Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Psoriatic Arthritis and Ankylosing Spondylitis From 2001 Annual Scientific Meeting Of The American College Of Rheumatology

Introduction

Psoriatic arthritis is a chronic disease that is characterized by inflammation of the skin (psoriasis) and joints (arthritis). Psoriasis is a common skin condition that affects 2% of the Caucasian population in the United States. It is often characterized by patchy, raised, red areas of skin inflammation with scaling. Psoriasis often affects the tips of the elbows and knees, the scalp, the navel, and around the genital areas or anus. Approximately 10% of patients who have psoriasis also develop an associated inflammation of their joints. Patients who have arthritis and psoriasis are diagnosed as having psoriatic arthritis.

Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. The sacroiliac joints are located in the low back where the sacrum (the bone directly above the tailbone) meets the iliac bones (bones on either side of the upper buttocks). Chronic inflammation in these areas causes pain and stiffness in and around the spine. Over time, chronic spinal inflammation (spondylitis) can lead to a complete cementing together (fusion) of the vertebrae, a process called ankylosis. Ankylosis causes total loss of mobility of the spine.

Ankylosing spondylitis and psoriatic arthritis are genetically and clinically related diseases. I will, therefore, report on papers presented at this meeting related to both of the diseases here.

Medications

Remicade (infliximab)

Remicade (infliximab) is an antibody that blocks the effects of tumor necrosis factor alpha (TNF-alpha). TNF- alpha is a substance made by cells of the body that has an important role in promoting inflammation. By blocking the action of TNF-alpha, infliximab reduces the signs and symptoms of inflammation. Remicade is infused into a vein in the arm, usually every 2 months.

Remicade was reported as effective for treating psoriatic arthritis and ankylosing spondylitis. For those with psoriasis, Remicade not only helped the arthritis, but also helped to clear the psoriasis, often dramatically. A number of papers not only documented the effectiveness and safety of Remicade, but also showed how it gets prompt results and improved the quality of life for these patients.

Dr. Shiel's Perspective: A welcome addition to treatment options that have been sorely lacking for these diseases. (I have actually been treating patients with these diseases very effectively with Remicade for some time now based on preliminary data reported at previous meetings.)

Remicade was found to be effective in much higher than the recommended doses.

Dr. Shiel's Perspective: This is similar to findings in patients with rheumatoid arthritis. That is, many times we must increase the doses above the starting doses to get the best results.

Remicade was also reported as effective in treating psoriasis and psoriatic arthritis in patients who had previously failed methotrexate or Enbrel.

Dr. Shiel's Perspective: This is consistent with recent reports of the effectiveness of Remicade in treating rheumatoid arthritis.

Remicade was shown to be extremely beneficial in the treatment of plaque-type psoriasis.

Dr. Shiel's Perspective: This was a fine study of 33 patients and documents not only the clinical benefit of Remicade alone in the treatment of this common form of psoriasis, but also its rapid onset of response of the inflamed skin to the drug.

Enbrel (etanercept)

Enbrel is an injectable anti-tumor necrosis factor for treating rheumatoid arthritis. Tumor necrosis factor (TNF) is a protein that the body produces during the inflammatory response, which is the body's reaction to injury. TNF promotes the inflammation and its associated fever and signs (pain, tenderness, and swelling) in several inflammatory conditions, including psoriatic arthritis and ankylosing spondylitis . Enbrel is a synthetic (man-made) protein that binds to TNF. Enbrel thereby acts like a sponge to remove most of the TNF molecules from the joints and blood. This prevents TNF from promoting inflammation and the fever, pain, and tenderness and swelling of joints in patients with psoriatic arthritis and ankylosing spondylitis. Enbrel is injected into the skin twice weekly.

Enbrel was reported as effective for treating psoriatic arthritis and ankylosing spondylitis. For those with psoriasis, Enbrel not only helped the arthritis, but also helped to clear the psoriasis, often dramatically. In those treated with Enbrel, there were no serious unforeseen side effects.