Psoriatic Arthritis – Treatment

Psoriatic Arthritis – Treatment


(piano music) – Treatment is important
in psoriatic arthritis. And again, timely treatment, I can’t emphasize enough
how important it is to get treated to prevent
serious damage down the road. Treatment is tailored to the severity of the psoriatic arthritis, to the type of psoriatic arthritis, and to the, to any prior
damage that has accumulated. Which would mean if
somebody already comes in with damage from their
psoriatic arthritis, means that they have a pretty
severe form of the disease, so you’d wanna get them on very effective treatment without delay. (piano music) Let’s say if symptoms are just beginning. It’s reasonable if there’s
no damage to start with, and on certain
anti-inflammatory medication. And this is what guidelines
tell us that to be the first line in most instances. But then knowing that this is a disease that is not going away,
and has the potential to cause damage, follow-up is critical. And then, if control hasn’t been achieved, if the symptoms are not gone, and if there’s persistent
joint inflammation, then you usually go to a medication that we call a disease-modifying drug. Meaning it doesn’t just take the symptoms and the swelling away,
it’s also preventing the immune system to cause damage in the joints, in the tendons,
in the spine, or wherever the psoriatic arthritis manifests
in that specific person. And then, periodically,
every three months, or every six months, we reassess. Are we here? And if we are not at the
target, we tailor treatment. Does it need to be intensified? Yes. Are there any compelling indications for this medication or this medication? And then we make our choices. If we are at target, then we are happy. And we continue treatment, and hopefully, patients experience long-term remission. And then when long-term
remission is experienced, and there’s no damage in the background, then there can be a conversation about do we want to decrease treatment. But that usually happens after people have been controlled for a long time. And it has to be done carefully, because there’s always the
potential for a relapse. (piano music) Another important aspect in treatment is, for example, physical therapy. We know physical therapy is essential for the spine to retain
the range of motion, to prevent regression,
to strengthen the muscles that stabilize the spine. So, the rheumatologists will most often prescribe physical therapy. And then physical therapy is
also important for tendons. Of course, not when
they’re acutely inflamed. But, when the inflammation has subsided and there’s no risk of rupture or damage. And physical therapy is,
again, an important modality to rehabilitate a tendon
that has been affected, and to strengthen the
muscles and the joint, and to increase the overall stability of the musculoskeletal structure. Other interventions that people can do and will help treatment. One of the most important things is in people who are overweight
or obese, weight loss. Losing 10% of the body
weight in people who who are overweight or obese is
like adding a new treatment. It increases the chance of responding. (piano music) Topical treatments are
frequently prescribed for the treatment of psoriasis. Patients are sometimes
not excited about them because it’s a relative
burden to apply those, those creams, and then
to keep them on the skin. It’s very important to
note that it is creams, especially the steroid ones,
have different potencies. So, if, if a doctor prescribed a certain cream for lesions on the legs, for example, it’s not okay to use that on the face, or some other lesion that developed because by having different strengths they can have many more
side effects on thin skin. Like the face for example. So, those, those preparations
are not interchangeable. That’s why when there are more, more complicated forms of psoriasis, for example affecting the face, it’s a really important
to have a dermatologist to prescribe a special
preparation for that. Which ideally wouldn’t even be a steroid because that can lead to
skin thinning, and so on. So that’s a very important aspect. We don’t use topical preparations for psoriatic arthritis for the joints. These are mainly used for the management of the skin disease in
the first-line stage. (piano music)

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