Is biologic therapy a long-term treatment for psoriasis?

Question

Hello doctor,

My 49-year-old aunt has symptoms of psoriatic arthritis, including joint pain, stiffness, and swelling, particularly in her fingers and toes. She has a history of psoriasis, like red, itchy patches on her skin, which she manages with frequent moisturizers. She complains of fatigue and difficulty in performing daily activities due to pain and reduced range of motion. After visiting the doctor, he said he could see psoriatic lesions and joint inflammation. So he did some laboratory tests that came with elevated inflammatory markers. The doctor suggested starting with NSAIDs for pain relief and may consider biologic therapy for long-term management. Is this the routine treatment for psoriasis?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your aunt’s symptoms and medical history strongly indicate psoriatic arthritis (PsA), a chronic inflammatory condition that often affects individuals with psoriasis.

The combination of joint pain, stiffness, swelling, fatigue, and elevated inflammatory markers aligns well with this diagnosis. Her doctor’s recommendation to start with non-steroidal anti-inflammatory drugs (NSAIDs), for immediate pain relief, is a common first step in managing the symptoms of PsA.

NSAIDs can help reduce pain and inflammation, providing some relief and improving mobility. However, while NSAIDs can manage symptoms, they do not address the underlying disease process.

If NSAIDs alone are insufficient in managing her symptoms, disease-modifying anti-rheumatic drugs (DMARDs) may be recommended. Methotrexate is one of the most commonly prescribed DMARDs for PsA and can help slow disease progression and prevent further joint damage.

In cases where the disease is more severe or not adequately controlled by DMARDs, biologic therapy may be considered. These targeted therapies, such as TNF-alpha inhibitors and IL-17 inhibitors, can significantly reduce inflammation, manage joint damage, and improve overall quality of life.

Biologics are often effective in treating both the skin and joint manifestations of the disease. In addition to pharmacological treatments, maintaining skin health is crucial given her history of psoriasis.

Topical treatments, including corticosteroids and vitamin D analogs, can effectively manage psoriatic lesions.

Engaging in physical therapy may also be beneficial. Physical therapy can help improve joint mobility and strengthen the muscles surrounding affected joints, which can alleviate discomfort and enhance daily functioning.

Lastly, lifestyle modifications such as adopting a balanced diet, maintaining a healthy weight, and participating in regular low-impact exercises can contribute positively to managing her symptoms.

Regular follow-up appointments with her rheumatologist will be essential to monitor the progression of her disease and to adjust her treatment plan as needed. By taking a comprehensive approach to treatment, that includes medication, physical therapy, and lifestyle changes, your aunt can work toward better managing her psoriatic arthritis and improving her quality of life.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.