Ywellen: New Hope for Sufferers of Psoriasis-Related Arthritis

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New Hope for Sufferers of Psoriasis-Related Arthritis

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Article dated Feb. 2000

A new, injectable medication called etanercept and marketed under the

trade name Enbrel is achieving significant results treating psoriatic

arthritis (a form of the joint-inflaming disorder linked to the skin

disease psoriasis). Better yet, the new drug also improves the skin

lesions caused by the disorder.

Philip J. Mease, MD, medical director of the Division of Clinical

Research at the University of Washington in Seattle and lead

investigator of a trial of etanercept recently reported to the American

College of Rheumatology, says psoriatic arthritis has been getting more

recognition lately but is not really on the rise. Nevertheless, 7

million Americans suffer from psoriasis and about a tenth to a third of

those develop arthritis symptoms linked to this genetically passed,

noncontagious disorder.

" The Heartbreak "

People with psoriatic arthritis, which usually develops between the ages

of 30 and 50, suffer swelling or tenderness in one or more joints

and " crookedness " or reduced range of motion in the joint. Unlike

standard rheumatoid arthritis, psoriatic arthritis affects the joints

nearest the tips of finger or toes. " It is also more likely to be

asymmetrical, meaning you don't have it on both sides in the affected

area, and it is likely to be seen in fewer joints than rheumatoid, "

Mease says. Also affected by psoriatic arthritis are lower back, wrists,

and knees. So severe can the finger afflictions be that the digits can

swell and start to look like sausages. Fingernails can flake off or

separate from the nail bed or may show pitting.

Although Mease says it is common for physicians to believe that

psoriatic arthritis is milder and less disfiguring than the other forms,

it can be very mild or very severe or anywhere in between. " You can have

just as much joint destruction, " he says, " and in my personal

experience, people are more upset about it, which is probably due to the

emotional burden of dealing with the skin lesions of psoriasis at the

same time. "

In psoriasis, skin cells " programmed " to grow normally kick over into

" wound-healing " mode. The result is that cells pile up faster than they

shed. The blood supply increases and the area becomes inflamed. Cells

are created and pushed to the surface in as little as 2-4 days. They

crust up as " silver scales. " That's the reason for the name psoriasis,

which comes from the Greek for " disease of the silver scales. " As in

psoriasis of the skin, the symptoms of psoriatic arthritis result from

the body's normal processes distorting and turning in on

themselves--technically called auto-immune malfunction.

In extreme cases, patients suffer embarrassment, fear, and depression.

Remember that TV commercial referring to the " heartbreak of psoriasis " ?

It wasn't far off. Some sufferers even withdraw from society completely.

For decades, researchers have struggled to come up with a cure.

Psoriasis itself is treated many different ways. Topical steroids,

smelly coal tar, sunshine, ultraviolet phototherapy, and internal

medications such as methotrexate are all used and provide good control

in some patients, but not so good in others. It's an individual thing.

Physicians usually base treatment on severity, trying different methods

as the sufferer climbs the " treatment ladder. "

Etanercept Represents New Mechanism

The systemic (internal) medications for psoriasis, according to Mease,

work in different ways. " The antiinflammatories, such as Celebrex

[celecoxib] and Naprosyn [naproxen], help diminish the inflammation, but

don't change the cell-creation mechanism, " he explains. " The

steroids, such as prednisone, are now kind of a no-no because of the

side effects, and they only work for a limited period of time, followed

by a flareup. Methotrexate actually alters the immune cells and tinkers

with their chemistry to make them less 'warrior-like' and more pacific,

but this tinkering can also affect cells in the gut and other parts of

the body, with unpleasant side effects. "

Etanercept, Mease explains, is a new approach: It's called a " biological

response modifier, " and it represents the dawn of a new group of drugs.

Etanercept acts as sort of a floating sponge that circulates in the

bloodstream and soaks up TNF (tumor necrosis factor), which is turning

normal cells into overproducing warrior cells that deform and inflame

joints and create psoriatic lesions on the skin.

In Mease's 3-month, double-blind study of 60 sufferers with severe

psoriatic arthritis, 87% showed significant improvement in joint pain

and swelling--with no serious side effects. What's more, the researchers

saw marked improvement in the patients' skin patches, as well.

It was notable that no one wanted to stop taking the etanercept even

though several subjects tired on the placebo, saying nothing was

happening. Patients use an auto-injector to administer the medicine

twice a week. " Nothing to it, " Mease reports, saying even patients with

misgivings about the injection aspect of the treatment quickly got used

to it. " For me, Enbrel allowed me to experience the joys of life again, "

says Thorgerson.

Will you be able to get Enbrel from your doctor? And will your health

plan pay for it? At the moment, the drug is FDA-approved only for

moderate to severely active rheumatoid arthritis, but Mease expects a

larger follow-up study now being conducted to prompt the FDA to

consider okaying its use for psoriatic arthritis.

In the meantime, you should know that it is common for physicians to

prescribe available drugs for alternate uses, especially when test

results are so promising. Some health plans may be wowed by the

blindingly positive test results and decide to pay. Ask your doctor

about it. More information on psoriasis and psoriatic arthritis can be

found at http://www.psoriasis.org.

One note: After etanercept is discontinued, problems may return. " It's

not a cure, as such, " Mease stresses, " but it can turn off the

inflammation and keep the joint from being destroyed. "

Feb.2000 © 2000 by Medscape Inc. All rights reserved.

Lawrence is a medical journalist based in Chandler, Arizona.