PSORIATIC ARTHRITIS NEWS AND VIEWS
VOLUME- 4 ISSUE- 15
October 31, 2004
PSORIATIC ARTHRITIS MEDICAL NEWS
Editorâs note: I am providing multiple articles from different sources
regarding the current Cox-2 controversy.
U. S. DOCTORS RECEIVE BEXTRA WARNING
Oct. 15, 2004 -- Bextra -- one of two U.S. approved Vioxx sister drugs --
may cause rare skin and heart side effects, its manufacturer today warned
doctors.
The warning comes in the wake of Merck's voluntary withdrawal of Vioxx. That
action came after a clinical trial confirmed that Vioxx increased patients'
risk of heart attack and stroke.
Since then, there's been an upsurge of attention on Bextra and Celebrex.
Like Vioxx, these drugs -- both made by Pfizer, a WebMD sponsor -- are in the
drug class of Cox-2 inhibitors. All these drugs are effective in relieving
arthritis pain. Because they have the same mechanism of action, a lot more
attention is being paid to whether these drugs might also increase heart risk.
Some doctors are now calling for more studies. They're worried that few
clinical trials of these drugs have looked at people with existing heart
disease.
Many arthritis patients also suffer or are at high risk of heart disease.
But so far, there's no hard evidence that Celebrex increases heart risk, says
Mitch Gandelman, MD, Pfizer vice president for worldwide medical, oncology,
and pain information.
"In Celebrex, we have much more data than with Bextra," Gandelman tells
WebMD. "We have a slew of studies. ⦠We have no knowledge from those studies
of
any heart safety issues with Celebrex. So we have a green light to move ahead."
To date, there's no evidence that Bextra increases heart risk in arthritis
patients without heart disease. But new studies of Bextra alone or in
combination with parecoxib raise a red flag. Parecoxib is an injectable Cox-2
inhibitor nearly identical to Bextra. It's approved in Europe -- but not the
U.S. --
for postoperative pain.
Pfizer today said it is warning doctors that new data from a recently
completed clinical trial -- together with a study published in 2003 -- show an
increase in "cardiovascular events" in patients undergoing heart bypass surgery.
Bextra is not currently approved in the U.S. for surgery patients.
"With Bextra, we have studies going out one year -- but we don't have as
much data as we do for Celebrex," Gandelman says. "Now we have data in coronary
artery bypass graft studies that there is some heart risk. But we feel this is
very specific to those patients and not indicative of the osteoarthritis or
rheumatoid arthritis populations."
Gandelman says that Bextra and Celebrex studies continue. He says the
company is also considering launching new theoretical studies -- to look at ways
the drugs might cause problems -- as well as practical safety studies. In
addition, he says, the company will continue to change the drugs' labels to
reflect new knowledge as it becomes available.
Since 2002, Bextra's label has warned patients that the drug may cause rare
but serious skin reactions. Now Pfizer warns that Bextra causes such reactions
more often than other Cox-2 inhibitors. The risk of these skin reactions,
Pfizer says, is greatest during the first two weeks of Bextra treatment.
What Arthritis Doctors Are Saying
On the front lines of the Vioxx/Cox-2 furor is Stephen M. Lindsey, MD, head
of the rheumatology department at the Ochsner Clinic in Baton Rouge.
"My physician assistant and I are in the trenches - we're the ones answering
all these phone calls," Lindsey tells WebMD.
What Lindsey is telling patients is simple: Don't get too hysterical. Not
everybody who took Vioxx - and not everybody who is taking Bextra or Celebrex -
is going to have a problem.
"It's not like everybody is going to keel over from a heart attack," Lindsey
says. "Certainly when patients get into their 60s and 70s, arthritis and
heart disease run together. Those are the kind of people who, with all this
information coming out, would be smart to see their doctor and make sure they
are
being treated properly for heart disease before taking one of these [Cox-2]
drugs. But people, who are young, with no heart risks, don't necessarily have
to worry if they are on Bextra or Celebrex."
No single arthritis drugs works for every patient. Some patients, Lindsey
says, are lucky. They get relief from the first thing they try: Tylenol,
perhaps, or maybe Aleve. Others run through many different medications before
finding one that works. If the only thing that works for a particular patient is
a
Cox-2 drug, it's probably a good idea for that patient to be sure to keep his
or her heart risk low.
And, Lindsey says, not everyone with arthritis needs a drug
"I always emphasize that for people with mild arthritis, there are a lot of
things to try before prescription drugs," he says. "Try exercise, weight loss,
Tylenol, over-the-counter supplements like glucosamine, or oils like omega-3
fatty acids. A lot of these simple measures might be work without having to
worry about drugs with more toxicity."
SOURCES: Stephen M. Lindsey, MD, head of rheumatology department, Ochsner
Clinic Foundation, Baton Rouge. Pfizer news release, Oct. 15, 2004. Mitch
Gandelman, MD, vice president for worldwide medical, oncology, and pain
information, Pfizer, New York. Ott, E. Journal of Thoracic and Cardiovascular
Surgery,
June 2003; vol 125: pp 1481-1492. © 2004 WebMD Inc. All rights reserved.
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PFIZER WARNS OF ARTHRITIS DRUG HEART RISKS
Anti-inflammatory Bextra in the same class as Vioxx
NEW YORK - Pfizer Inc. on Friday said two small clinical trials showed heart
bypass surgery patients taking Bextra, an anti-inflammatory in the same
class as the recently withdrawn drug Vioxx, had a higher risk of stroke and
heart
attack.
Bextra is approved to treat pain from arthritis and, like Merck & Co.âs
Vioxx, is a COX-2 inhibitor. A recent trial showed Vioxx doubled the risk of
heart attack and stroke in arthritis patients who took the drug for more than 18
months.
The Vioxx withdrawal has cast a cloud over the entire class of COX-2
inhibitors, which includes Bextra, Celebrex and an experimental drug from
Novartis
AG called Prexige.
However, Pfizer said that following the Vioxx withdrawal it re-examined its
clinical database of 8,000 patients with rheumatoid arthritis and
osteoarthritis and found no increased risk of so-called heart events in
patients taking
Bextra for up to a year. The company also found no increased risk in a trial
of patients taking Bextra in a general surgery setting.
Doctors said it is too early to quantify the potential risk of Bextra or of
Pfizerâs other COX-2 inhibitor Celebrex as neither have tested for long
enough. Pfizer said it is conducting longer-term trials in arthritis patients.
The coronary bypass trials are ones that Dr. Eric Topol of the Cleveland
Clinic Foundation and an early and outspoken critic of Vioxx, said he finds
concerning as they show a cluster of heart attacks and strokes. But he said the
danger signal does not appear to be as strong as it was with Vioxx.
âCelebrex and Bextra do appear safer than Vioxx but whether they are really
safe, especially in patients with heart risk, thatâs an open question,â
Topol
said.
Pfizer also said it is updating its label on Bextra to strengthen a warning
about a rare but serious skin reaction that can occur mainly within the first
two weeks of therapy. Copyright 2004 Reuters Limited. All rights reserved.
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SAFETY OF ALL COX-2 DRUGS QUESTIONED
Expert says they work on same heart mechanism as recalled Vioxx
By E.J. Mundell - HealthDay Reporter
FRIDAY, Oct. 8 (HealthDayNews) -- A week after drug giant Merck & Co.
withdrew its arthritis drug Vioxx from the market, doubts are being raised about
the safety of the two other approved medications in this class, Bextra and
Celebrex.
In an article released Thursday by the New England Journal of Medicine, an
expert with a long history of research in the cox-2 inhibitor class of
medications said cardiovascular problems seen with Vioxx might yet surface with
the
other two drugs.
The problem, said Dr. Garrett A. FitzGerald, is that all cox-2 inhibitors
suppress the production of a heart-protecting fat called prostaglandin I2.
"Vioxx, Celebrex and Bextra all have the same effect on this biochemical
system. Therefore, until proven otherwise, evidence would suggest that this
mechanism would involve all drugs in this class," explained FitzGerald, who is
chairman of pharmacology at the University of Pennsylvania's Institute of
Translational Medicine and Therapeutics.
After halting a study suggesting that long-term Vioxx users faced double the
risk of heart attack or stroke compared to non-users, Merck announced Sept.
30 it was pulling the drug from markets worldwide.
A day later, Pfizer Inc. -- Merck's main rival in the billion-dollar
arthritis medication market -- issued a statement defending its biggest cox-2
drug,
Celebrex.
Citing a number of ongoing, long-term studies, Pfizer's president of
worldwide development, Dr. Joe Feczko, said, "the data we've accumulated over
time
demonstrate that Celebrex does not increase the risk of serious cardiovascular
events in patients with arthritis and pain, even at higher-than-recommended
doses."
One top U.S. Food and Drug Administration official echoed those sentiments.
Dr. Steven Galson, acting director of the FDA's Center for Drug Evaluation and
Research, told reporters at a press conference last week that cox-2
inhibitors other than Vioxx "do not have this same incidence of heart attack
and
stroke in clinical trials. There is a real difference in the data."
But FitzGerald said he remains uneasy.
"Back in 1999, we performed studies on Celebrex and Vioxx, and we showed
that they had an effect on the same mechanism whereby they relieved pain and
inflammation," he explained. That mechanism -- inhibition of an enzyme called
cyclooxygenase-2 -- leads to reductions in lipids called prostaglandins.
These prostaglandins "are responsible for pain and inflammation, and they
also protect the stomach" so Vioxx users got needed relief without the
gastrointestinal upset often associated with other pain relievers, FitzGerald
explained.
Unfortunately, prostaglandins, especially prostaglandin I2, "are also
responsible for protecting the heart," he added.
The bottom line, according to FitzGerald, is that as cox-2 drugs soothe
arthritis pain and reduce risks for gastrointestinal symptoms, they may also
raise cardiovascular risks over the long term. That turned out to be the case
with Vioxx.
But what about long-term use of Celebrex, or the other Pfizer cox-2
inhibitor, Bextra?
Right now, "we just don't have a handle on 'how long is long,'" FitzGerald
said. "In the [Vioxx] trial, nothing much happened to patients for a year, and
then things started to come apart. But maybe with other drugs, other
circumstances, or in other types of patients, it may be two years, three years
--
who knows?"
FitzGerald believes that, given the failure of Vioxx, "the burden of proof
has now shifted" to Pfizer and the FDA.
He also believes the time has come for the FDA, especially, to take the
lead. "I'd really like the FDA, in short order, to give us some advice one way
or
another, based on their best guess, as to what people at high cardiovascular
risk should do," FitzGerald said.
The FDA faced much harsher criticism in a second article released in the
same journal. The journal's editors released the articles -- originally
scheduled for Oct. 21 publication -- early because of concerns surrounding the
use of
Vioxx.
In that second report, Dr. Eric J. Topol, a cardiovascular expert at the
Cleveland Clinic Foundation, says his team reviewed the available data on Vioxx
and Celebrex as far back as 2001, and at that time strongly recommended "a
trial specifically assessing [the] cardiovascular risk and benefits of these
agents."
He claims that although the FDA had the power to order such a trial, "it
never took the initiative," while at the same time letting Merck spend more than
$100 million in direct-to-consumer ads promoting Vioxx.
In the meantime, he writes, "tens of thousands" of patients taking Vioxx may
have suffered heart attacks or strokes linked to their use of the drug.
And on Thursday, Sen. Charles Grassley (R-Iowa) alleged that the FDA tried
to suppress a top safety official in the agency who raised concerns over the
safety of Vioxx.
David Graham, associate science director of the Office of Drug Safety, told
Grassley that agency officials "ostracized" him and subjected him to "veiled
threats" as he tried to have his study cleared for publication, the Washington
Post reported. When another top FDA official suggested "watering down" the
report, Graham said in an e-mail: "I've gone about as far as I can without
compromising my deeply held conclusions about this safety question."
Grassley made the accusations in a press release, which also said, "Instead
of acting as a public watchdog, the Food and Drug Administration was busy
challenging its own expert and calling his work 'scientific rumor,'" according
to the Post account. An FDA spokesman told the paper the allegations were
"baloney."
"I believe that there should be a full Congressional review of this case,"
Topol wrote. "All the facts can and should be scrutinized closely in a
Congressional review in order to avert such a catastrophe in the future."
SOURCES: Garrett A. FitzGerald, M.D., chairman, pharmacology, Institute for
Translational Medicine and Therapeutics, University of Pennsylvania,
Philadelphia; Oct. 1, 2004, statement, Pfizer Inc.; Oct. 1, 2004, press
conference,
U.S. Food and Drug Administration, Rockville, Md.; Oct. 21, 2004, New England
Journal of Medicine; Oct. 8, 2004, Washington Post
Copyright © 2004 ScoutNews, LLC. All rights reserved.
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ARTHRITIS PATIENTS TRY MEDITATION FOR PAIN
Stress-relief technique may reduce need for medication - The Associated Press
BALTIMORE - Dalia Isicoff knows pain. A lifelong sufferer of rheumatoid
arthritis, she has had seven hip replacement surgeries.
Since leaving the hospital in February following her latest operation,
however, she hasnât taken any painkillers. Not because the pain isnât there
â it
is. But Isicoff, 52, said she has learned to accept the pain, the disease, and
herself, thanks to meditation.
âWhen you have an illness like this, what one tends to do is say, âOh, my
God! Here we go again, this is going to render me disabled, Iâm going to wind
up in a wheelchair!â and you rush to the medicine cabinet,â she said.
âThis
has allowed me to have the patience to deal with these flare-ups and become
relaxed enough so the need for pain medication is almost not there.â
The 52-year-old Clarksville resident said meditation has made her symptoms
less severe, helping relieve stress that she said made the condition worse.
âWith this type of approach, you learn to acknowledge you have pain and, by
realizing it and by being in this relaxed state, the pain is less,â she said.
Researchers at the University of Maryland School of Medicine in Baltimore
are studying others like Isicoff to see if meditation helps sufferers of the
autoimmune disorder, which affects about 2.1 million Americans, mostly women.
Those with the disease often have general fatigue, soreness, stiffness and
aches at first. Joints may swell and become damaged over time.
'Mindfulness' technique counters stress
Groups of rheumatoid arthritis patients are being trained in âmindfulness,â
a form of stress reduction meditation developed 30 years ago at the
University of Massachusetts. Their progress is being compared to patients not
in the
program.
Mindfulness is similar to many meditation techniques. Participants are
taught to focus on breathing to quiet the mind and become aware of the moment.
The method has been used successfully to help patients with chronic pain
from a variety of conditions, but this marks the first time it is being studied
to see if it can help the physical and psychological symptoms of rheumatoid
arthritis patients, said Lisa Pradhan, one of the study leaders for the
University of Marylandâs Center for Integrative Medicine.
Evidence suggests flare-ups of the disease are associated with stress, she
said.
Thirty-six patients took an eight-week course that started in March. Results
from the first group are not available yet, but âthe people who have come
through the study have been very pleased to have been involved with it,â
Pradhan said.
Trish Magyari, director of the mindfulness program, said participants are
taught to âquiet the mind and feel more connected to your body.â
Isicoff said she tries to meditate in the morning and at night, although
mindfulness can be as simple as being aware of feeling the wind on your skin.
Such a simple process, however, can be difficult to put into practice, she
said.
âMost of us have this crazy internal dialogue,â she said. âFor me, it was
difficult to say, âI want to relaxâ and, âI donât want to think.â You
learn
to be an observer of the thought. Itâs sort of best to acknowledge it: âOh,
there you are,â thereâs a judgment, thereâs an angry thought, and the
moment
you acknowledge them, they go away.â
Eventually, she said she learned to be patient â with herself and the
situation.
âYes, I have the arthritis and the suffering, but it doesnât have to be so
negative, so devastating, focusing on that thing day in and day out and not
knowing, not believing that it can get better,â Isicoff said.
âYou learn to cultivate other areas of your life that are there, that are
untapped. When someone is in that frame of mind you can handle anything, you can
be more compassionate. You donât put yourself down so much; you donât have
to struggle with yourself trying to be perfect.â © 2004 The Associated
Press.
All rights reserved.
*********************************************************
BAROMETER TIED TO ARTHRITIS FLARE-UPS
By Janice Billingsley - HealthDay Reporter
MONDAY, Oct. 18 (HealthDayNews) -- For years, arthritis sufferers have
insisted that changes in the barometer and cold weather worsen their joint pain,
and now new research backs them up.
"We see this all the time with our patients. People swear to their grave
that the weather affects their arthritis," said Dr. Sam Lim, a rheumatologist at
the Emory University School of Medicine in Atlanta. "But this is the first
time we have nice, independent data that seems to correlate one with the
other."
The researchers began by examining two separate sets of data -- one
consisting of weather reports, and one of arthritis sufferers' pain reports. The
scientists found that when they matched the weather to the ZIP codes of the
patients, there was a strong correlation between changes in barometric pressure
and increased knee pain. To a lesser extent, cooler temperatures were also
associated with an increase in pain.
Results of the study were presented Oct. 17 at the American College of
Rheumatology annual meeting in San Antonio, Tex.
The study's lead investigator, Dr. Timothy E. McAlindon of Tufts-New England
Medical Center in Boston, said previous research efforts that have tried to
document a link between weather changes and arthritis symptoms had been
undermined by people's strong opinions on the matter; those biases influenced
the
reports. But by relying on sets of data that were independent of each other,
the new study allowed the scientists to conduct a "robust" review that really
does suggest an association between weather and aches and pains, he said.
Lim added, however, that it's important to note that, while the new research
shows an association between weather and pain, "it doesn't mean that the
weather changes cause an increase in pain. That's the next step."
For the study, the researchers merged data from an online glucosamine trial
(a large-scale study of an over-the-counter arthritis treatment) with National
Oceanic and Atmospheric Administration (NOAA) weather data. The glucosamine
study, which was conducted across 41 states from 2000 to 2002, tracked 205
arthritis patients who reported on their arthritis pain for a three-month
period.
Only after the study was completed did McAlindon and his colleagues begin to
look at weather patterns where the study participants lived. The scientists
first identified the nearest weather station by ZIP code for each of the study
participants. Then they examined daily weather reports from NOAA that
identified the temperature, barometric pressure, rainfall, and dew points for
the
locations of each of the participants for the three months they took part in
the study. The scientists averaged the weather reports from one, three, and
seven days prior to each person's report of pain, and then looked for any
change in each measure in the 24 hours before each pain report.
They found that changes in barometric pressure had a strong association with
knee pain, as did cooler temperatures, although to a lesser extent. Rainfall
and dew points had no significant associations, the researchers said.
SOURCES: Timothy McAlindon, M.D., M.P.H., chief, Division of Rheumatology,
Tufts-New England Medical Center, Boston; Sam Lim, M.D., assistant professor of
medicine, department of rheumatology, Emory University School of Medicine,
Atlanta; Oct. 17, 2004, presentation, American College of Rheumatology annual
meeting, San Antonio, Tex.
Copyright © 2004 ScoutNews LLC. All rights reserved.
*******************************************************
CANCER DRUG MAY HELP FIGHT ARTHRITIS
Medication could offer targeted treatment for disease - The Associated Press
For the first time, a drug has relieved rheumatoid arthritis by knocking out
a certain type of immune cell â an approach that could open the way for
precisely targeted, âsmartâ treatments for the joint disease and other
illnesses, too.
Other arthritis drugs on the market either treat just the symptoms, or
employ a broader, more scattershot effect against the underlying process. Such
drugs can have toxic side effects because they kill healthy cells along with the
diseased ones.
The latest research, an international study led at University College London
and published in Thursdayâs New England Journal of Medicine, looked at a
drug called rituximab, and the results were promising.
'A new era of targeted biologic therapies'
âI think this is a pivotal study,â said Dr. John Klippel, president of the
Arthritis Foundation. âThis is opening up a new era of targeted biologic
therapies for rheumatoid arthritis.â
In rheumatoid arthritis, antibodies misdirect friendly fire against the bodyâ
s own joint linings. Joints become inflamed, swollen and painful. More than
2 million Americans, mostly women, have the disease.
Rituximab, which is sold under the brand name Rituxan and is already
approved for non-Hodgkinâs lymphoma, targets B cells, which manufacture these
antibodies.
The researchers compared rituximab to other drugs in 161 patients with
arthritis.
For two weeks, patients took rituximab alone or in combination with two
other drugs: the standard drug, methotrexate, and the less widely used
cyclophosphamide. Another group took methotrexate alone. Roche, a distributor of
rituximab, funded and participated in the study.
After six months, more than 40 percent of patients who took rituximab
combinations were greatly improved. One-third of patients on rituximab alone
were
greatly improved. But only 13 percent of those on the standard drug alone
improved that much.
âOne of the things that are truly unique is that a very short course appears
to have a very long-lasting effect,â Klippel said.
Similar approaches being tested
Some doctors, including the studyâs authors, said rituximab needs more
testing before any widespread use. They said other B-cell-killing drugs are
under
development and could eventually outperform rituximab.
Researchers are also testing similar targeted approaches against lupus,
multiple sclerosis and other autoimmune diseases.
Both methotrexate and cyclophosphamide are sometimes employed as
chemotherapy drugs and attack a broader range of tissue than rituximab. The
newer drug
kills close to 90 percent of B cells, which the body then replenishes with
healthy new ones.
Rituximab is one of the most narrowly aimed and efficient members in the
modern family of targeted drugs that include the breast cancer treatment
Herceptin.
Of all the tested treatments for rheumatoid arthritis, âit goes closest to
the root of the disease,â said the studyâs lead author, Dr. Jonathan Edwards
of University College London.
However, the drug could pose a danger of chest infection, especially if
given repeatedly, Edwards said. One rituximab patient in the study died of
pneumonia, though it was not clear if the drug was responsible. © 2004 The
Associated Press. All rights reserved.
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CHOLESTEROL DRUGS MAY FIGHT ARTHRITIS
Statins helped reduce swelling in three joints, study finds - Reuters News
Service
LONDON - Cholesterol-lowering drugs, already widely used to cut the risk of
heart attack and tipped as a prevention for some cancers, may also help fight
rheumatoid arthritis, scientists said..
Researchers from the Glasgow Royal Infirmary in Scotland found a small but
statistically significant improvement in arthritis symptoms in patients given
40 mg of Pfizerâs Lipitor daily in addition to standard arthritis medication.
The news underscores the reputation of cholesterol-lowering statins -- the
worldâs top-selling drug class with global sales of $22 billion a year -- as
potential wonder pills.
Already hailed for revolutionizing the management of heart disease, statins
are also being studied in the fight against multiple sclerosis, Alzheimerâs
disease, glaucoma and osteoporosis, as well as in preventing various forms of
cancer.
The new study reported in The Lancet, which involved 116 patients randomly
allocated to receive Lipitor or a placebo for six months, was the first
controlled trial of a statin in rheumatoid arthritis.
Reduction of swelling
It adds to a growing body of evidence that statins could have important
anti-inflammatory properties, since rheumatoid arthritis is a disease
characterized by chronic inflammation of the joints.
âThe clinical benefit is modest ... but there is a hint that something is
happening,â Professor Iain McInnes, one of the researchers behind the study,
told Reuters.
His team found patients on average reported a reduction of swelling in three
joints -- significantly less than the 6-8 joints relieved with modern
rheumatoid arthritis drugs, known as TNF blockers, which must be given by
injection.
Most patients entering such trials have an average of 12-15 swollen joints
at the start.
Although the symptomatic benefits may be limited statins could still become
an important future part of treatment since rheumatoid arthritis sufferers
have an inherently higher risk of heart attack and stroke.
A drug that can relieve swelling while cutting cholesterol could therefore
prove a winner.
âAlthough of limited size and short term, their findings support the use of
atorvastatin (Lipitor), and presumably other statins, to prevent
cardiovascular disease in patients with rheumatoid arthritis,â Lars Klareskog
and Anders
Hamsten said in an accompanying editorial.
McInnes and his colleagues now plan to conduct a large-scale clinical trial,
lasting three to five years, to see whether adding statins to standard
treatment improves the survival of rheumatoid arthritis sufferers. Copyright
2004
Reuters Limited. All rights reserved.
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PSORIASIS MORE THAN COSMETIC - Food and Drug Administration, author Linda
Bren
It's not easy living in Leah Bird's skin. "The worst thing is when people
just stare," says Bird. "I almost like it better if someone comes up to me and
asks me what it is."
Then she'll tell them, "I have psoriasis. It's not contagious."
Bird, 51, of suburban Boston, has had flare-ups of this chronic skin disease
since she was a teen-ager. The dry, red, scaly patches of skin that
characterize psoriasis have covered as much as 85 percent of her body, she says.
"It
alarms people. It looks very scary to people who don't know what it is."
But psoriasis is more than cosmetic. "This disease is common, chronic, and
costly, both in monetary terms and in quality of life," says Jonathan Wilkin,
M.D., director of the Food and Drug Administration's Division of Dermatologic
and Dental Drug Products.
More than 5 million Americans have psoriasis, and they spend between $1.6
billion and $3.2 billion each year to treat the disease, according to the
National Psoriasis Foundation (NPF). Between 150,000 and 260,000 new cases are
diagnosed each year, including 20,000 in children younger than 10.
"Psoriasis can be painful and can be profoundly disruptive to a person's
life," says Jill Lindstrom, M.D., an FDA dermatologist. "People who don't have
it don't understand how burdensome the disease can be. There is constant
shedding of scales. There can be functional impairment, itching, and pain." And
health complications, such as arthritis, accompany some cases.
There is no cure for psoriasis, but a broad range of treatments is available
to reduce the symptoms, clear up the skin, and send the disease into
remission. FDA-approved treatments range from creams rubbed into the skin, to
lasers
that aim ultraviolet rays at the skin, to the newest treatments--injectable
drugs made from living cells.
Emotional Impact
For many people, dealing with the emotional impact of psoriasis can be as
challenging as treating the disease.
Bird says that mothers have pulled their children away from her on the
subway, and some people, horrified by her skin lesions, have asked her if she
has
AIDS. As her disease has evolved over 30 years, so has Bird's way of dealing
with these reactions. In her teens, she'd tell people she had leprosy just for
the shock value, she says. Today, Bird is open about the disease but still
relies on her defiant attitude to "steel myself for the experience" of going
to the beach. "I love to swim," she says. But Bird knows that without covering
herself up in a public place, she "runs the risk of people just
rubbernecking."
"When I'm feeling forgiving, I try to ignore them," she says, "but when I'm
angry, I think 'didn't your mother teach you not to stare?'"
Bird advises others with psoriasis to find out what works best for them to
cope with the emotional effects of the disease. Going to therapy has helped
her, she says. So has leading a support group for psoriasis sufferers. "It's
important for people to work on their emotional well-being," says Bird, "however
they choose--whether it's meditation, yoga, or putting on long pants and
going out dancing."
What is Psoriasis?
Psoriasis is an inflammatory skin disease in which skin cells replicate at
an extremely rapid rate. New skin cells are produced about eight times faster
than normal--over several days instead of a month--but the rate at which old
cells slough off is unchanged. This causes cells to build up on the skin's
surface, forming thick patches, or plaques, of red sores (lesions) covered with
flaky, silvery-white dead skin cells (scales).
In psoriasis, an activated immune system triggers the skin to reproduce
every three to four days, building up on the outer layers (epidermis and
keratin). The epidermis thickens, blood flow increases and reddens the skin, and
silver-gray scales cover it.
Rarely life-threatening, at its mildest, psoriasis can be itchy and sore. At
its worst, it's painful, disfiguring, and debilitating. About two-thirds of
the people with psoriasis have a mild form of the disease, says the NPF. About
one-third have moderate or severe psoriasis. Psoriasis can affect people at
any age, but it most often strikes those between the ages of 15 and 35.
There are five forms of psoriasis. Plaque psoriasis is the most
common--affecting 4 out of 5 people who have psoriasis, says the NPF. Plaque
psoriasis
may start with small red bumps and progress to larger lesions.
The plaques of psoriasis occur most frequently on the elbows, knees, other
parts of the legs, scalp, back, face, palms, and soles of the feet. Psoriasis
can also affect the fingernails and toenails, causing pitting, discoloration,
or tissue buildup around the nails. According to the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, about 15 percent of people
with psoriasis also get psoriatic arthritis, which can be progressively
disabling if untreated.
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Good Health to All,
Jack Nicholas
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Issue 2004 10/31/04 -15