When is it better to use a biologic for psoriasis?

Question

Hello doctor,

I am 45 years old and have had plaque psoriasis for the past 10 years, with significant involvement of my elbows and scalp. I also experience joint stiffness, particularly in the mornings. Although I am currently using Calcipotriol and Clobetasol, the relief is only temporary. My recent blood tests showed a CRP level of 18 and an ESR of 42. I am also concerned about the risk of liver issues, as my ALT levels are mildly elevated.

Could this indicate the early stages of psoriatic arthritis?
How is the decision made between using oral medications like Methotrexate and biologics such as Secukinumab?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Thanks for your clear and important questions.

Given your 10-year history of plaque psoriasis, involvement of elbows and scalp, morning joint stiffness, and elevated CRP (18) and ESR (42), you may be developing psoriatic arthritis (PsA). These inflammatory markers and symptoms are often early warning signs, even if joint damage has not yet occurred visibly on imaging.

The following suggests early PsA:

Morning joint stiffness (especially >30 minutes).
Swelling or stiffness in fingers, toes, or spine.
History of moderate-to-severe skin psoriasis.
Elevated inflammatory markers (CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate)).
Nail changes, fatigue, or joint tenderness.

I hope this helps.

Kindly follow up if you have more concerns.