There has been much recent work carried out on the genetic predisposition to the condition of psoriatic arthritis although nothing is as yet fully clarified.
There are now a number of different drug treatments for this disorder and in the last few years trials of these drugs have been published in international and national journals showing their efficacy to suppress the disease.
Why then do many sufferers from psoriatic arthritis not receive these drug treatments and continue to be told by general practitioners and rheumatologists that there is nothing that can be done for them at the present time? This seemingly negative attitude causes much frustration and distress to the sufferers and their relatives. The answer to this question lies both in the nature of psoriatic arthritis and the types of drugs that are available.
Except in its very severest form which occurs in less that 5% of sufferers, psoriatic arthritis is a very much milder disease than the other common forms of arthritis such as rheumatoid arthritis or ankylosing spondylitis. Indeed it does not cause as much disability when attacking the lower limbs as osteo-arthritis, and tends to be confined to a few joints and damage to these joints is slow and less destructive than that caused by rheumatoid arthritis.
In addition flare ups from psoriatic arthritis tend to settle down and may be followed by some years of remission during which time no drugs or treatment are required and a completely normal life can be led.
The dilemma for the rheumatologist in treating patients with psoriatic arthritis is to try and identify those patients who belong to a group who will become severely disabled. Except in a few cases this is not usually obvious in the first year or two of the disease and since the majority of patients with psoriatic arthritis will only be mildly affected, clearly simple local treatment and advice and the use of the safest drugs possible are all that will be recommended.
Drugs used to treat any disease necessarily carry side effects, many of them maybe serious, others uncomfortable for patients. The treatments used for rheumatic diseases are no exception to this. Even the mildest of drugs available across the counter, such as paracetamol, asprin or Ibuprofen can cause indigestion or damage to the liver or kidneys if used long term and in the case of the latter to gastro-intestinal bleeding. The more powerful anti-inflammatory drugs, which are only available on prescription, also have a heavy burden of side effects, particularly on the gastro-intestinal tract and others drugs may have to be given alongside so as to try and prevent these side effects.
Newer drugs certainly have and will revolutionise the treatment of rheumatic diseases, enabling many patients to lead a normal and relatively pain free life but need to be prescribed with circumspection and after discussion between patient and doctor so that all the risks and benefits are understood.
The more powerful drugs available for the treatment of psoriatic arthritis are not curative but may suppress the disease to a significant degree, cut short an acute attack and prevent or delay long term damage to the joints. Their side effects are however far more severe and include damage to the bone marrow, kidneys, liver and skin.
Although these side effects can be prevented in some instances or minimised in others, most of them are reversible, provided that the patient is regularly monitored. Nevertheless they occur in large numbers and many patients, their relatives and doctors find this unacceptable. A balance therefore has to be struck in deciding the treatment required for a patient, by putting the risks of the disease to the patient and the likely benefits of the drug and the risks of the side effects. In many patients with psoriatic arthritis the balance will come down on the side of drug risk. Nevertheless any patient should have a chance to discuss with their doctor, the types of treatment available for psoriatic arthritis, the risks of the drug and the reasons why these drugs might or might not be used in their particular case. The right for these discussions and the chance to give informed consent for the use of the drugs is now a patients right.
People with psoriatic arthritis should be prepared to ask questions of their doctors during consultations and should equally be prepared to take decisions for themselves as to whether they will or will not accept modern drug treatment for their condition.
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