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The future of autoimmune diseases: psoriatic disease

By Rebecca Haberman, MD, told to Stephanie Watson

Psoriatic disease is not curable, but it is becoming more and more treatable. While not everyone can achieve clear skin or joints without pain, things get better with every new drug we have to treat them with.

Our stable of drugs is growing exponentially, which is really important when a particular drug isn’t treating everyone with the disease.

The diagnosis of psoriatic disease has also come a long way. It has long been overlooked. It’s only been in the last 10-15 years that people have really started to pay attention to it. Since then, it has become easier to diagnose it.

Biological drugs

Psoriatic disease can be difficult to treat because it manifests in many ways. Inflammation can affect:

  • Your joints
  • Where tendons and ligaments connect to bone (called entheses)
  • your fingers and toes
  • Your spine
  • Your skin
  • Your nails

While we think of psoriatic disease as a condition, it’s possible that the illnesses that make it up are a little different.

So it makes sense that we need different drugs to treat it. Older disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, target overall inflammation to slow disease and prevent joint and skin damage.

A new group of drugs called biologics has more specific targets within the immune system. They block certain proteins in your immune system that trigger inflammation. There are a growing number of these treatable targets, including those called:

trial and error

No test can show which of these targets is best for you. So your doctor won’t know which of these drugs will work best for your condition until you try it.

The severity of your illness and the parts of your body it affects the most (skin, joints, etc.) will help determine which medicine the doctor will prescribe for you first. For example, IL-17, IL-23, and IL-12/23 inhibitors seem to work particularly well against plaque psoriasis.

It’s also important to know if you have any other medical conditions that might make one biologic riskier for you than another.

But overall, prescribing these drugs can involve trial and error.

The ultimate goal is to put you into remission, where you have no symptoms. But if you’ve been living with the condition for a long time, less pain, less swollen joints, and fewer patches of skin may be more realistic goals.

The future of treatment

Current treatments for skin lesions are more effective than those available for joint inflammation. Thanks to the wide range of topical medications, biologics, and other therapies, we can achieve nearly 100% skin removal much easier than before.

It’s hard to do that with the joints. So we try to find new ways to make people feel better.

The outlook for joint involvement may change as companies discover new drugs and they become available.

Pharmaceutical companies are looking for new ways to block inflammation in psoriatic disease. Some ideas involve combining biologics or targeting more than one inflammatory pathway at a time. For example, a drug in development, bimekizumab, targets two inflammatory proteins, IL-17A and IL-17F. In studies, it has helped some people’s symptoms improve by up to 90%.

Researchers are also working on more personalized approaches to diagnosing psoriatic disease.

The ultimate goal is to get to precision medicine, where I can take a blood test and say, “This is how the patient looks and this is the medicine 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.

webmd Gt

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