From the Guidelines
Elevated alkaline phosphatase (ALP) levels in patients with psoriasis should be evaluated and treated with a comprehensive approach, including disease-modifying antirheumatic drugs (DMARDs) and biologics, to manage underlying psoriatic arthritis and prevent bone damage, as recommended by guidelines of care for the management of psoriasis and psoriatic arthritis 1.
Evaluation and Treatment Approach
The treatment approach for patients with elevated ALP levels and psoriasis typically involves:
- Managing the underlying psoriasis with DMARDs such as methotrexate (starting at 7.5-15 mg weekly) or biologics like TNF inhibitors (adalimumab 40 mg every other week or etanercept 50 mg weekly) 1
- Using newer IL-17 or IL-23 inhibitors for patients who do not respond to traditional therapies 1
- Recommending vitamin D supplementation (1000-2000 IU daily) and calcium (1000-1200 mg daily) to support bone health 1
- Regular monitoring of ALP levels every 3-6 months to track treatment effectiveness 1
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of psoriatic arthritis (PsA) are crucial to prevent persistent inflammation and progressive joint damage, which can occur in up to 50% of patients with PsA if left untreated 1.
Role of Dermatologists and Rheumatologists
Dermatologists play a key role in screening for PsA and referring patients to rheumatologists for further evaluation and treatment, as recommended by guidelines of care for the management of psoriasis and psoriatic arthritis 1.
Quality of Life and Treatment Outcomes
The goal of treatment is to alleviate signs and symptoms, inhibit structural damage, and improve quality of life (QOL) parameters, which can be achieved through a comprehensive treatment approach and regular monitoring of treatment effectiveness 1.
From the Research
Alkaline Phosphatase (Alk Phos) and Bone Health in Psoriasis
- Alkaline phosphatase (Alk Phos) is an enzyme found in the body, primarily in the liver, bones, and kidneys 2.
- In patients with psoriatic arthritis, liver abnormalities, including elevated alkaline phosphatase levels, are common and associated with higher body mass index (BMI), more severe disease, and certain therapies 2.
- However, there is limited direct evidence on the relationship between alkaline phosphatase and bone health in psoriasis patients.
Psoriasis Treatment and Alk Phos
- Topical vitamin D analogs are used to treat psoriasis and have been shown to be effective in reducing symptoms 3, 4.
- Systemic therapies, such as biologics and oral medications, are also used to treat moderate to severe psoriasis and may have an impact on liver function and alkaline phosphatase levels 5, 6.
- The effect of these treatments on alkaline phosphatase and bone health in psoriasis patients is not well understood and requires further research.
Bone Health in Psoriasis
- Psoriasis is associated with an increased risk of osteoporosis and fractures, particularly in patients with psoriatic arthritis 6.
- The relationship between alkaline phosphatase and bone health in psoriasis patients is complex and may be influenced by various factors, including disease severity, treatment, and comorbidities.
- Further studies are needed to understand the relationship between alkaline phosphatase, bone health, and psoriasis.