups do, too. Don’t just come in when your symptoms are bad. I may see someone as often as every 2 weeks during a flare. But if you’re stable, I still want to see you a couple times a year to monitor for changes and to make sure your treatment plan is still working.

Managing psoriasis takes a team approach -- and that means working together through the bad and the good.

Continued

 

Anca Askanase, MD is the founder and clinical director of the Lupus Center at Columbia University Irving Medical Center in New York. She's also their director of rheumatology clinical trials.

WebMD Feature

Sources

Anca Askanase, MD, MPH,  ColumbiaDoctors; associate professor of medicine, Columbia University Medical Center, New York City.

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