I was doing some recent reading on Psoriasis, and wanted to share some of my own insight of what seems to be the latest discoveries in the disease and the current treatments. Psoriasis is considered by many, including myself, to be a form of autoimmune disease. Psoriasis has a primary trigger, which to date seems to be somewhat elusive. We are beginning to understand the cascade of immune responses after psoriasis develops, but have yet to isolate a specific initiator. It seems to be a multi-factorial process to me. I suspect it is a composition of genetic factors that lead to a sensitivity to some environmental factors. Our understanding of psoriasis being an immune mediated disease began in the 1970’s when it was discovered that cyclosporine a potent modifier of immune cells called T-cells was seen to decrease psoriasis activity. Since this discovery, we have been full bore researching how modification of the immune response at more and more specific locations is the answer to psoriasis control. To date, a cure has been elusive, but it seems we are getting closer to finding the immune cells most associated with psoriasis and leaving the rest of the immune system intact.
Psoriasis therapy currently is directed at modification of the over amplification of the cutaneous immune system. Most treatments work on this immune response and cause an immune suppression; there are a few therapies that are considered non-immunosuppressive. I find in my current practice there is a genuine and well placed concern about using these immunosuppressive therapies for a disease that is non-lethal. I am excited about the therapies we have and the new ones that are in the pipeline. Psoriasis therapy is getting so specific that the bulk of the immune system is left intact enabling great control of the disease without cause harm to the patient. It is quite intimidating to most individuals and providers when you read the laundry list of side effects in the drugs product information. If you just went off the list of side effects of the current therapies and didn’t look at the real risk of developing these side effects none of these drugs would be utilized. The biologic therapies in particular are the medications I am referring to. When the side effects are broken down into the real risk, it is much more comforting and reassuring. Most of these medications have a relatively low risk compared to natural illness and malignancy rates seen in the general population. When a drug is being analyzed it does so under extreme scrutiny and any negative or even positive side effects have to be attributed to the drug during study evaluation. Unfortunately, most drugs are compared to a short period of placebo use and not what happens in the general population over time. A few companies have engaged in long term safety studies and have led to a greater understanding and confidence in safety of these drugs in a general practice setting versus a controlled study setting. So how do you find reassurance in the utilization of these drugs? I encourage you to engage in a candid and open discussion with your healthcare provider as to the real risk and side effect percentages and comparison with the general population. If your provider is not sure what those rates are, ask them too kindly point you in the direction of someone or somewhere you can get those. I am always pleased when I find individuals who are open to learning more about their disease state and treatment options. That is the target audience for my blogs. The seekers of knowledge.
See Jason M Cheyney, MPAS, PA-C speak this April in Orlando, FL at the Skin, Bones, Hearts & Private Parts CME Conference.