Medications or biologic agents that target T-cells, white blood cells involved in the body’s immune system, appear to offer significant benefit to patients suffering from psoriatic arthritis (PsA), a type of arthritis that affects up to 48 percent of patients with the skin disease psoriasis, according to a new review article in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). About 7.5 million Americans – roughly 2.2 percent of the population – have psoriasis, an autoimmune disease that causes red, flaky skin.
“Although these new immunosuppressive agents are expensive, they are the only agents that have demonstrated a decrease in radiologic progression of peripheral arthritis, and can be used to manage associated types of inflammation, as well as skin and nail disease,” said lead study author Michael S. Day, MD, MPhil, a resident orthopaedic surgeon with the Department of Orthopaedic Surgery at NYU Hospital for Joint Diseases.
PsA can range in intensity from mild, involving only a few joints, to severe, where more joints are affected and pain may be significant. In about 15 percent of patients with PsA, skin lesions appear before arthritic symptoms; however, patients with more severe psoriasis are not necessarily at greater risk for developing PsA, Dr. Day said.
“When patients in dermatology clinics are screened for evidence of inflammatory arthritis, many have evidence of joint inflammation that they did not report, suggesting that many of these patients are undiagnosed and untreated,” said study co-author, Dr. Susan M. Goodman, an assisting attending rheumatologist and internist at Hospital for Special Surgery.
Currently, initial treatments for PsA include nonsteroidal anti-inflammatory drugs (NSAIDs) that reduce inflammation, pain and fever. In the near future, drugs aimed at providing more targeted therapy will allow more PsA patients to avoid progressing to end-stage arthritis and joint destruction, she added.
Similarities between PsA and rheumatoid arthritis (RA) have spurred PsA researchers to consider early, aggressive treatment, an approach that has proved to be successful in RA patients.
Surgery may also be considered for patients who have joint deformities as a result of PsA, but so far there have been few large-scale, high-quality clinical trials, Dr. Day said. “The disease typically follows a moderate course, but up to 48 percent of cases develop into destructive arthritis in which the inflammatory process leads to bone erosion and loss of joint architecture,” he said.
“Initially, it was believed that PsA had a more benign course than does RA, but this belief has been disproven,” said Dr. Goodman.
Orthopaedic surgeons play a key role on the PsA treatment team. Dr. Day added that collaboration with dermatologists, rheumatologists, internists and family physicians is essential to the successful surgical treatment of PsA.
“PsA is a systemic inflammatory disease with multi-organ system effects,” said Dr. Day. “As such it should be treated with a multi-disciplinary approach.”
“Those who do progress to joint destruction may benefit from surgery, and may provide researchers with insights and further data regarding outcomes as well as the risks of surgery in this population,” Dr. Goodman said.
Disclosure: From the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY (Dr. Day), the Department of Orthopedic Surgery (Dr. Nam, Dr. Su, and Dr. Figgie), and the Department of Rheumatology (Dr. Goodman), Hospital for Special Surgery, New York. Dr. Su or an immediate family member serves as a paid consultant to Smith & Nephew and has received research or institutional support from Smith & Nephew and Cool Systems. Dr. Figgie or an immediate family member has received research or institutional support from Ethicon. None of the following authors or any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Day, Dr. Nam, and Dr. Goodman.
Kayee Ip | EurekAlert!
3D images of cancer cells in the body: Medical physicists from Halle present new method
16.05.2018 | Martin-Luther-Universität Halle-Wittenberg
Better equipped in the fight against lung cancer
16.05.2018 | Friedrich-Alexander-Universität Erlangen-Nürnberg
At the LASYS 2018, from June 5th to 7th, the Laser Zentrum Hannover e.V. (LZH) will be showcasing processes for the laser material processing of tomorrow in hall 4 at stand 4E75. With blown bomb shells the LZH will present first results of a research project on civil security.
At this year's LASYS, the LZH will exhibit light-based processes such as cutting, welding, ablation and structuring as well as additive manufacturing for...
There are videos on the internet that can make one marvel at technology. For example, a smartphone is casually bent around the arm or a thin-film display is rolled in all directions and with almost every diameter. From the user's point of view, this looks fantastic. From a professional point of view, however, the question arises: Is that already possible?
At Display Week 2018, scientists from the Fraunhofer Institute for Applied Polymer Research IAP will be demonstrating today’s technological possibilities and...
So-called quantum many-body scars allow quantum systems to stay out of equilibrium much longer, explaining experiment | Study published in Nature Physics
Recently, researchers from Harvard and MIT succeeded in trapping a record 53 atoms and individually controlling their quantum state, realizing what is called a...
The historic first detection of gravitational waves from colliding black holes far outside our galaxy opened a new window to understanding the universe. A...
A team led by Austrian experimental physicist Rainer Blatt has succeeded in characterizing the quantum entanglement of two spatially separated atoms by observing their light emission. This fundamental demonstration could lead to the development of highly sensitive optical gradiometers for the precise measurement of the gravitational field or the earth's magnetic field.
The age of quantum technology has long been heralded. Decades of research into the quantum world have led to the development of methods that make it possible...
02.05.2018 | Event News
13.04.2018 | Event News
12.04.2018 | Event News
23.05.2018 | Life Sciences
23.05.2018 | Life Sciences
23.05.2018 | Physics and Astronomy