Optimal Management of Rheumatic Disease During COVID-19 - Episode 2

Psoriatic Arthritis Treatment Factors: Comorbidities

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Amar Majjhoo, MD: I had the honor of presenting at this last ACR Convergence [American College of Rheumatology annual meeting]. It was a unique but pleasurable experience being able to present virtually from my home. I was able to present and enjoy being a part of the meeting and attending sessions myself. I presented on treatment options for patients with psoriatic arthritis.

When we’re confronted with patients with psoriatic arthritis, the decision for treatments can be complex. We’re fortunate that our treatment options have expanded in the last several years, and we have a lot of options. Because of that, we can afford to be choosy in terms of what treatment option we want to pick first, and certainly as we pick different options sequentially after patients have tried and been intolerant to or failed various treatments.

Typically when I’m confronted with a patient with psoriatic arthritis, I fully appreciate that this is a heterogeneous, multifaceted disease, so I want to get an idea of what is going on with the patient in terms of domains that are involved. Do they have skin involvement, and how much involvement? Do they have peripheral joint involvement, and how severe is that? We look at enthesitis and dactylitis and spondylitis and nail disease. And again, we look at the severity of each of these domains, and we refer mentally to our knowledge of different treatment options and how they work within each of these domains.

We think about what’s the published literature? What’s our clinical experience with these different treatment options in terms of response within each of these domains? We also must take into consideration if there are data to support radiographic inhibition, if that patient, we feel, is at risk for radiographic progression. We certainly need to keep that in mind. We also must look at comorbidities. We have to know what else is going on with that patient. Do they have fatty liver disease? Are they obese?

Are there fertility issues that we need to be aware of? Have they been formally diagnosed with inflammatory bowel disease? Or are we suspecting that they may have mild disease, including microscopic involvement, and they just have to date maybe symptoms such as abdominal pain, bloating, diarrhea, but have not been formally diagnosed? Then we must factor in patient preferences. Do they want an oral agent? Do they want a self-administered injection?

Do they want IV [intravenous] therapy? Do they want to come in for an IV or an injection that’s administered by a health care professional? These are all the kinds of things that we must factor in. Certainly, the frequency of administration, that may be important to the patient as well. And certainly, coverage and cost is something that we need to factor in.

We are blessed to have a lot of different treatment options available for our patients with psoriatic arthritis, and all of us have gotten good at running this algorithm in our minds when we are picking a treatment option for a patient who’s sitting with us in the room at that particular moment. There’s this continuous kind of calculation going on in our minds.

Transcript Edited for Clarity