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Interview with Dr. Mark Lebwohl: A better understanding of Psoriatic Arthritis

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Psoriasis is a skin condition that causes minor or severe skin irritation in nearly 125 million people, and about 7.5 million people in the U.S., according to the National Psoriasis Foundation. Furthermore, the condition typically appears in individuals between 15 and 30 years old.

Psoriatic arthritis is a painful and inflammatory condition that is often linked to psoriasis. It reportedly impacts nearly 38 million people worldwide (Discover PSA). Individuals who engage in physical activity are impacted by the condition because it can cause stiffness to the joints and inflammation in the ligaments and tendons.

Managing the condition isn’t easy because of the often excruciating pain it causes. The pharmaceutical company Celgene recently sponsored a survey known as MAPP (Multinational Assessment of Psoriasis and Psoriatic Arthritis) to gain a better understanding of the impact psoriasis and psoriatic arthritis have on patients’ lives.

Dr. Mark Lebwohl is a professor and chairman of the Department of Dermatology at Mount Sinai School of Medicine in New York City, and he is also chairman of the National Psoriasis Foundation Medical Board.

Dr. Lebwohl revealed in an interview that the condition can impact anyone and at any age; however, it often affects individuals with European decent. “Interestingly, psoriasis is most common among Caucasians and particularly in Scandinavia and other parts of northern Europe,” he stated.

What is psoriasis?
Psoriasis is a non-contagious chronic inflammatory skin disorder that can vary in severity from minor localized patches to complete body coverage. The majority of people who develop psoriasis have what is known as plaque psoriasis, which appears as patches of raised, reddish skin covered by silvery-white scales; however, there are other types of psoriasis, as well.

What is the difference between psoriasis and eczema?
Both psoriasis and eczema are inherited inflammatory skin diseases, but they differ substantially. In psoriasis, immune cells function in a way that causes skin cells to multiply quickly, resulting in the scaling and redness we call psoriasis. There are several types of eczema, but what they have in common is that, in genetically predisposed individuals, certain triggers result in “epidermal edema” or swelling. This causes severe itching, oozing and occasionally even blistering.

Is psoriasis genetic?
Psoriasis is a disease in which multiple genes combined with external factors (such as certain infections or absence of sunlight) result in the development of skin lesions.

Are psoriasis and psoriatic arthritis long-term illnesses? Can diet help to alleviate the symptoms?
Psoriasis and psoriatic arthritis are both considered chronic conditions, so technically yes; it is true to call them “long-term illnesses.” Many people living with psoriasis and psoriatic arthritis make modifications to their diets in an effort to reduce inflammation in the body. Such modifications are typically considered part of a more comprehensive treatment plan and are usually administered along with medications.

What are the current treatment options?
There are a number of different ways to treat psoriasis, depending on the severity of a person’s condition. Typically, medications fall into the following categories: Topical (meaning medications applied to the skin), therapy with light (called “photo-therapy”), systemic treatments (which can be further categorized as either traditional or “biologic”) or a combination of these choices.

Usually, mild psoriasis will first be treated with topical and/or photo-therapy, with systemic therapies being introduced only if these treatments fail to improve symptoms. With moderate or severe forms of the disease, doctors may prescribe systemic treatments from the beginning.

Why was the MAPP survey conducted?
The insights provided by the MAPP (Multinational Assessment of Psoriasis and Psoriatic Arthritis) survey will certainly help provide a deeper understanding of what patients are experiencing and what they need from us. The MAPP survey is the largest comprehensive survey of its kind, and the first probability survey to look at patients, regardless of whether they are seeing a healthcare provider or are part of an advocacy organization. This survey was also designed to include the perspective of physicians.

What were the main findings of the MAPP survey?
The survey uncovered a number of surprising statistics. One of the most important findings of the MAPP survey was that, overall, psoriasis and psoriatic arthritis patients are largely undertreated, and some are not receiving treatment at all.

  • Nearly 60 percent of psoriatic arthritis patients surveyed said they were not receiving treatment, and the majority of psoriasis patients with four percent or more of their body surface area covered by psoriasis were receiving no treatment or only topical therapy.
  • 85 percent of patients stated there was a need for better therapies.
  • 57 percent of patients who were treated with traditional oral medication discontinued treatment, and 45 percent of patients who used newer “biologic” medications discontinued treatment.

Further information regarding the MAPP survey is available through Discovery PDE4.

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