Psoriasis: Young MS

Doherty SD, Van Voorhees A, Lebwohl MG, Korman NJ, Young MS, Hsu S, National Psoriasis Foundation. · Department of Dermatology, Baylor College of Medicine, Houston, Texas 77030, USA. · J Am Acad Dermatol. · Pubmed #18485527 No free full text.

Abstract: BACKGROUND: Chronic immunosuppression is a known risk factor for allowing latent tuberculosis (TB) infection to transform into active TB. Immunosuppressive/immunomodulatory therapies, while highly efficacious in the treatment of psoriasis and psoriatic arthritis, may be associated with an increased rate of active TB in patients receiving some of these therapies. OBJECTIVE: Our aim was to arrive at a consensus on screening for latent TB infection in psoriasis patient treated with systemic and biologic agents. METHODS: Reports in the literature were reviewed regarding immunosuppressive therapies and risk of TB. RESULTS: Screening patients for latent TB infection before commencement of treatment is of utmost importance when beginning treatment with the tumor necrosis factor-alpha inhibitors, T-cell blockers, cyclosporine, or methotrexate. The currently recommended method for screening is the tuberculin skin test. It is preferable that positively screened patients be treated with a full course of latent TB infection prophylaxis before immunosuppressive/immunomodulatory therapy is initiated. However, in the opinion of many experts, patients may be started on the immunosuppressive/immunomodulatory therapy after 1 to 2 months, if their clinical condition requires, as long as they are strictly adhering to and tolerating their prophylactic regimen. LIMITATIONS: There are few evidence-based studies on screening for latent TB infection in psoriasis patients treated with systemic and biologic agents. CONCLUSIONS: The biologic TNF-alpha inhibitors are very promising in the treatment of psoriasis. However, because TNF-alpha is also an important cytokine in preventing TB infection and in keeping latent TB infection from becoming active disease, the use of TNF-alpha inhibitors has been associated with an increased risk of developing active TB. A higher incidence of TB has also been reported with other immunosuppressive/immunomodulatory treatments for psoriasis. It is, therefore, of utmost importance to appropriately screen all patients for latent TB infection prior to initiating any immunologic therapy. Delaying immunologic therapy until latent TB infection prophylaxis is completed is preferable. However, if the patient is adhering to his prophylactic regimen and is appropriately tolerating the regimen, therapy may be started after 1 to 2 months if the clinical condition requires.

Young MS, Furfaro N. · Modern Dermatology, Dallas, TX, USA. · Dermatol Nurs. · Pubmed #17444251 No free full text.

Abstract: Psoriatic arthritis (PsA) of often has a destructive course, characterized by progressive damage to bone and joints. Consequently, prompt detection is critical, allowing effective, disease-modifying treatment to be administered at the earliest possible point in the progression of the disease. The collaboration between dermatologic and rheumatologic professionals in the early diagnosis, and subsequent management, of PsA is explored, with a focus on case studies that illustrate the potentialfor such collaboration.

Young MS. · Modern Dermatology, Dallas, TX, USA. · Dermatol Nurs. · Pubmed #17444249 No free full text.

Abstract: There is a considerable area of intersection between the negative consequences of psoriatic skin inflammation and the negative consequences of psoriatic joint inflammation. However, available evidence indicates that PsA also has a unique set of possible undesirable outcomes, such as severe disability and increased mortality, that are particularly serious. In light of this evidence, it has become increasingly clear that PsA is not the relatively mild condition it was once believed to be, but rather a disease that can have a dramatic negative impact on affected patients.

Young MS. · University of Texas, Arlington School of Nursing, USA. · Dermatol Nurs. · Pubmed #14619318 No free full text.

This publication has no abstract.