From the Guidelines
Psoriasis is a chronic autoimmune condition characterized by red, scaly patches on the skin and potential joint inflammation, with treatment options varying based on severity and type, and including topical treatments, phototherapy, systemic medications, and biologics. The main skin features include well-demarcated erythematous plaques with silvery scales, commonly affecting the scalp, elbows, knees, and lower back. Some patients also develop psoriatic arthritis, which causes joint pain, stiffness, and swelling, typically in the fingers, toes, and spine.
Key Features of Psoriasis
- Red, scaly patches on the skin
- Potential joint inflammation
- Well-demarcated erythematous plaques with silvery scales
- Commonly affects the scalp, elbows, knees, and lower back
Treatment Options for Psoriasis
- Topical treatments: corticosteroids, vitamin D analogs, retinoids, and calcineurin inhibitors
- Phototherapy: UVB light
- Systemic medications: methotrexate, cyclosporine, and oral retinoids
- Biologics: TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors, and IL-12/23 inhibitors
Treatment Options for Psoriatic Arthritis
- NSAIDs: help with pain and inflammation
- Disease-modifying antirheumatic drugs (DMARDs): slow disease progression
- Biologics: same as those used for skin manifestations, effective for joint symptoms Treatment selection depends on disease severity, comorbidities, patient preference, and previous treatment response 1. The goal of treatment is to alleviate signs and symptoms, inhibit structural damage, and maximize quality of life (QOL) 1.
Key Considerations for Treatment
- Disease severity
- Comorbidities
- Patient preference
- Previous treatment response
- Quality of life (QOL) It is essential to monitor patients regularly and adjust treatment accordingly, with a focus on achieving minimal disease activity or remission 1. By prioritizing morbidity, mortality, and quality of life, healthcare providers can provide effective and personalized care for patients with psoriasis and psoriatic arthritis.
From the FDA Drug Label
HUMIRA is a tumor necrosis factor (TNF) blocker indicated for: Psoriatic Arthritis (PsA) (1.3): reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active PsA. Plaque Psoriasis (Ps) (1. 7): treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate.
The features of psoriasis that are relevant to the use of adalimumab include:
- Skin manifestations: moderate to severe chronic plaque psoriasis
- Joint manifestations: active psoriatic arthritis (PsA) The treatment options for these conditions include adalimumab, which is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active PsA, and for treating adult patients with moderate to severe chronic plaque psoriasis 2.
From the Research
Features of Psoriasis
- Psoriasis is a chronic inflammatory skin disease characterized by an excessively aberrant hyperproliferation of keratinocytes 3
- It is associated with multiple comorbidities, including psoriatic arthritis, cardiometabolic diseases, and depression 4
- The most common variant of psoriasis is plaque psoriasis, which is associated with a number of comorbidities 4
- Psoriatic arthritis (PsA) is a form of inflammatory arthritis that occurs in patients with psoriasis and is distinct from rheumatoid arthritis (RA) 5
Skin Manifestations
- Plaque psoriasis is the most common variant of psoriasis, characterized by red, scaly patches on the skin 4
- Skin manifestations can significantly impact a patient's quality of life, causing physical or psychological distress 6
- Topical agents, such as topical corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics, are commonly used to treat mild psoriasis 4
Joint Manifestations
- PsA can cause significant joint damage and disability if left untreated 6
- Non-steroidal anti-inflammatory drugs or local intra-articular injections of corticosteroids can be used to treat mild PsA, but neither treatment prevents the development of structural joint damage 6
- Disease-modifying antirheumatic drugs (such as methotrexate), TNF inhibitor treatments (adalimumab, etanercept, infliximab and golimumab) or their combination are considered first-line treatment for moderate to severely active PsA 6
Treatment Options
- Topical agents and targeted phototherapy are appropriate treatments for mild psoriasis 6
- Systemic therapies, such as methotrexate and phototherapy, are recommended options for patients with more severe psoriasis, but their long-term use is hindered by safety concerns 6
- Biological therapies, such as targeted therapies (alefacept) and anti-cytokine therapies (anti-tumour necrosis factor [TNF] therapies and a monoclonal antibody against interleukin [IL]-12 and IL-23 [ustekinumab]), are suitable options for patients with extensive disease 6, 4
- Methotrexate is one of the most commonly used drugs for the treatment of PsA, yet there is scant controlled trial data to document its efficacy 5