PSORIATIC ARTHRITIS
Report #6918; 10/9/96
One of the most difficult types of arthritis to treat is associated with psoriasis.
Psoriasis means that you make too much skin. Old skin cells are being shed and new ones are constantly replacing them. A new skin cell is laid down at the innermost part of the skin. Then as each successive new cell is laid down underneath it, it moves toward the outer layer until it is shed on the 28th day as dander, or scaling. Psoriasis means that the skin turns over 7 times as fast as normal, so cells are shed after four days. This causes thick plaques to form on the skin. However, the rapid turnover of cells is not limited just to the skin. Other tissues, such as joints, turn over too fast also.
The only effective treatments for joint pains are drugs that slow the rate of new tissue formation, and all have potentially toxic effects. The safest of the drugs commonly prescribed to treat psoriatic arthritis is probably sulfasalazine at 1000 mg three times a day with meals. A person who takes this drug needs to have blood tests to check for side effects once every month or two. Other treatments for psoriatic skin lesions include a special tape impregnated with cortisone-type medications (Cordran Tape) and cortisone and vitamin D ointments. Other drugs used to treat psoriatic arthritis include gold shots and pills and the more toxic immune suppressants such as methotrexate.
By Gabe Mirkin, M.D., for CBS Radio News
1) SL Gottlieb, et al. Response of psoriasis to a lymphocyte-selective toxin (DAB389IL-2) suggests a primary immune, but not keratinocyte, pathogenic basis. Nature Medicine 1995;2:442-447.
2) Z Evenpaz, R Gumon, V Kipnis, DJ Abels, D Efron. Dead Sea sun versus Dead Sea water in the treatment of psoriasis. Journal of Dermatological Treatment 7: 2 (JUN 1996):83-86.
Psoriatic arthritis is very difficult to treat. I prescribe sulfasalazine 1000 mg T.I.D. plus (doxycycline 100 mg BID or azithromycin 1 gram once a week) plus Cordran tape on the lesions.
3) B Combe, P Goupille, JL Kuntz, J Tebib, F Liote, C Bregeon. Sulfasalazine in psoriatic arthritis: A randomized, multicentre, placebo-controlled study. British Journal of Rheumatology 35: 7 (JUL 1996):664-668. SSZ, at a dose of 2.0 g/day appeared to be a safe treatment in patients with psoriatic arthritis. At this dosage, its efficacy was only demonstrated for the pain variable.
I treat extensive psoriasis with sulfasalazine 1000 mg TID, cephalexin 500 mg TID and Cordran tape.