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N AT ION A L P S ORI A SIS FOUND AT ION
an overview of
PSORIASIS and
PSORIATIC ARTHRITIS
» Diagnosis
» Symptoms
» Triggers
» Treatments
» + more
Living with psoriasis and
psoriatic arthritis
Psoriasis [pronounced sore-EYE-ah-sis] is a chronic,
lifelong condition. For some people, psoriasis
appears as a recurrent minor skin irritation that’s
itchy. For others, psoriasis can cause regular skin
lesions or take the form of psoriatic arthritis, a
painful and potentially disabling disease that
affects the joints and/or tendons.
Psoriatic arthritis is a chronic inflammatory
disease of the joints and connective tissue,
resulting in pain, fatigue, and swelling. Psoriatic
arthritis is linked to psoriasis on the skin, but the
severity of skin disease and joint disease do not
always match.
In addition to a physical toll, both psoriasis and
psoriatic arthritis can affect people’s feelings,
behaviors and experiences. Receiving a diagnosis
of psoriasis or psoriatic arthritis can be confusing.
In this booklet you’ll read about the causes of
psoriasis and psoriatic arthritis, the most common
forms of psoriasis and psoriatic arthritis, and the
different types of treatments available.
If you think you may have psoriasis or psoriatic
arthritis, don’t delay seeking a diagnosis. The
more you understand about these diseases and
the treatment options the better able you will be to
manage your symptoms and possibly even reduce
the severity of the disease, minimizing the impact
psoriasis or psoriatic arthritis have on your life.
This booklet shouldn’t serve as a replacement
for in-person discussions with your physician,
dermatologist, rheumatologist or other health care
provider. Instead, use this information as a guide
to help you learn more about the conditions and the
many treatment options that are available to you.
Cover photo © iStockphoto.com/Kali Nine
AN OVERVIEW
OF PSORIASIS
PSORIASIS is a chronic disease of
the immune system that is usually
characterized by painful, inflamed
patches of skin. Psoriasis varies
from person to person, both in
severity and how it responds to
treatment. Some people with
psoriasis experience symptoms
only occasionally; others live with
constant skin irritation.
Q: How do I know if I have psoriasis?
A: Not all skin irritations are caused
by psoriasis. That’s why it’s important
you schedule a visit with your doctor or
dermatologist as soon as symptoms appear
in order to ensure a proper diagnosis. (Some
cases of psoriasis are easy to diagnose by
appearance alone; others may require more
involved testing, such as viewing a small
piece of skin under a microscope.) Psoriasis
most commonly appears on the scalp, knees,
elbows and torso, but it can develop anywhere,
including the nails, palms, soles, genitals and
face. Psoriasis can be limited to a few patches
or can involve large areas of skin.
Q: What causes psoriasis?
A: No one knows exactly what causes psoriasis.
However, most researchers agree that parts of
the immune system are mistakenly triggered,
which increases inflammation and speeds up
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the growth cycle of skin cells. A normal skin
cell matures and falls off the body in 28 to 30
days. But a psoriatic skin cell takes only three
to four days to mature and move to the surface.
Instead of falling off or shedding, the cells pile
up, forming psoriasis lesions.
Researchers suspect that genetics may also
play a major role in the development of the
disease. Psoriasis often runs in families,
although many people without any family
history also develop the condition.
Q: Who gets psoriasis?
A: Psoriasis affects approximately 7.5 million
Americans. Symptoms often first appear
sometime between the ages of 15 and 25, but
the condition can develop at any age. Psoriasis
occurs nearly equally in men and women and
across all socioeconomic groups. It also is
present in all racial groups, but at varying rates.
Q: Is psoriasis contagious?
A: Psoriasis is not contagious. It is not something
you can “catch” or that others can “catch” from
you. Psoriasis lesions are not infectious.
There are five major forms of psoriasis:
• Plaque [plak] psoriasis:
Characterized by
raised patches
of skin called
“lesions” or
“plaques,” which
become inflamed
and are covered by silvery white scale.
This is the most common form of psoriasis.
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• Guttate [GUH-tate] psoriasis:
Characterized by
small round, spotlike lesions. This
type of psoriasis
may be associated
with streptococcal
bacterial infections (e.g., strep throat) in
children.
• Pustular [PUS-choo-ler] psoriasis:
Characterized by
the presence of
pus-filled bumps.
Patients having a
severe pustular
flare should see
a doctor immediately. Involvement of the
palms and/or soles can be particularly
painful and debilitating.
• Inverse psoriasis (or intertriginous
psoriasis):
Characterized by
intense
inflammation,
deep redness and
scaling in the body
folds such as the underarms, under the
breasts and groin.
• Erythrodermic [eh-REETH-ro-der-mik]
psoriasis:
Characterized by
intense redness
and shedding of
multiple layers
of the skin, often
over nearly the entire body surface. Only
1 percent of those with psoriasis have this
form. Patients having an erythrodermic
flare should see a doctor immediately.
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PSORIASIS SEVERIT Y
The severity of psoriasis can vary from person
to person. When people have less than 3
percent of their body affected by psoriasis,
their condition is considered to be mild. (For
most people, the surface
area of one hand equals
about 1 percent of the
skin surface.) When 3
to 10 percent of the body
is affected psoriasis is
generally considered to
be moderate; when more
than 10 percent is affected it’s
considered severe. The severity
of psoriasis can also be measured by how
the disease affects a person’s quality of life.
Psoriasis can have a serious impact even if it
involves a small area of skin.
Q: Does psoriasis become more severe
over time?
A: Psoriasis is not usually a progressive disease.
In fact, the degree to which you’re affected can
change over time. Some people with psoriasis
experience symptoms rarely while other people
live with some degree of skin irritation at all
times. A flare—or worsening of psoriasis—can
vary in severity, length and the amount of area
that is affected. The age that psoriasis first
occurs is not a definite indicator of how severe
or how often psoriasis symptoms will appear in
the future.
Q: What influences the severity of psoriasis?
A: Many factors can affect psoriasis, triggering
the onset, the worsening or the improvement
of symptoms. Triggers vary from person to
person. For some people, stress can cause
a flare; for others it might be allergies, diet,
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National Psoriasis Foundation
infections, or even changes in the weather.
Skin care is especially important for managing
psoriasis. Hot showers and personal hygiene
products with fragrance can be drying and
should be avoided; moisturizer should be
applied liberally and regularly to reduce
redness and itching and to help the skin heal.
Skin that’s been injured or traumatized—such
as with a bug bite, sunburn, scratch or even
a needle puncture from a vaccination or
injection—may also trigger a psoriasis flare.
This is known as the “Koebner phenomenon”
and it’s one reason people with psoriasis should
never scratch or pick at a psoriasis lesion.
Certain medications, including anti-malarial
drugs (especially Plaquenil), lithium and some
blood pressure medications, have also been
linked to changes in the severity of psoriasis
symptoms. Prednisone and other systemic
steroids may cause psoriasis to flare when
stopped. Check with your health care provider
for treatment options if you take any of these
medications.
Q: Is there a cure for psoriasis?
A: At this time, there is no cure for psoriasis.
However, researchers are closely studying
psoriasis and continue to gain a better
understanding of its genetic origin and its
involvement with the immune system. This
information may someday lead to a cure. In
the meantime, many different treatments can
reduce the severity of symptoms and/or clear
psoriasis for periods of time.
Q: Is psoriasis linked to other diseases?
A: Recent studies show that people with
psoriasis are at an elevated risk of developing
other chronic and serious health conditions.
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People with severe psoriasis are 58 percent more
likely to have a major cardiac event, such as a
heart attack; 43 percent more likely to have a
stroke; and up to 46 percent more likely to have
type 2 diabetes. People with psoriasis may also
have an increased incidence of:
• Cardiovascular disease
• Metabolic syndrome (a cluster of
conditions — increased blood pressure,
a high blood sugar level, excess body
fat around the waist and abnormal
cholesterol levels)
• Inflammatory bowel disease
• Certain types of cancer
• Obesity
• Depression
• Other immune-related conditions
Because of this increased risk it’s important that
people living with psoriasis regularly schedule
appointments with their general health care
professional for routine health exams in addition
to psoriasis-related check-ups.
Psoriasis can also cause emotional distress
for patients, including changes in mood and a
decrease in self-esteem. One study estimates
that one in four people with psoriasis suffers
from depression. But research also suggests
that treating the symptoms of psoriasis can help
alleviate symptoms of depression. If you think
you suffer from depression, ask your health care
provider or a mental health professional about
treatment options.
Finally, psoriatic arthritis is a condition that
is closely linked to psoriasis. Up to 30 percent
of people with psoriasis are diagnosed with
psoriatic arthritis. If you currently suffer
from persistent joint stiffness or pain ask your
physician about the condition. For an overview
on psoriatic arthritis, keep reading.
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National Psoriasis Foundation
AN OVERVIEW
OF PSORIATIC
ARTHRITIS
PSORIATIC ARTHRITIS causes
pain, stiffness and swelling
in and around the joints and
the places where tendons and
ligaments connect to bone. The
condition can develop at any time,
but for most people it appears
approximately 10 years after the
onset of psoriasis. If you have
persistent joint stiffness in the
morning or joint pain -- two of
the early symptoms of psoriatic
arthritis -- tell your health
care provider or dermatologist.
Appropriate recognition,
diagnosis and treatment of
psoriatic arthritis can relieve
pain and inflammation, and
early intervention may prevent
additional damage. Without
treatment, psoriatic arthritis is
potentially disabling.
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Q: How do I know if I have psoriatic arthritis?
There is no specific test for diagnosing
psoriatic arthritis, although some of the most
common symptoms include:
• Stiffness, pain, throbbing, swelling and
tenderness in one or more joints
• Tenderness, pain and swelling over
tendons
• Swollen fingers and toes
• A reduced range of motion
• Morning stiffness
• Nail changes—for example, the nail
separates from the nail bed and/or
becomes pitted and mimics fungus
infections
• Redness and pain of the eye, such as
conjunctivitis
• Generalized fatigue
When you bring up concerns about the
condition with your health care provider, be
sure to share your medical history, including
your own experience with psoriasis as well as
any incidence of psoriasis or psoriatic arthritis
in your family. (Both conditions appear to have
a genetic component.) Diagnosis is based mostly
on symptoms so your health care provider will
likely review your skin, nails and joints and
may even order X-rays or an MRI and in some
cases perform an ultrasound examination. In
some cases a blood test will be needed to rule
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National Psoriasis Foundation
out other diseases. You will be referred to a
rheumatologist. This type of doctor specializes
in arthritis and can provide further evaluation
and/or a diagnosis.
Q: What causes psoriatic arthritis?
A: As with psoriasis, doctors are unsure exactly
what causes psoriatic arthritis, although 85
percent of the time it is found in people who
already have psoriasis. Genetics may play a
role in determining who develops the condition,
and so may other factors that affect immune
system function. Psoriatic arthritis can be
made worse by things like stress and other
health problems.
Q: Is all psoriatic arthritis the same?
A: Just like psoriasis, psoriatic arthritis can
range from mild to severe. The number of
joints affected will have a large impact on the
particular treatment plan a rheumatologist
will recommend, and the prognosis for an
individual. Psoriatic arthritis that affects
four or fewer joints is sometimes referred to
as oligoarticular. Others may have a more
severe polyarticular form that affects four or
more joints. All types of psoriatic arthritis are
characterized by pain, swelling, and stiffness
in the joints. Psoriatic arthritis can involve
the peripheral joints (the joints of your arms
and legs including the elbows, wrists, hands
and feet) or, less commonly, the spine, hips and
shoulders.
Q: Why is it important to treat psoriatic arthritis?
A: Treatment for psoriatic arthritis can relieve
pain, reduce swelling, help keep joints working
properly and possibly prevent further joint
damage. Doctors will recommend treatments
based on the type of psoriatic arthritis, its
severity and your reaction to treatment.
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Early diagnosis and treatment can help slow
the disease and preserve joint function and
range of motion. Good control of psoriasis
may be valuable in the management of
psoriatic arthritis.
Q: What can I do about psoriatic arthritis pain?
A: The chronic pain of psoriatic arthritis
differs from the pain experienced by the
average person. The inflammation of
psoriatic arthritis can cause long-term
damage to joints and may even make you
more sensitive to pain. Pain relievers such
as nonsteroidal anti-inflammatory drugs
(NSAIDs) and prescription pain medicine
can help manage immediate pain. Biologics,
which can decrease the severity of psoriatic
arthritis but may take several months to
kick in, are one long-term solution for pain
reduction and prevention of joint destruction.
Stress can aggravate psoriatic arthritis
and can make you more sensitive to pain,
so stress management techniques such as
meditation have helped some people manage
the pain associated with psoriatic arthritis.
Two other coping mechanisms include
exercise—which helps reduce inflammation—
and acupuncture, which some scientific
studies have found contributes to general
pain reduction.
Q: How can I become/remain active?
A: Exercise is not just possible for people with
psoriatic arthritis, it’s essential. Movement
keeps the joints and tendons looser and more
limber. Strong muscles can take pressure off
the joints, making it easier to move. Weight
loss can not only lead to improvement in
psoriasis and psoriatic arthritis but also
lessens the load on weight bearing joints that
can lead to more joint pain and damage.
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National Psoriasis Foundation
Yoga, swimming, walking and bicycling are
just a few examples of activities people with
psoriatic arthritis can do that place minimal
strain on the joints. If psoriatic arthritis is
keeping you from being more active, you may
want to consider working with a physical
therapist to create an exercise plan.
Q: What are psoriatic arthritis triggers?
A: Many of the triggers for psoriasis flares
may also affect the severity of your psoriatic
arthritis. Injury or medical trauma can cause
psoriatic arthritis to worsen and so can
unmanaged stress. Other triggers include
certain medications, such as anti-malarials,
lithium, beta blockers and some heart
medicines. Food and diet can also play a role
in the severity of your condition: Transfats,
sugar and alcohol are all believed to cause
inflammation so avoiding these ingredients
may help minimize symptoms.
Q: Is psoriatic arthritis linked to other diseases?
A: Researchers are still trying to determine
the relationship between psoriatic arthritis
and other diseases. However, because so
many who have psoriatic arthritis also have
psoriasis, people with either condition may be
at risk for the same diseases. See page 6 for
the list of conditions associated with psoriasis.
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AN OVERVIEW
OF TREATMENTS
Because many treatments for
psoriasis are also used to treat
psoriatic arthritis, all treatment
options are listed together in this
booklet. Some treatments for
psoriasis and psoriatic arthritis
are found over the counter at drug
or health food stores while others
require a prescription from a doctor.
Everyone is different. How a treatment affects
you may not be the same for someone else.
Discuss any side effects with your health care
provider to ensure you receive the best care.
The goal is to find a treatment that works well
with few side effects. Your health care provider
will recommend a treatment based on the
location and severity of your symptoms and the
impact of the disease on your quality of life.
Finding the treatment that will give you the
most relief from psoriasis and/or psoriatic
arthritis symptoms may take time. No single
treatment works for everyone and treatments
can stop working over time. It is common to
try several approaches before you and your
health care provider decide on one that is right
for you. You and your physician will want to
consider all aspects of a treatment, including
how well it works, side effects, cost and how the
treatment regimen fits into your lifestyle. Your
health care provider may prescribe more than
one treatment at a time, which is known as
combination therapy.
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National Psoriasis Foundation
Look for the:
Psoriasis ( ) and psoriatic arthritis ( )
symbols to determine if a treatment is indicated
for psoriasis, psoriatic arthritis or both.
Here are some of the treatment options available:
TOPICAL TREATMENTS
Topical treatments—medications applied to
the skin—are usually the first line of defense
in treating localized psoriasis. Topicals
slow excessive cell reproduction and reduce
inflammation. Topical treatments are available
over the counter and by prescription for the
treatment of psoriasis.
Over-the-counter (OTC) topicals
Salicylic acid
Also referred to as “sal acid,” salicylic
acid helps to remove scales and is often
recommended for use with topicals such as
topical steroids, anthralin or tar to enhance
effectiveness. Sal acid products are available in
both OTC and prescription strengths.
Tar
Coal tar and pine tar are available in topical,
shampoo and bath solution forms. Tar can help
slow the rapid growth of skin cells and help
reduce inflammation, itching and scaling. It
can also be used in combination with other
topicals and phototherapy (see page 14).
Other OTC topicals
Many other OTC topicals relieve itch and
soothe and repair damaged skin. Moisturizing
psoriasis lesions with body lotions, creams,
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13
bath soaks or salves can significantly reduce
the discomfort of itching, scaling and dryness.
The ingredients calamine, hydrocortisone (a
weak steroid), camphor, diphenhydramine
hydrochloride (HCl), benzocaine and menthol
have all been approved by the FDA for treating
itch; however, they may increase irritation
and dryness. Ingredients such as aloe vera,
jojoba, zinc pyrithione, capsaicin, tea tree
oil, oats, dead sea salts, apple cider vinegar
and others are also frequently used to treat
psoriasis; however few studies have examined
the effectiveness of these products. Be aware
that even “natural” ingredients can cause side
effects or allergic reactions. If irritation occurs,
discontinue use.
Prescription topicals
Anthralin
Anthralin is used to treat plaque psoriasis. It
works by reducing the rapid growth of skin
cells associated with plaque psoriasis.
Vitamin D medications (Dovonex and Vectical)
These medications slow the rate of skin cell
growth, flatten psoriasis lesions and remove
scale. Dovonex (generic name calcipotriene) is
a synthetic form of vitamin D3 and is available
in a cream and scalp solution. Vectical (generic
name calcitriol) is a naturally occurring active
form of vitamin D3 that is available as an
ointment.
Taclonex
This prescription solution contains both
calcipotriene and the potent steroid
betamethasone dipropionate. The two
ingredients work together to slow skin cell
growth and reduce inflammation and itch.
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Tazorac
Tazorac (generic name, tazarotene) is a
vitamin A derivative that belongs to a group of
medicines called topical retinoids. It is available
as a gel or cream and can be used on the face,
scalp and nails.
Topical steroids
Topical corticosteroids, simply called “steroids”
by doctors and patients, are routinely used to
treat psoriasis. Topical steroid medications
can be very effective in controlling localized
disease (less than 5 percent body surface
involvement). Corticosteroids range from mild
to superpotent, and it is important to take into
account the location of the psoriasis and the
extent of involvement when choosing topical
steroid treatment. They are available in a
variety of forms including ointments, creams,
solutions, gels, lotion, foam, shampoo, tape and
spray and are sold as name brand formulas as
well as generics.
Other prescription topicals
Treatments for other skin conditions can be
helpful to those with psoriasis, even though
they were not developed specifically to treat
psoriasis. Protopic (tacrolimus) and Elidel
(pimecrolimus) are two such topical treatments.
These two nonsteroidal, anti-inflammatory
treatments have been approved for treating
eczema and some people find they are also
helpful in treating psoriasis in sensitive areas,
such as the face, genitals and skin folds.
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PHOTOTHERAPY
Phototherapy involves exposing the skin to
wavelengths of ultraviolet light under medical
supervision. Ultraviolet light A (UVA) and
ultraviolet light B (UVB) are found in natural
sunlight. Both types are used to treat psoriasis.
Treatments usually take place in a doctor’s
office or psoriasis clinic. However, it is possible
to follow a treatment regimen at home with a
unit prescribed by a doctor. The key to success
with phototherapy is consistency. Here are
some ways this treatment may be performed:
PUVA
PUVA is an acronym for the light-sensitizing
medication psoralen combined with UVA
exposure. UVA is relatively ineffective unless
used with a light-sensitizing medication such
as psoralen, which can be applied topically or
taken orally.
UVB
There are two types of UVB treatments:
broad band and narrow band. Narrow-band
UVB units emit a more specific range of UV
wavelengths. Several studies indicate that
narrow-band UVB clears psoriasis faster and
produces longer remissions than broad-band
UVB. Narrow-band UVB may be effective
with fewer treatments per week than broadband UVB and is considered a safer and
easier alternative to PUVA.
Excimer (UVB) laser
The excimer laser is a small (less than
1-inch diameter) intensely focused beam
of ultraviolet light that can be targeted at
individual lesions. Several sessions may be
needed to achieve clearing in an area. This
treatment is recommended for those with
lesions localized to specific areas of the body.
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Pulsed dye lasers
Although no longer commonly used, pulsed
dye lasers are approved for treating localized
plaque lesions. Pulsed dye lasers destroy
the tiny blood vessels that contribute to the
formation of psoriasis lesions.
SYSTEMIC TREATMENTS
Taken by mouth or injected, systemic
treatments affect the entire body. Systemics
treat the body from the inside out, unlike
topicals or phototherapy, which treat the
body from the outside in. They are usually
reserved for patients with widespread
symptoms, people with psoriatic arthritis,
and those who are not responsive to or
cannot use conventional topical medications
or phototherapy.
Nonsteroidal anti-inflammatory drugs
(NSAIDs)
NSAIDs can help relieve pain, swelling and
stiffness in your joints. NSAIDs are available
in over-the-counter and prescription
strengths. Examples of over-the-counter
NSAIDs include aspirin, ibuprofen (Advil,
Motrin) and naproxen sodium (Aleve). If
you need to take frequent doses of over-thecounter NSAIDs to control your arthritis you
may need to move to prescription strength.
Systemic steroids
When steroid medications are taken in pill
form or injected into the muscle they are
called systemic steroids. Selective low-dose
steroid injections directed into inflamed
joints and around tendons can relieve
swelling and improve range of motion in
patients with psoriatic arthritis. Warning:
Steroid medications taken systemically are
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not recommended for long-term treatment
of psoriasis or psoriatic arthritis. The use
of systemic steroids in treating psoriasis
is sometimes associated with worsening of
disease, including flares of pustular psoriasis
in people who never had it before.
Cyclosporine
Cyclosporine is considered a disease-modifying
anti-rheumatic drug (DMARD). DMARDs may
relieve more severe symptoms and attempt
to slow or stop joint/tissue damage and the
progression of psoriatic arthritis. Cyclosporine
suppresses elements of the immune system,
which in turn slows down the processes of
psoriasis and psoriatic arthritis. Cyclosporine
is usually only used for several months to
control severe flares.
Methotrexate
Methotrexate, usually sold as a generic, is a
DMARD that inhibits an enzyme involved in
the rapid growth cycle of cells. In people with
psoriasis, the drug slows down the rate of
skin cell growth. Methotrexate has been used
to reduce psoriatic arthritis inflammation,
although controlled studies have not shown
it to be effective in the treatment of psoriatic
arthritis.
Oral retinoids
Soriatane (Acitretin) is an oral retinoid, which
is a synthetic form of vitamin A. In people
with psoriasis, retinoids help control how skin
cells multiply, including how fast skin cells
will grow and shed from the skin’s surface.
Oral retinoids are often used to help make
phototherapy more effective.
Sulfasalazine (off-label)
A combination of anti-inflammatory and
antibiotic agents, sulfasalazine is a DMARD
sometimes used in treating psoriatic arthritis.
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BIOLOGIC TREATMENTS
Biologic treatments are delivered by injection
or IV infusion. You may administer it yourself
or have a trained family member or health
care provider do it for you. These medications
target specific proteins known to contribute
to the immune system, blocking the action of
certain immune cells or chemical messengers
that play a role in the development of
psoriasis and psoriatic arthritis. There
are currently two types of biologics for
treating psoriasis and psoriatic arthritis:
Tumor necrosis factor-alpha blockers and
interleukin 12/23 blockers.
Tumor necrosis factor-alpha blockers block
tumor necrosis factor alpha (TNF-alpha),
a chemical messenger, or cytokine, of the
immune system that causes cells to release
other proteins that add to the inflammatory
process. In psoriasis and psoriatic arthritis,
there is excess production of TNF-alpha in
the skin or joints. This leads to the rapid
growth of skin cells typical of psoriasis, or
to the joint inflammation characterized by
stiffness, pain, warmth and redness seen in
psoriatic arthritis. A reduction in TNF-alpha,
a critical regulator of inflammation, stops the
inflammatory cycle of psoriasis and psoriatic
arthritis.
There are five biologic medications in this
category:
Cimzia (certolizumab pegol)
FDA-approved for the treatment of psoriatic
arthritis. Patients receive an injection under
the skin (by a health care provider or by selfinjection after proper training) every other week.
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Enbrel (etanercept)
FDA-approved for the treatment of psoriasis
and psoriatic arthritis. Patients give themselves
an injection just under the skin once or twice
per week.
Humira (adalimumab)
FDA-approved for treating psoriatic arthritis
and psoriasis. Patients give themselves an
injection just under the skin every other week.
Remicade (infliximab)
FDA-approved for treating psoriasis and
psoriatic arthritis. Remicade is given by
intravenous (IV) infusion in a doctor’s office
three times during the first six weeks of
treatment and then typically every eight weeks
after that.
Simponi (golimumab)
FDA-approved for the treatment of psoriatic
arthritis. Patients give themselves an injection
just under the skin once per month.
Interleukin 12/23 blockers work by selectively
blocking the cytokines interleukin-12 (IL-12) and
interleukin-23 (IL-23). Interleukins 12 and 23
play a role in inflammation. They are abundant
in blood of people with psoriasis and psoriatic
arthritis and are thought to promote the
accumulation of psoriatic disease-causing T cells,
which are immune system cells.
There is one biologic medication in this category:
Stelara (ustekinumab)
FDA-approved for the treatment of psoriasis
and psoriatic arthritis. Patients receive an
injection by a health care provider (or deliver a
self-injection after proper training) once every
12 weeks.
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COMPLEMENTARY AND
ALTERNATIVE MEDICINE
Complementary and alternative medicine
(CAM) treatments are popular with many
people; however, they have been studied less
than other treatment options and may be
administered differently from practitioner to
practitioner. There is evidence that suggests
several types of CAM treatments may ease the
symptoms of psoriasis and psoriatic arthritis.
CAM looks at the body from a comprehensive
point of view and therapies involve diet
and lifestyle changes along with supportive
therapies. Some of these therapies include:
Acupressure
Developed in Asia more than 5,000 years ago,
acupressure uses gentle pressure on the body’s
key healing points to reduce pain and stress,
increase circulation and boost the immune
system. There is no scientific evidence that
acupressure can control pain associated with
psoriasis or psoriatic arthritis, but some people
may find it beneficial.
Acupuncture
Like acupressure, acupuncture has its roots
in ancient China. Acupuncture involves the
insertion of fine needles along key meridians.
The World Health Organization states that
acupuncture is useful as adjunct therapy in
more than 50 disorders including low back
pain, headaches and nausea. No clinical
studies directly support its use with psoriasis or
psoriatic arthritis. However, some patients have
reported success. A large scale review published
in the October 2012 Archives of Internal Medicine
showed positive results when using acupuncture
to treat chronic pain conditions.
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Massage
Massage involves the manipulation of
superficial layers of muscle and connective
tissue to enhance function, improve lymph
circulation and promote relaxation. During a
massage a licensed massage therapist may use
a variety of techniques to loosen and stretch
muscles and joints. Massage can be beneficial
for those with psoriasis and psoriatic arthritis.
An experienced massage therapist can modify
any massage session to meet your comfort level.
Reiki
Reiki (pronounced ray-kee) is an energy
healing system that was introduced by a
physician in Japan in the early 1900s. Reiki
is a relaxation technique that can address
mental stress and emotional stress. A Reiki
practitioner uses healing touch by placing his
or her hands on meridian positions on your
body. You also can learn to practice Reiki on
yourself.
Stress management
Because stress can trigger the onset or
worsening of psoriasis and psoriatic arthritis,
some health care professionals recommend
therapies designed to help lower stress
levels. Stress reduction therapies including
aromatherapy, meditation and exercise—
particularly yoga and tai chi—have all helped
manage psoriasis and psoriatic arthritis in
certain people.
Diet and Nutrition
Eating a balanced whole foods diet can help
reduce inflammation and may help improve
overall health. While there is no definitive
research linking a specific diet to improvement
of psoriasis, many patients report they have
benefited from an anti-inflammatory or glutenfree diet.
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National Psoriasis Foundation
Anti-inflammatory diets focus on eating whole
unprocessed foods and eliminating the foods
that some believe to be more inflammatory
such as dairy, gluten, nightshades (eggplant,
peppers, tomatoes), corn, soy and sugar.
While there is not scientific evidence linking
anti-inflammatory diets to improvement
of psoriasis, many people report having
improved symptoms from eating an antiinflammatory diet.
Gluten-free diets focus on removing gluten,
a protein found in most grains and their
derivatives such as flour, soy sauce and grain
alcohols among many other foods. There are
mixed data regarding the benefit of glutenfree diets for people with psoriatic diseases. A
2010 study in the Journal of Clinical Laboratory
Analysis found that psoriasis patients with the
HLA CW6 gene, a gene linked to psoriasis, had
an increased sensitivity to the gliadin protein
(gluten). By contrast, studies conducted in the
U.S. and in Kashmir found no elevation in
anti-gladin and other antibodies associated
with celiac disease in people who had mild to
moderate psoriasis.
Also diets rich in turmeric, the spice found
in curry, have been shown to reduce
inflammation. A 2012 review by the
International Union of Biochemistry and
Molecular biology highlights turmeric’s
ability to alter the inflammatory response of
TNF-alpha.
Supplements
There are many reports that certain supplements
improve psoriasis and psoriatic arthritis. Vitamin
D and fish oil, in particular, may be beneficial
not only for psoriasis and psoriatic arthritis, but
for the related diseases often associated with
psoriasis, such as heart disease and diabetes.
an overview of psoriasis + psoriatic arthritis
23
Other CAM treatments
Balneotherapy (water-based treatments that
involve thermal, spring or mineral water),
climatotherapy (treatments involving natural
water and sun exposure), oat baths, dead sea
salt scrubs and creams containing capsaicin
have all been reported as helpful in treating
psoriasis symptoms.
Like conventional approaches, not all CAM
approaches work for everyone. Results may
vary from person to person. It’s important to
ask your primary health care provider about
any dietary supplements you are taking, as
they may interact with your psoriasis and
psoriatic arthritis medication. If you are
interested in complementary and alternative
medicine, be sure to look for a licensed CAM
health care provider.
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National Psoriasis Foundation
A DDI T ION A L RE S OURCE S A ND
T RE AT MEN T INFORM AT ION
The National Psoriasis Foundation maintains
an extensive library of information on
psoriasis and related topics. To learn more,
visit our website at www.psoriasis.org or
e-mail education@psoriasis.org.
Thanks to diligent scientific
research, today’s treatments are
providing a wide range of safe and
effective options for people with
psoriasis and psoriatic arthritis.
And the search continues to find
safer and even more effective
treatments.
The National Psoriasis Foundation
tracks the movement of drugs for
psoriasis and psoriatic arthritis
from preliminary studies through
the three phases of clinical trials as
required by the U.S. Food and Drug
Administration. This information is
compiled, along with that from other
sources, and entered into our drug
research pipeline.
To learn more about research
and upcoming treatments visit
www.psoriasis.org/pipeline.
an overview of psoriasis + psoriatic arthritis
25
Bill of Rights and Responsibilities
for People with Psoriasis and
Psoriatic Arthritis
1
People with psoriasis and/or psoriatic
arthritis have the right to receive medical
care from a health care provider who
understands that psoriasis and psoriatic
arthritis are serious autoimmune diseases
that require lifelong treatment.
2
People with psoriasis and/or psoriatic
arthritis have the responsibility to be
actively involved in managing their
disease by participating in health care
decisions, closely following treatment plans
recommended by their health care providers,
and making healthy lifestyle choices to ease
their symptoms.
3
People with psoriasis and/or psoriatic
arthritis have the right to a health care
provider who is able to fully assess
their disease and related conditions, is
knowledgeable about the benefits and risks of
all psoriasis treatments and medications, and
readily coordinates psoriasis treatment plans
with the individual’s other providers.
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National Psoriasis Foundation
4
People with psoriasis and/or psoriatic
arthritis have the responsibility to be
honest with their health care provider
about their health and lifestyle decisions
that may affect the success of his or her
treatment plan.
5
People with psoriasis have the right to
expect clear or almost clear skin with
effective treatment throughout their
lifetime, and to seek another health care
provider if their current provider is not
comfortable with prescribing and monitoring
the range of psoriasis treatments.
6
People with psoriasis and/or psoriatic
arthritis have the responsibility to ask
for support and encouragement from
their loved ones, friends, health care
providers, clergy and others with whom
they feel comfortable discussing personal
and health issues.
7
People with psoriasis and/or psoriatic
arthritis have the right to be treated
in a courteous and nondiscriminatory
manner by their health care providers,
employers and others.
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27
We’re here for you.
At the National Psoriasis Foundation, our
priority is giving you the information and
services you need to take control of your
psoriasis and/or psoriatic arthritis, while
funding research to find a cure.
RESEARCH
Finding a cure for psoriasis and psoriatic
arthritis is our highest priority. We’re working
for you by:
• Funding promising new studies through our
Discovery and Translational grants programs
• Increasing the number of scientists doing
research through our Medical Fellowship
program
• Hosting the world’s largest collection of
psoriasis DNA for genetic research
ADVOCACY
We’re ensuring that people with psoriasis and
psoriatic arthritis have a say in the policies that
affect their lives. Join us as we:
• Work to increase federal funding for psoriasis
and psoriatic arthritis research
• Improve access to health care for patients
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National Psoriasis Foundation
HEALTH EDUCATION
National Psoriasis Foundation is your one-stop
shop for news and information about psoriasis
and psoriatic arthritis. Visit www.psoriasis.org
to learn more about:
• The latest treatment information and
research updates
• Health events in your area
CONNECTION
Sometimes the best resource to manage
psoriasis and psoriatic arthritis is another
person with your condition. Share information
and get support from:
• TalkPsoriasis.org, the largest online community
for people with psoriasis and psoriatic arthritis
• Psoriasis One to One mentor program
• National Walk to Cure Psoriasis events
LEARN MORE
Find more information and resources at
www.psoriasis.org.
an overview of psoriasis + psoriatic arthritis
29
NOTES
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National Psoriasis Foundation
NOTES
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31
NOTES
32
National Psoriasis Foundation
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National Psoriasis Foundation is a 501 (c) (3) charitable organization governed
by a volunteer Board of Trustees and advised on medical issues by a volunteer
Medical Board.
National Psoriasis Foundation educational materials are reviewed by members
of our Medical Board and are not intended to replace the counsel of a physician.
National Psoriasis Foundation does not endorse any medications, products
or treatments for psoriasis or psoriatic arthritis and advises you to consult a
physician before initiating any treatment.
©2013 National Psoriasis Foundation
December 2013
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