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. 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 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 relapse. (piano music) Another important aspect of 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 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 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 the 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 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.
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