Every day on Figure 1, specialists from around the world share what they’re seeing. These medical cases offer a unique view of medicine as it happens. Taken in aggregate, this data reveals trends and insights unavailable anywhere else.
With the help of Figure 1’s robust rheumatology community, we explored the topic of Psoriatic Arthritis. Our medical team reviewed more than 800 anonymized comments from healthcare practitioners across the US. Here’s what they found.
Caregivers agreed on these treatment strategies
1. Always prioritize joint pain
Treatment of joint disease is always prioritized over treatment of cutaneous disease. Further, the level of immunosuppression induced by treatment of joint disease as compared to skin disease should be considered.
2. Biological DMARDs
Using bDMARDs is largely viewed positively. When shown to be inefficient, physicians largely recommend they be used in tandem with steroids or other conventional disease-modifying anti-rheumetic drugs.
3. Treatment can get expensive
Majority of negative feedback voiced over DMARDs relates to their expense. There are lower-cost treatments, though not always as effective.
4. Some side effects
The most commonly cited side-effect of bDMARDs was pulmonary infections and Hepatitis B and C. bDMARDs are often paired with other medications to manage the cutaneous manifestations of psoriasis, such as plaques, pustules, or fissures.
View the cases on Figure 1 that helped inform these conclusions
Unilateral Hand Swelling
“50-year-old male with unilateral hand swelling. Healthy except on Humira® for psoriasis. Similar episode three weeks ago while doing floor tile work. Resolved with NSAIDs and elevation. Now recurrent and more severe. Any thoughts on a potential diagnosis?” (View comments)
“40-year-old male with pain on right foot. Uric acid 3.8, ESR 2, ANA (-), RF (-). Has pain in the right elbow, left shoulder, and wrists. Current medication was effective, but ran out a month ago. Name the disease and abnormality seen, and the treatment.” (View the case)
“Plaque psoriasis and psoriatic arthritis. These pictures are before steroids and methotrexate. Patient has no insurance. Rash returning once patient is out of the sun. His arthritis is crippling. Any ideas on further treatment? Patient is debilitated to the point of using a walker. Steroid helps temporarily, but in need of a long-term fix.” (View comments)
Severe Long-term Psoriasis
“30-year-old male, severe psoriasis for a long time. He presented to rheumatology with polyarthritis of the hands. TNF blockers have failed. He’s on secukinumab, but responding poorly.”
A physician’s assistant recommends this treatment:
“I would try Stelara or add Otezla. Taltz is about as efficacious as Cosentyx but with more injection site pain/reactions in my experience. I’ve had patients do well with joints with Stelara, but the speed of improvement is slow. I have no experience with Tremfaya in this instance, still starting my Derm pts with joint pain on TNF’s or IL-17.” (View more comments).
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