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Blood Pressure Medications: A Concise Guide
High blood pressure is unfortunately something that most people
have to deal with as they age. This is especially true for the
average person in the western part of the world. The national
average for high blood pressure is approximately 24% in...
EFFECTS OF HORMONE LOSS
EFFECTS OF HORMONE LOSS As women age estrogen levels fall, which impacts many parts of the body including skin, bones, and bladder Dry itchy skin is a common complaint. FACT: Without estrogen, the body tissues lose elasticity and shrink. A common...
Health Care Costs Are Rising At Epidemic Proportions - Here's What You Can Do About It!
Health care costs are now approaching 15% of our national economy and the economic repercussions have been felt by most American families as employers are unwilling to absorb the bulk of the health care cost burden. In 2004, employer health...
The First Harvest
First responders arrived at the home initially, followed
soon thereafter by paramedics. We picked up the dispatch over the radio scanner and prepared our minds and equipment in trauma room one. This one was a long time coming which surprised us...
WRONG DECISIONS
There is a famous saying, “All is well that ends well.” So even if I teach you the art of making wise decision, there is a chance that your decision will end up in a failure. But if you master this art, it will help you in reducing the factor of...
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Understanding New Psoriasis Treatments Like Enbrel
The majority of the biologic therapies involve changing the
amount of Tumor Necrosis Factor - Alpha (TNF-Alpha). TNF-alpha
is involved in regulating abnormal responses like inflammation,
increased blood vessel formaton (angiogenesis), and excessive
development of skin cells (keratinocyte proliferation). It can
also affect bone and cartilage erosion hence the reason that
psoriatic arthritis is especially responsive to the new biologic
therapies.
High Levels of TNF-Alpha are found in psoriasis as well as a
host of other conditions including Crohn's disease, juvenile
rheumatoid arthritis, and ankylosing spondylitis.
Interestingly, the severity of psoriasis correlates quite well
with the levels of TNF-Alpha found in the blood.
The goal of the TNF inhibitor biologic therapies is to eliminate
the excess TNF that is present so that you have normal levels.
It is the excess TNF that is associated with the inflammatory
reactions and hence some of the diseases manifestations. All of
the underlying reasons for this are still uncertain.
Early treatments in psoriasis targeted large sections of the
immune system. As we learn more the therapies such as the ones
discussed in this article become more and targeted and affect a
smaller segment of the immune system apparatus.
The three TNF inhibitors are etanercept (Enbrel), infliximab
(Remicade) , adalimumab (Humira).
The medicines at this point appear safe. They should not be used
in patients with a history of tuberculosis and congestive heart
failure. As a dermatologist I have seen enormous improvements in
the quality of life of patients due to these medicines. Caution
still needs to be exercised as these are relatively new
medicines and I feel they should be prescribed only when other
medicines have failed or if there are signs of early and
progressive joint involvement with failure of other medicines.
If one is able to completely control psoriasis with topical
medicines and moderate light exposure / ultraviolet light
phototherapy then this should be continued. I do not feel at
this point that one should use these medicines because of the
"ease" of treatment if other low risk traditional treatments
work.
Due to the cost of these medicines and the
profits the drug
companies have the potential to make, there is an aggressive
marketing campaign to promote these drugs direct to people with
psoriasis. As a result, I often have patients who come in
requesting these medicines without them having any knowledge
beyond 30 second commercials.
I tell all patients that at this point they appear safe with the
emphasis on the "at this point." We never know what potential
problems could arise 20-30 years down the road although they do
appear safe. The decision to go on a biologic therapy should be
balanced by several factors. 1) Do you have psoriasis covering a
large part of your body and have conventional treatments that
have been done exactly as prescribed by your doctor failed? 2)Do
you have progressively worsening psoriatic arthritis?
If you have answered yes to either of the above questions you
could be a candidate for these medicines and as always you
should discuss treatment options with your physician.
Unfortunately, the medicines are not able to be taken by mouth.
The simple reason for this is that biologics are proteins in
structure and would be digested if taken by mouth. So, they must
be given by injection or intravenously. The overwhelming
majority of patients have little problem with this. The point I
want to make is that just because they are injectable or
intravenous does not mean that they are stronger with more side
effects than medicine taken by mouth.
In summary, the new biologic therapies in psoriasis and other
diseases like Crohn's and Rheumatoid Arthritis are a great
advance in treatment and have improved the quality of life of
many people suffering from the above diseases. They represent a
whole new way of targeted treatment and are best used when safe,
well known traditional treatments have failed.
About the author:
Jonathan Carp, M.D. is a board certified dermatologist
practicing in Southern California. Although a firm believer and
practictioner of western medicine, he has a special interest in
nutrition, anti-aging medicine, fitness, and traditional health
maintenance practices. He is committed to providing sensible,
sound, scientfically-based health information. He publishes a
psoriasis health blog at http://www.psoriasisinsider.com/
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