By Rebecca Haberman, MD, as shared with Stephanie Watson
There is no cure for psoriasis disease, but it is becoming more and more treatable. While not everyone can achieve clear skin or pain-free joints, things improve with every new drug we have to treat them with.
Our inventory of drugs is growing exponentially, which is really important when a given drug doesn’t treat everyone with the disease.
The diagnosis of psoriasis is also well advanced. She has been underestimated for a long time. It’s only in the last 10 to 15 years that people have started to really pay attention to it. Since then it has become easier to diagnose.
Psoriasis can be difficult to treat because it manifests itself in so many ways. Inflammation can affect:
While we think of psoriasis as a disease, it’s possible that the diseases that make it up are a little different.
So it makes sense that we would need different drugs to treat it. Older disease-modifying anti-inflammatory drugs (DMARDs) like methotrexate target general inflammation to slow the disease and prevent joint and skin damage.
A newer group of drugs, called biologics, have more specific targets within the immune system. They block certain proteins in your immune system that trigger inflammation. There is a growing number of these treatable targets, including those labeled:
No test can show which of these goals is best for you. So your doctor won’t know which of these drugs works best for your condition until you try it.
The severity of your condition and the parts of your body most affected (skin, joints, etc.) will help decide which medicine the doctor prescribes for you first. For example, IL-17, IL-23 and IL-12/23 inhibitors appear to work particularly well against plaque psoriasis.
Also important is whether you have other medical conditions that could make one biologic more risky for you than another.
But overall, prescribing these drugs can involve some trial and error.
The ultimate goal is to get you into a state of no-symptoms remission. But once you’ve lived with the condition for a long time, less pain, less swollen joints, and fewer skin plaques may be more realistic goals.
Today’s treatments for skin lesions are more effective than those available for joint inflammation. Thanks to the wide range of topical medicines, biologics and other therapies available, we can achieve almost 100% cleansing of the skin much more easily than before.
That’s hard to achieve with the joints. So we’re trying to find new ways to make people feel better.
The prospects for joint ownership may change as companies discover new medicines and they become available.
Pharmaceutical companies are looking for new ways to block inflammation in psoriasis. Some ideas involve combining biologics or treating more than one inflammatory pathway at the same time. For example, one drug in development, bimekizumab, targets two inflammatory proteins, IL-17A and IL-17F. In studies, it helped some people improve their symptoms by up to 90%.
Researchers are also working on more personalized approaches to diagnosing psoriasis disorders.
The ultimate goal is to get to precision medicine, where I can take a blood test and say, “This is what the patient is saying and this is the drug that’s going to work.”
Rebecca Haberman, MD, is a rheumatologist at NYU Langone Health in New York. She is also a Clinical Instructor at NYU’s Grossman School of Medicine.