Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Ankylosing Spondylitis and Psoriatic Arthritis From 2003 Annual Scientific Meeting Of The American College Of Rheumatology

Introduction

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 can lead to total loss of mobility of the spine.

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 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

Several reports noted the safety and effectiveness of Enbrel (etanercept) for treating patients with psoriatic arthritis. Enbrel was also shown, in a separate study, to improve quality of life in patients with psoriatic arthritis.

Dr. Shiel's Perspective: Enbrel has been granted FDA approval for psoriatic arthritis this year because of previous reports that had similar results.

Enbrel was reported effective in treating ankylosing spondylitis.

Dr. Shiel's Perspective: Look for FDA approval for this purpose soon.

Remicade (infliximab) was reported as safe and effective in psoriasis, psoriatic arthritis, and ankylosing spondylitis.

Dr. Shiel's Perspective: Actually, rheumatologists have been using the drug for these patients for some time because of other preliminary positive reports in these conditions. It is good to have the support of this further long-term follow-up research.

Remicade was also reported to be effective in juvenile ankylosing spondylitis.

Dr. Shiel's Perspective: Welcome news for this painful form of arthritis in children.

Remicade's beneficial effect in treating ankylosing spondylitis was shown to be sustained over a 2 year study period.

Dr. Shiel's Perspective: This is a type of study that demonstrates that not only does Remicade work for spondylitis patients, but its benefits are longterm.

Arava (leflunomide) was significantly effective in treating BOTH the skin inflammation (psoriasis) and the arthritis in patients with psoriatic arthritis.

Dr. Shiel's Perspective: Another fine addition to the ammunition chest against psoriatic arthritis.

Psoriatic Arthritis Under Diagnosed

Psoriatic arthritis was reported to be under diagnosed, especially in dermatology clinics.

Dr. Shiel's Perspective: This means people are living with chronic pain and stiffness without proper treatment. Psoriatic arthritis is a diagnosis made mainly on clinical grounds, based on a finding of psoriasis and the typical inflammatory arthritis of the spine and other joints. There is no laboratory test to diagnose psoriatic arthritis. Blood tests such as sedimentation rate may be elevated and merely reflect presence of inflammation in the joints and other organs of the body. Other blood tests such as rheumatoid factor are obtained to exclude rheumatoid arthritis. When one or two large joints (such a knees) are inflamed, arthrocentesis can be performed. Arthrocentesis is a office procedure whereby a sterile needle is used to withdraw (aspirate) fluid from the inflamed joints. The fluid is then analyzed for infection, gout crystals, and other inflammatory conditions. X-rays may show changes indicative of arthritis of the spine, sacrum, and joints of the hands. Typical x-ray findings include bony erosions resulting from arthritis. The blood test for the genetic marker HLA-B27, mentioned above, can be found in over 50% of patients with psoriatic arthritis who have spine inflammation. Rheumatologists are experts in evaluating patients with symptoms of psoriatic arthritis.



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