Rheumatologists, dermatologists, and patient advocates have come together to publish the first-ever international guidelines for the treatment of psoriatic arthritis, a disease that mainly affects people who have psoriasis but also some people without it.
The guidelines by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) were presented at the annual meeting of the American College of Rheumatology. The group was headed by Christopher Ritchlin, M.D., M.P.H., professor of Medicine at the University of Rochester Medical Center, who presented the guidelines Sunday, Oct. 26.
"In the past few years, new medications have become available that are incredibly effective for the various manifestations of psoriatic arthritis," said Ritchlin, who treats about 250 patients with the disease. "Many patients' find their lives changed for the better within just a couple of weeks. These guidelines are designed as a platform to make sure physicians around the world are aware of what's available for their patients and to help them make sound treatment decisions."
Psoriatic arthritis is an oft-forgotten cousin to its better known counterparts, osteoarthritis and rheumatoid arthritis. Doctors estimate that somewhere between 500,000 to 1 million people in the United States have psoriatic arthritis. Doctors say that about one out of four patients with psoriasis also gets psoriatic arthritis, and that conversely, about 15 percent of people who get the disease don't have psoriasis.
It's an autoimmune disease in which errant signaling molecules causes a person's body to attack itself. The disease literally eats away at patients' joints, causing some bones or digits such as fingers or toes to shrink or literally disappear while also triggering abnormal, disfiguring and disabling bone growth in their hands, feet, spine, and other joints. Doctors are also finding that patients with psoriasis are more prone that others to several ailments, including diabetes, high blood pressure, and heart attacks.
"The presenting symptoms of psoriatic arthritis vary tremendously from patient to patient," said Ritchlin. "It's a very challenging disease to treat, because so many different parts of the body can be involved. The skin can be inflamed, a particular joint or tendon can hurt tremendously, the patient might have back pain, or a single swollen finger or toe.
"Oftentimes a patient will come in with something you might call 'tennis elbow,' or they might have a sore Achilles heel, and that's their only symptom. It can be very difficult to diagnose," said Ritchlin, who is director of the Clinical Immunology Research Unit at the Medical Center. He has served as a consultant to Amgen, Wyeth, Abbott, and Centocor, and has received research funding from Centocor, Abbott, and Amgen.