Thursday 16 March 2023

Expert perspectives: Will there be a cure for psoriatic arthritis?


Psoriatic arthritis (PsA) is a complicated condition that can present very differently in different people. Currently, there is no cure for this condition.

PsA occurs in about 30% of people with psoriasis. However, one study suggests that up to two-thirds of individuals with PsA have not received a diagnosis from a rheumatologist.

Because PsA is so complex, treatment can be difficult. The same study suggests that up to 60% of people with PsA do not respond well to traditional treatments.

As our understanding of the condition grows, more and more treatment options are becoming available. However, it remains unclear if a cure will be available in the future.

Learn more below about the changing landscape of PsA treatment from experts in the field.

“[PsA] is caused by an imbalance in the body’s immune system, which causes inflammation in the joints and skin,” explained Dr. Joseph F. Merola, director of the Center for Skin and Related Musculoskeletal Diseases at the Brigham and Women’s Hospital in Boston, MA, and Dr. Lourdes Perez-Chada, a dermatologist and PsA research fellow at the Brigham and Women’s Hospital.

“This abnormal immune response is likely [regulated] by genetic factors. For example, many people with PsA have a family history of either psoriasis or PsA, and several genetic markers have been associated with PsA,” they added.

There are other factors involved, as well.

“We know a fair amount of the genetics, but the genetic contribution [of PsA] is quite incomplete and not very useful in the clinic,” said Dr. Arthur Kavanaugh, a professor of medicine at the University of California, San Diego.

“As most people who develop PsA have skin psoriasis long before they develop PsA, there are clearly other factors involved,” Dr. Kavanaugh noted.

“Environmental factors, our gastrointestinal microbiome, and physical trauma may also play a role in triggering or perpetuating PsA in people with an inherited tendency,” Drs. Merola and Perez-Chada suggested.

“There has been tremendous progress, with many new therapies available recently,” said Dr. Kavanaugh.

“It is as good a time as any in the past to have psoriatic disease,” Drs. Merola and Perez-Chada stated. “Treatments for psoriatic skin disease have come a particularly long way, with newer agents able to get a majority of [people] clear or almost clear with regard to skin disease.”

“Treatments for PsA have also come a long way, although we have a harder time pushing the envelope on [more complicated aspects of PsA], such as low disease activity or remission.”

“The management of PsA is mainly challenged by the multifaceted nature of the disease. PsA may present with different clinical features […] that sometimes respond differently to different treatments,” they noted.

Drs. Merola and Perez-Chada also explained that treatment may be complicated by the presence of other health concerns, which may affect the availability of safe treatment options and make it harder to determine whether or not treatment is working.

Where is PsA treatment heading?

“To optimize treatment in PsA, most treatment guidelines suggest following a treat-to-target approach. In this approach, [doctors] monitor disease activity through the measurement of well-defined, clinically relevant targets and adjust therapy accordingly,” said Drs. Merola and Perez-Chada.

However, they added that there is still work to be done for this kind of treatment approach. Challenges include:

  • the lack of a clear definition of PsA disease remission
  • limited data to guide the selection of one treatment over another
  • the presence of joint damage from PsA, which may not respond well to treatment

This “trial-and-error” approach to treatment may also require more visits to the clinic, higher treatment costs, and more frequent side effects.

Experts tend to agree that markers that can guide treatment at an individual level would represent a much-needed advancement for PsA treatment. This strategy is known as precision medicine.

“The ultimate goal would be a marker of some sort so that we know what specific treatment is best for each individual,” Dr. Kavanaugh explained.

“Predicting which treatment will [work well] for an individual [person] or disease manifestation is one of the key unmet needs in psoriatic disease management,” Drs. Merola and Perez-Chada added.

“While several studies have identified genetic, [blood], and cellular factors that might be associated with treatment response in psoriatic disease, more research is needed to confirm [if these markers work well enough].”

Psoriatic arthritis and weight gain: What to know

People with psoriatic arthritis often have obesity, and obesity may worsen the symptoms of psoriatic arthritis. Taking medications and losing weight can improve the symptoms of psoriatic arthritis.

Psoriatic arthritis (PsA) is a form of inflammatory arthritis that involves pain and stiffness in the joints. Without treatment, it can lead to permanent joint damage.

Some statistics suggest that up to 45% of people with PsA have obesity. However, they do not know precisely what links them. Scientists say the relationship is complex and probably bidirectional, meaning PsA and obesity contribute to each other.

There are several reasons why obesity might make the symptoms of PsA worse.

First, they both involve inflammation, and obesity may exacerbate this. Carrying extra weight puts additional pressure on weight-bearing joints, affecting mobility and exercise capacity. Obesity may also stop some PsA medications from working as well as they could.

In this article, we look at the links between PsA and weight, including ways to safely lose weight with PsA.

ExpertsTrusted Source say there is a link between obesity and PsA. What links them remains unclear. However, obesity appears to be a risk factor for PsA.

People with overweight or obesity appear to have a higher risk of developing psoriasis and PsA. People living with PsA who are overweight also seem to have more severe symptoms and find it harder to manage symptoms.

Carrying extra weight can also put extra pressure on joints, ligaments, and tendons. In turn, painful joints can make it harder to exercise. This can lead to weight gain, which then puts more pressure on the joints, making symptoms worse.

According to the Arthritis Foundation, if people with overweight and arthritis lose 10% of their body weight, they could experience 50% less pain, and their mobility may improve.

Exercise

Dietary choices

Eating a varied, balanced, and nutritious diet is also essential for weight management.

The AF offers the following steps for losing weight:

  • Nutritious food: Focus on whole foods, including fruits, vegetables, fish, nuts, and beans, and limit highly processed foods.
  • Portion size: Using a smaller dish may reduce how much a person eats by as much as 20%.
  • Staying hydrated: Drinking water before a meal can help people to feel fuller quicker.
  • Sleep: A lack of sleep can slow the body’s production of leptin, a protein that makes people feel full. It also increases the body’s production of ghrelin, a hormone that drives hunger.
  • Eating mindfully: Eating more slowly and mindfully — for example, sitting down at the table to eat rather than on the sofa watching television — may help reduce calorie intake by 300 calories per day.

2019 studyTrusted Source found that short-term weight loss on a very low-energy diet improved symptoms of PsA. However, people should not try this or other significant dietary changes without first discussing it with a doctor.

What is a suitable diet for people with PsA?

Losing excess weight through exercise and diet may help someone with PsA to:

  • ease pain
  • improve mobility
  • decrease inflammation
  • improve their body’s response to medication

Compared with the general population, people with PsA have a higher riskTrusted Source of having metabolic syndrome, which features:

  • obesity
  • type 2 diabetes
  • high cholesterol levels
  • high blood pressure
  • cardiovascular disease

Managing weight can help reduce the risk of these potentially serious complications.

Does obesity cause psoriatic arthritis?

Can medications help people with psoriatic arthritis lose weight?

Does losing weight improve symptoms of psoriatic arthritis?

There appears to be a link between psoriatic disease, including PsA, and obesity.

One reason for this may be that obesity can contribute to inflammation. The extra weight can also put extra pressure on the joints, worsening the symptoms of pain and stiffness. This, in turn, can make exercise more challenging, increasing the risk of weight gain.

Obesity may also affect the way some PsA medications affect a person. DMARDs and TNFi drugs appear to work more effectively when people with obesity lose weight.

Maintaining a moderate weight may help manage the symptoms of PsA and boost an individual’s overall health and well-being. Dietary choices and exercise can help achieve this.

Anyone considering changes to their diet and exercise routine should first speak with a healthcare professional, who will help them make a suitable treatment plan.

Source - Medical News Today


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