PSORIATIC ARTHRITIS MEDICAL NEWS

Hello again to all of our PA members and guests. It's time for our
third
edition of the newsletter. Please be reminded that we are providing
this
information for educational purposes and it is not intended as
medical
advice. Articles relating to general health issues can be equally
important
too. Occasionally there may be topics of sufficient value that
warrant a good
discussion with your medical caregivers.
Secondly, I would like to remind all of us who may have abnormal
immune
systems due to PA & P, that flu season is on its way. The flu, which
normally
peaks between January and March, causes the familiar high fever,
chills, dry
cough, headache, runny nose, sore throat, and achy muscles and
joints. It
usually leads to extreme fatigue that lasts several days to weeks.
Influenza
vaccine will soon be available for high risk groups such as the
elderly and
November & December for everyone else.
For our new members who joined after the first two newsletters were
issued,
you can read them by going to PsoriaticArthritis@y... Sign in as
a member, go to the left column and look for the word MESSAGES. Issue
No. 1
is message #15233 (9/03/01) and Issue No. 2 is message #15455
(9/09/01) If
you are unable to access the newsletters, please e-mail me direct at
Cornishpro@a..., and I can forward them on to you.

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FDA OKS FAST REVIEW OF NEW USE FOR IMMUNEX' ENBREL - New york, Sept
17
(Reuters) - Immunex Corp. on Monday said U.S. regulators would give a
speedy
review of the firm's request to widen the approved use of its Enbrel
arthritis drug to include patients with PSORIATIC ARTHRITIS.
The Seattle-based biotech firm said the U.S. Food and Drug
Administration had
granted "priority review'' of its request to market Enbrel for
psoriatic
arthritis. Such reviews typically indicate the FDA will act on a
marketing
request within six months, rather than the 12 months or longer
typical for
most marketing applications.
Psoriatic arthritis affects an estimated 300,000 people in the United
States.
It is a form of arthritis that occurs in people who have psoriasis, a
condition linked to an overactive immune system that causes inflamed
scaly
red patches of skin throughout the body.Enbrel is already approved
for
treating moderate to severe rheumatoid arthritis -- a genetic
condition
affecting an estimated 1.5 million Americans in which the body's
immune
system attacks its own joints and cartilege.

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STUDY BACKS CHOLESTEROL DRUGS SAFETY - September 4, 2001 STOCKHOLM,
Sweden
(AP) - Heart patients worried about the safety of cholesterol-
lowering
medicines known as statins should be reassured by new research
showing that
one of the more established brands is not harmful, experts said.
Heart patients have been nervous since a newer statin, Lipobay -
known as
Baycol in the United States - was pulled off the market three weeks
ago after
being linked with deadly muscle destruction. Some patients have
stopped
taking statins altogether, despite the overwhelming evidence that
they save
lives.
The latest study, led by doctors at Brigham and Women's Hospital in
Boston,
examined Pravachol, generically known as pravastatin, the most
comprehensively studied of the statin drugs. Results were presented
Monday at
a meeting of the European Society of Cardiology.
The findings, involving 20,000 patients followed for five years, were
based
on the safety evidence from three trials combined, so that any
adverse
effects could be more easily noticed.The scientists found that there
were no
more serious side effects among those taking the drugs than among
those
getting fake pills.
"A study like this is quite significant in terms of reassuring
patients that
statins that have been used for 10 to 15 years are, in fact, safe and
that
the concern over a recently developed statin should not be translated
to
those that have been used for years around the world," said Dr.
Sidney Smith,
chief science officer of the American Heart Association, who was not
connected with the research. "We probably can never get enough
information,
and there is always a risk/benefit situation with all drugs," Smith
said. Dr.
John Simes, director of the National Health and Medical Research
Council
Clinical Trials Center at the University of Sydney in Australia, who
conducted one of the original Pravachol studies, said the latest
findings
effectively rule out any problems that could have outweighed the
benefits of
the medication.
Statins, which dramatically lower cholesterol, have been shown to
reduce the
risk of heart attack and stroke by 30 percent. There are four other
statins
being given to patients - Lipitor, Zocor, Mevacor and Lescol. Experts
say
each statin drug should be considered individually because they
differ
slightly in chemical structure.
Bayer Pharmaceutical recalled Lipobay (and Baycol) Aug. 8, after it
was
linked to 31 U.S. deaths and at least nine more in other countries.
Baycol
was tied to rhabdomyolysis, a life-threatening condition in which
muscle
cells are destroyed and released into the bloodstream. The condition,
which
can cause extreme muscle pain, is occasionally so severe that
patients
develop potentially fatal kidney failure.
Some cases were attributed to incorrect dosage, while others were
blamed on
mixing the drug with other medications. About one in 30,000 bad
reactions
could be attributed directly to the tablet, according to Bayer. "If
people
stop taking their medicines because of what they've heard, then this
study
becomes much more important," said one of the investigators of the
latest
study, Dr. Marc A. Pfeffer, a cardiologist at Brigham and Women's and
a
professor of medicine at Harvard Medical School. The study was not
initiated
in response to the recent fears over statins, but was planned in
1995. It was
funded by the drug's maker, Bristol-Myers Squibb Company. Copyright
2001 The
Associated Press. All rights reserved

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FDA SAYS MERCK MISLEADING ON VIOXX - September 26, 2001 WASHINGTON
(AP) - The
government has ordered Merck & Co. to cease promotions aimed to get
doctors
to prescribe its blockbuster arthritis painkiller Vioxx, saying they
minimize
potential safety risks. The Food and Drug Administration told Merck
to set
the record straight by sending a "Dear Doctor" letter to all health
workers
who may have been exposed to the misleading campaign.
Merck has until Oct. 1 to respond. The main issue: Whether Vioxx
users face
an increased risk of heart attacks and strokes. A recent study
comparing
Vioxx to another painkiller, naproxen, suggested they do. Many heart
experts
are divided about the risk and want more research. But an FDA
advisory panel
has said Vioxx should carry a warning label about the potential risk.
Merck has argued that Vioxx falsely looked risky because naproxen
thins the
blood much like aspirin does and thus protected against heart
attacks. It
aired that view in the recent promotions that state, "Vioxx is a
wonderful,
effective" painkiller but not one that has a blood-thinning side
benefit.
"In fact, the situation is not at all clear," the FDA responded,
saying no
studies prove naproxen thins blood enough to explain the discrepancy.
"The company continues to stand behind the overall safety and
cardiovascular
safety of Vioxx," said Merck spokeswoman Jan Weiner. Copyright 2001
The
Associated Press. All rights reserved.

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VITAMINS REPAIR DAMAGE FROM POLLUTION - By Michael Smith Web MD
Medical News
(Sept. 27) - Since pollution doesn't seem to be going anywhere any
time
soon, researchers are looking for ways to help protect our lungs from
the
damaging effects of ozone. Researchers at the University of North
Carolina at
Chapel Hill, in conjunction with the National Institutes of Health,
have
found that antioxidant supplements can reduce the harmful effects of
ozone
gas on our lungs.
Ozone gas, the main chemical in smog, affects millions of Americans
daily,
and previous studies have shown that this highly active gas leads to
decreases in lung function. Since the destructive effects are
believed to be
due to harmful types of oxygen in a process called "oxidation,"
researchers
set out to see if antioxidants, such as vitamins A, C, and E, could
save our
lungs.
They looked at 31 adults and first put them on a vitamin C-restricted
diet
for three weeks. They then gave each volunteer either an antioxidant
supplement or placebo while continuing them on the special diet.
While
exposing everyone to ozone gas for two hours, the researchers
measured lung
function while exercising. As expected, the group taking the
antioxidant
supplements had higher levels of both vitamins C and E in their
blood, but
they also saw that this group had a 25%-30% improvement in lung
function
tests compared to those taking placebo.
The researchers did not find that the antioxidants reduced
inflammation in
the lungs but do believe that antioxidant supplements could be a safe
and
effective way to prevent some of the damaging effects of pollution
and ozone
gas on the lungs. Of course, this is just one study, and we can't
change our
way of living based only on these results, but these findings do lend
support
to antioxidants as one way to save our lungs from the haze and smog
of
everyday living. © 2001 Web MD Corporation. All rights reserved.

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SMOKING, DIABETES, AND SHORT PERIOD OF FERTILITY ASSOCIATE WITH
RHEUMATOID
ARTHRITIS - September 17, 2001 (BMJ Specialty Journals) - Smoking,
diabetes,
and in women, a short period of fertility, are associated with the
development of rheumatoid arthritis, finds a study in the Annals of
Rheumatic
Diseases. Research has so far failed to identify a cause for
rheumatoid
arthritis, but this study also shows that several environmental
factors may
have a role.
Swedish researchers surveyed over 400 patients with rheumatoid
arthritis who
had been treated at a University Hospital clinic between 1980 and
1995. Over
800 randomly selected healthy people were also surveyed. The
questionnaires
included requests for information on lifestyle factors, reproductive
history,
illness, stress, and exposure to a range of potential allergens.
Just over two thirds of the patients and 59 per cent of the healthy
people
responded. The results showed that women who had insulin-dependent
diabetes
were 10 times more likely to have the disease, and those who started
their
periods late and entered menopause early were over twice as likely to
have
rheumatoid arthritis. Prolonged use of hair dyes also doubled the
risk.
Being an ex or current smoker significantly increased the risk of
developing
rheumatoid arthritis for both sexes. And in men this rose according
to the
number of cigarettes smoked every day, with those smoking more than a
pack a
day almost three times as likely to have the disease.
A history of allergies did not increase risk; if anything, it seemed
to do
the opposite. But men who had been repeatedly exposed to mould in
their homes
were over four times as likely to have the disease, while those
living or
working with farm animals were over three times as likely to be
affected.

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GOOD NEWS/BAD NEWS
Osteoarthritis...Good News
The FDA recently approved the hyaluronate sodium compound Supartz for
the
treatment of the pain of knee OA in patients whose pain has not
responded
adequately to nonpharmacologic therapies or simple analgesics.
Supartz, which
is injected directly into the knee joint in a series of five weekly
injections, is the third in a class of products called
viscosupplements
(sometimes referred to as joint fluid therapy) to receive FDA
approvals. The
others are Hyalgan and Synvisc.
Source: Smith & Nephew

Rheumotoid Arthritis...Good News
Short-term physical therapy can have long-term benefits for people
with
rheumatoid arthritis, a new study shows. In a study of 127 patients
with
moderate to severe symptoms, those who underwent six weeks of home-
based
physical therapy continued to experience benefits in pain, grip
strength and
morning stiffness at a 52-week follow up.
Source: Journal of Rheumatology, Vol. 28, No. 1

Ankylosing Spondylitis...Bad News
People with a form of arthritis that affects the spine
(spondylarthropathy),
such as ankylosing spondylitis or psoriatic arthritis, face an
increased risk
of a condition called vitiligo, in which areas of the skin lose their
pigment
and become white. In a recent study of 702 people - 234 who had a
spondylarthropathy and 468 who didn't - those with a
spondylarthopathy were
more than twice as likely to have vitiligo as well. The connection
between
the two conditions is unknown.
Source: Journal of Rheumatology, Vol. 28, No. 1

Sjögren's syndrome...Good News
Lozenges containing interferon alpha (a biological substance that has
the
ability to inhibit viruses) have been shown to improve saliva
production in
people with dry mouth caused by Sjögren's syndrome. In clinical
studies of
256 people with the syndrome, those taking the lozenges three times
daily
produced twice the saliva of those who used a placebo lozenge.
Source:
Amarillo Biosciences

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Editors comment: Our members vary in age, severity of disease,
multiply
diseases, medications, dosages, various abilities to cope, etc. All
of us
have the desire to learn and understand what it is that we are living
with
each and every day. To that end, I will be including extensive
background
information from time to time for those who are just facing a
diagnosis of
Psoriasis and Psoriatic Arthritis. Knowledge doesn't make it go away,
but
through understanding the nature of the beast, it can help. I am
beginning
this part of the newsletter with two areas that may help: 1- How you
Measure
the Severity of your Psoriasis. 2- Current Traditional Methods of
Treatment.
The next newsletter will deal with all the various Alternate
Treatment
Methods. The following articles are from information provided by the
National
Psoriasis Foundation. I urge any of you who are not members to
support this
worthwhile organization. They are a major voice in this country
dealing in an
effective way with psoriasis and psoriatic arthritis.

1. - MEASURING THE SEVERITY OF PSORIASIS
Psoriasis is divided into three degrees of severity: mild, moderate
and
severe. About 75 percent to 80 percent of people with psoriasis have
what is
considered mild disease, and about 20 percent to 25 percent have
moderate to
severe psoriasis. These categories are useful for selecting what
treatments
might be appropriate for individuals with psoriasis.
The physical measure of severity is based on how much skin on the
body is
affected by psoriasis. As a general rule of thumb, the palm of the
hand
represents 1 percent of the body's surface. Severity can also hinge
on how
psoriasis affects a person's quality of life. If psoriasis covers
only a
small area yet is serious enough to be disabling-for example, bad
psoriasis
of the hands or feet-it could be considered a severe case of the
disease.
MILD PSORIASIS
People with psoriasis on less than 2 percent of their body are
considered to
have a mild case. Generally, isolated patches of psoriasis are found
on the
knees, elbows, scalp and hands and feet. Topical treatments-including
moisturizers and over-the-counter and prescription creams, ointments
and
shampoos-are usually sufficient to keep the psoriasis in check.
MODERATE PSORIASIS
Moderate psoriasis is defined as affecting between 2 percent and 10
percent
of the body's surface. Psoriasis may appear on the arms, legs, torso,
scalp
and other areas. Appropriate therapies include topical treatments,
phototherapy and oral medications, depending on the location and
extent of
the psoriasis and other individual factors.
SEVERE PSORIASIS
Psoriasis covering more than 10 percent of the body is considered
severe.
Extensive areas of skin may be covered with psoriasis plaques or
pustules, or
widespread erythrodermic psoriasis can cause severe peeling of the
skin.
People with severe psoriasis are more likely to develop psoriatic
arthritis.
Powerful treatments, including phototherapy, oral medications or a
combination of these, are usually necessary to manage severe
psoriasis.

2. - PSORIASIS THERAPIES - THE GENERAL APPROACH
There are many safe, effective treatments that can improve the
condition of
the skin and reduce the symptoms of psoriasis: swelling, redness,
flaking and
itching. Some therapies can temporarily clear the skin (this is
called a
"clearance" or "remission" of psoriasis), and some can be used over a
period
of time to maintain control over the reappearance of lesions.
Treating psoriasis can be a challenging and long-term proposition,
because
the disease is chronic and unpredictable. It often improves and
worsens in a
natural cycle over time. But with persistence and dedication,
treatment
success can usually be achieved.
The goal in selecting a therapy is to find an approach that has the
best
results and the fewest side effects. It is generally recommended that
people
with psoriasis start with the least potent treatments and move to
stronger
ones until they find an acceptable combination of results and risks.
THE PSORIASIS TREATMENT LADDER
Treatments for psoriasis can be divided into three basic categories:
sunlight
and topical agents (external therapies); phototherapy (artificial
ultraviolet
light, or a combination of ultraviolet light and medications); and
systemic
(internal) medications taken by pill or injection.
Psoriasis therapies can be pictured in relationship to a ladder. At
the
bottom (sunlight and topical treatments) are the weakest treatments
that also
usually have the fewest side effects. The higher up the ladder, the
more
potent the treatments are and the more side effects they generally
have.
Treatments low on the ladder are mostly used for mild psoriasis, and
stronger
therapies up the ladder may become necessary as psoriasis becomes
more severe.
STEP 1 TOPICAL THERAPY - Steroids, Coal Tar, Calcipotriene, Vitamin
A,
Anthralin, Salicylic Acid, Sunlight, Other.
STEP 2 PHOTOTHERAPY - Ultraviolet Light B (UVB), PUVA.
STEP 3 SYSTEMIC MEDICATIONS-Methotrexate, Oral Retinoids,
Cyclosporine,Other
OTHER APPROACHES - Combination Therapy, Rotational Therapy

Step 1: Topical Therapy - Steroids: This class of topical medications
is one
of the most commonly prescribed therapies for mild to moderate
psoriasis.
Steroids are synthetic drugs made to resemble hormones (cortisone,
for
example) that occur naturally in the body. They are available in many
different forms, including ointments, creams, lotions, solutions,
sprays,
foam and tape. Steroids are generally effective at treating the
inflammation
that occurs with psoriasis. They come in a wide range of strengths,
although
the weakest, over-the-counter steroids are not helpful in treating
psoriasis.
Stronger steroids are usually more effective, but the risk of side
effects is
greater, and some potent steroids are not appropriate for psoriasis
in
certain areas (such as the skin folds or genitals). Common side
effects from
overuse or misuse of steroids include thinning of the skin, easy
bruising and
stretch marks.
Coal Tar: Topical coal tar preparations have been used for centuries
to treat
the scaling, inflammation and itching of psoriasis. Over-the-counter
products
with tar concentrations of 0.5% to 5.0% are approved by the U.S. Food
and
Drug Administration for treating psoriasis. Tar shampoos are very
often
effective for scalp psoriasis.Tar can be used by itself, and it is
often
combined with ultraviolet light B (UVB). Coal tar may make the skin
more
sensitive to ultraviolet light, so extreme caution is advised when
tar is
combined with UV therapy or sunlight-a severe burn can occur. Tar
products
stain clothing and linens, and some people may find certain products
irritating to the skin.
Calcipotriene: Calcipotriene is a synthetic form of vitamin D3 used
for
treating mild to moderate psoriasis. Sold as Dovonex in the U.S.,
this
prescription medication is available in a cream, an ointment and a
scalp
solution. It is not known for working quickly, but it is effective
and safe
for long-term control of psoriasis, with few side effects.
Dovonex is often prescribed in combination with other therapies,
including
topical steroids and ultraviolet light B (UVB). The drug is not
recommended
for treating psoriasis on the face, and it can cause temporary skin
irritation. To avoid the medication being absorbed internally, people
are
advised not to use more than 100 grams of Dovonex cream or ointment
or 60
milliliters of scalp solution in a week.
Vitamin A - Tazarotene is a prescription topical retinoid (or vitamin
A
derivative) approved for treating mild to moderate plaque psoriasis.
Sold in
the U.S. under the brandname Tazorac, this medication is available in
a gel
in two strengths: 0.1% and 0.05%. It only needs to be applied once
per day,
and Tazorac can be used to treat scalp psoriasis and nail psoriasis,
as well.
Tazorac can be prescribed by itself, but more and more dermatologists
are
prescribing it in combination with a topical steroid. The results are
better,
and the side effects are reduced-particularly the skin irritation
that
Tazorac can cause. The drug may also cause the psoriasis plaque to
turn red
before it clears, but this is a normal reaction and it will go away.
Anthralin - Anthralin is a prescription topical medication that has
been used
to treat psoriasis for more than 100 years. It is available in cream
form and
as a solution for scalp psoriasis, and physicians and pharmacists can
compound stronger formulations. Anthralin can be very effective for
mild to
moderate psoriasis, with the important added benefit of having no
long-term
side effects. It is often used in combination with ultraviolet light
B (UVB)
treatments for more severe psoriasis. However, the medication does
have two
key drawbacks: it can be irritating to the skin, and it has the
tendency to
stain anything it touches, including skin, clothing, linens and
bathroom
fixtures. Through special treatment regimens, the irritation and
staining can
be managed, but these problems have limited the use of anthralin,
particularly in the U.S.
Salicylic Acid - In strengths of 1.8% to 3%, salicylic acid is
approved by
the U.S. Food and Drug Administration as an over-the-counter
treatment for
psoriasis. It is a keratolytic, which means it is used to soften and
remove
scale from psoriasis plaques. Removing scale is important, because it
allows
topical medications to reach and penetrate the skin. Salicylic acid
is
available in many forms, and it is often combined with other topical
medications to enhance their effectiveness.
Sunlight - Ultraviolet light can clear or significantly improve
psoriasis
lesions for many people. The most effective wavelength, ultraviolet
light B
(UVB), is found in natural sunlight. Sunbathing on a regular schedule
with
careful monitoring of exposure is the wisest approach. Using sunshine
and
other natural elements like salt water to treat psoriasis is called
climatotherapy. A sunburn can cause psoriasis to get worse.
Unaffected skin
should be covered or protected with sunscreen to reduce UV exposure.
Sunbathing increases the risk of skin cancer, and those who sunbathe
regularly should schedule a yearly skin exam with a physician.
Other - There are many other remedies and treatments that people can
use at
home to help control their psoriasis. Moisturizing the skin is an
important
part of psoriasis care. Keeping the skin moist helps reduce
inflammation and
itching and promotes skin flexibility. The key to using moisturizers
is to
apply them regularly. Soaking in water can soothe the skin. Adding
certain
over-the-counter products to the bath, including tar solutions, oils,
Epsom
salts, Dead Sea salts and oilated oatmeal, may be helpful in removing
scale
and reducing itching.
Occlusion therapy involves covering the skin with an airtight,
waterproof
wrapping of a mild to moderate steroid or moisturizer. This enhances
the
penetration of the topical product and can help clear psoriasis,
particularly
stubborn, localized plaques. Occlusion of steroids or other
prescription
medications should only be done under the supervision of a physician.

Step 2: Phototherapy - Ultraviolet Light B (UVB) This type of
treatment
involves exposing the skin to a particular wavelength of ultraviolet
light
called UVB. It is a common, safe and very effective treatment for
moderate to
severe psoriasis or localized areas of stubborn plaques. It may be
used alone
or in combination with topical or systemic treatments.
Three to five treatments per week for one to two months are usually
required
for most patients to reach clearing. A maintenance schedule of one or
two
treatments a week may help prolong remissions.
Most people get UVB treatments at doctors' offices or clinics.
However, under
a doctor's supervision, a person can get a prescription to purchase a
home
UVB unit. This is not the same as a tanning bed; home phototherapy is
a
medical treatment that must be monitored by a physician.
There are two types of UVB treatment generally found in the United
States:
broad-band and narrow-band. The main difference is in the wavelength
of light
that is emitted by the equipment. Broad-band UVB has been around for
a long
time and is more common in doctors' offices and in home phototherapy
units.
Narrow-band UVB is newer, but it is becoming more widely available.
PUVA - PUVA involves the use of a prescription medication called
psoralen and
exposure to ultraviolet light A-hence the acronym PUVA. It is also
called
"photochemotherapy." The drug psoralen, which is taken by pill or
applied
topically to the skin, makes the skin more sensitive and responsive
to this
particular wavelength of UV light. PUVA clears or dramatically clears
psoriasis for more than 75% of patients and can lead to extended
remissions.
However, due to the risks involved, PUVA is recommended only for
moderate to
severe psoriasis or disabling psoriasis when other treatments don't
work.
Long-term PUVA therapy can lead to premature aging of the skin and
increase a
person's risk of skin cancer. The level of risk is related to several
factors, including the patient's skin type, the number of treatments
and the
cumulative "dose" of UVA light administered to the skin.

Step 3: Systemic Medications - Methotrexate - Methotrexate is the
most
commonly prescribed systemic medication for severe and disabling
psoriasis.
It is taken orally or given by injection once per week, in a single
or split
dose. Methotrexate has a long history of proven effectiveness in
clearing or
greatly improving psoriasis, including erythrodermic and pustular
forms of
the disease. Due to the possible risks associated with methotrexate,
extremely careful monitoring is required. Short-term side effects
include
nausea, fatigue, loss of appetite and mouth sores. When certain
dosage limits
are reached over the long term, a liver biopsy may be necessary to
verify
that the drug is not damaging the organ. Methotrexate should not be
used by
pregnant women or men or women who are trying to conceive.
Oral Retinoids - The retinoid family of drugs is related to vitamin
A.
Acitretin (prescribed under the brandname Soriatane in the U.S.) is
the only
approved retinoid for treating severe cases of psoriasis. It is
effective for
pustular and erythrodermic types of psoriasis, but alone, it does not
work as
well on severe plaque psoriasis as some other drugs. Acitretin is
also
commonly prescribed in combination with other therapies, particularly
UVB and
PUVA. Isotretinoin (brandname Accutane) is an oral retinoid best
known for
treating severe cystic acne, although it is prescribed in some cases
of
severe psoriasis. This medication is not as effective as acitretin.
While
retinoids are generally safe for long-term use, they all carry the
risk of
causing birth defects in developing fetuses if the mother is using
the drug.
Acitretin and isotretinoin are safer than older oral retinoids that
are no
longer available, however women who take them must still wait a
certain
amount of time before safely attempting to become pregnant. People
taking
oral retinoids should not take vitamin supplements containing vitamin
A, and
those taking acitretin should avoid alcohol.
Cyclosporine - This drug, which suppresses the immune system, was
originally
developed to prevent the rejection of transplanted organs.
Cyclosporine is
approved for treating severe psoriasis in those people who cannot
take or
have not responded to other systemic therapies. It is available in
either
capsule or liquid form, which must be diluted for use. Cyclosporine
generally
works very well at improving or clearing psoriasis, and it is
considered
quick acting: results may be seen in as little as two weeks. However,
cyclosporine has the risk of causing high blood pressure and damaging
kidney
function, and while these side effects are usually reversible if
treated
promptly, they are real and potentially serious. This medication is
not
approved for continuous treatment of more than one year.
Other Medications - Several other systemic medications have been used
over
the years for treating severe psoriasis, but they are prescribed less
often
than the drugs mentioned above. Hydroxyurea, sulfasalazine, 6-
thioguanine and
mycophenolate mofetil have all shown some effect in improving
psoriasis. Each
has its own risks and side effects, and none has been approved for
treating
this disease. Even so, they provide patients and physicians with
additional
therapeutic options.
Other Approaches: - Combination Therapy - When psoriasis is
resistant to one
therapy, a combination of treatments may be the answer. Such a
combination
can result in quicker response and may reduce the side effects.
Examples
include prescribing a low dose of acitretin in combination with UVB
or PUVA,
or using tazarotene in combination with a topical steroid. Patients
should
talk to their physician about possible combinations of treatments
that could
work for their individual case of psoriasis.
Rotational Therapy - All of the therapies used for treating moderate
to
severe psoriasis have risks and side effects. Rotating these
treatments can
minimize a patient's exposure to the toxic properties of these
therapies, and
people avoid becoming resistant to certain treatments. Five therapies
used in
rotation for extensive psoriasis are tar plus UVB, PUVA,
methotrexate,
acitretin and cyclosporine. One treatment is used for 12 to 36
months, and
then another is used, and so forth.
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I always welcome your comments and suggestions. Thanks and good
health to all.

Jack Nicholas
Cornishpro@a...
Issue 2001 10/18-3