be joint smart tampa slides june 27 2015

DoubleTree by Hilton Tampa Airport WestshoreSaturday, June 27, 2015

Thank you:

Presenting Sponsor:

National Sponsors:

The National Psoriasis Foundation is solely responsible for all content and development of this program.

Psoriatic Arthritis (PsA) Project

Largest, most comprehensive realignment and expansion of its psoriatic arthritis program since the Foundation began

Goals include:

• Reduce the average time of diagnosis

• Improve PsA outcomes for people with the disease

• Expand the PsA research community

Be Joint Smart

A program of the National Psoriasis Foundation designed to:

• Empower those who have psoriatic arthritis to better manage their disease.

• Provide resources that offer support and encouragement.

What You Will Learn Today

• About psoriatic arthritis and its impact on joints and overall health.

• Successful management and treatment strategies to help maintain joint health.

• Value of preventive care to limit the progression of joint damage.

Reminders….

• Cell phones• Restrooms• Questions• Evaluation form

“The Impact of Psoriatic Disease”

Robert Norman, D.O., M.P.H.

Board Certified Dermatologist

Private Practice

Tampa, FL

Disclosures – Dr. Norman

I have no financial relationships to disclose.

The National Psoriasis Foundation is solely responsible for all content and development of this program.

Psoriatic Disease

• Psoriasis affects approximately 7.5 million Americans

• Psoriatic Arthritis may affect up to 30 percent of people diagnosed with psoriasis

In nearly 85 percent of those with psoriasis, skin disease came

before joint disease, sometimes by up to seven to ten years*

*American Academy of Dermatology February 2011

a noncontagious, chronic, inflammatory disease of the immune system that affects the skin and/or joints

Psoriatic Disease

• Both genetic and environmental factors are associated with the development

• Can occur at any age

• The average diagnosis for psoriatic arthritis can take up to four or more years

Early recognition, diagnosis and treatment can helpreduce levels of inflammation and prevent progressive joint damage

Why Inflammation Matters

• Psoriatic disease is caused by abnormal activity of the body’s immune system

• Periods of intense flares of the disease

• With psoriatic arthritis, persistent warmth and swelling (inflammation) around a joint can lead to damage if not treated

Model of the relationship between skin and joint inflammation associated with psoriasis and psoriatic arthritis

Psoriatic Disease

Nograles K, Brasington, R., Bowcock, A. et al. (2009) New insights into the pathogenesis and genetics of psoriatic arthritis Nat Clin Pract Rheumatology. 2009 Feb; 5(2): 83-91.

skin

joint

Risk Factors Associated With Inflammation

• Degree of skin and joint inflammation

• Potential for development of other diseases – metabolic

syndrome, heart disease, myocardial infarction, peripheral

vascular disease (PAD)

• Use of certain drugs

• Lifestyle choices (smoking, overweight, stress, alcohol use)

Assessing Severity of Psoriasis

Types of Psoriasis

Plaque Psoriasis Guttate Psoriasis

Inverse Psoriasis Pustular Psoriasis

Types of Psoriasis

Palmoplantar psoriasis Erythrodermic Scalp Psoriasis

Nail Psoriasis

Common nail problems include:

• Pitting / horizontal lines • Deformation• Thickening

• Onycholysis • Discoloration• Crumbling

Symptoms of Psoriatic Arthritis

• Reduced range of motion

and stiffness in joints• Pain / joint tenderness• Swelling where tendons and

ligaments connect with bone• Lower back pain• Pain in the feet and ankles

In addition to nail changes other symptoms include:

Symptoms of Psoriatic Arthritis

• Red or warm to touch• Sausage-like swelling• Fatigue• Presence of skin lesions

You can take control to impact your risk factors and prevent joint damage

“What You Can Do”

Benefits of Early Intervention

• Improve skin disease and joint function

• Minimize disease

progression

• Ease pain and swelling

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Tips to Improve Psoriatic Disease

Ongoing care means:

• See your health care provider

• Take medications as prescribed

• Regular blood screenings

• Make lifestyle changes (if needed)

See your health care provider

• Visit your health care provider / team as prescribed.

• Work with your health care provider to find the best treatment options for you

Take medications as prescribed

• Topicals

• Light therapy

• Systemics

• Biologics

Treatment options for psoriasis include:

TopicalsUsually first line of treatment or used in combination therapy

Over-the counter (OTC) • Salicylic acid• Tar• Moisturizers or emollients

Prescription Topicals

• Corticosteroids Vitamin D Derivatives (varying strengths) Dovonex, Calcitrene (calcipotriene)

Vectical (calcitriol) • Vitamin A Derivatives Taclonex (calcipotriene and Tazorac (taxarotene) betamethasone dipropionate)

Light therapy

• PUVA• UVB (Broad and narrow band)• Excimer laser• Sunlight

• Targeted treatment is used for limited psoriasis of less than 5 percent of body surface

• Whole-body treatment is used when more than 5 percent of the body surface area is covered

Treatment may include topicals or medication taken by mouth

Systemic and Biologic Treatments for Psoriasis

Treat the body from the inside out. Used for widespread symptoms.

Systemics• Cyclosporine

• Methotrexate

• Soriatane (acitretin)

Biologics• TNF-alpha blockers: Enbrel (etanercept) Humira (adalimumab) Remicade (infliximab)

• Interleukin 12/23: Stelara (ustekinumab)

New Treatments for Psoriasis: Interleukin 17-A Inhibitor

Treat the body from the inside out. Used for widespread symptoms.

• Cosentyx (secukinumab)

-Prescribed for moderate to severe plaque psoriasis

-Given by injection at week 0, 1, 2, 3, 4 and then every 4 weeks

-Common side effects include: cold symptoms, diarrhea and upper respiratory infections.

New Treatments for Psoriasis: Phosphodiesterase-4 Inhibitor

Treat the body from the inside out. Used for widespread symptoms.

• Otezla (apremilast)

-Prescribed for moderate to severe plaque psoriasis and psoriatic arthritis

-Take orally as a 30-milligram tablet, increasing over five days to recommended dose of twice daily

-Common side effects include: nausea, diarrhea and headache

-Can be taken used with Methotrexate

Regular Blood Screenings

Visit your primary care provider regularly to check:

• Blood count levels (for potential side effects)

• Blood pressure (at every visit pending frequency of visits and other health conditions)

• Blood sugar (> age 45, every three years)

• Cholesterol (at annual physical)

Lifestyle ChangesTips to Improve Joint Health

Lifestyle choices to help reduce your risk of inflammation include:

• Revisit your eating habits• Watch portion sizes • Try to have a positive attitude• Reduce stress• Improve your sleeping habits• Try setting goals• Be active and joint smart

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Take A Look At Your Eating Habits

Instead of eating food choices such as:

• Processed foods (snacks)• Refined sugars• White flour, white rice• Omega-6 fatty acid (found in various meats, cow’s milk)• Processed meats (corn/grain

fed) and fatty red meats• Vegetable shortening (high Omega-6)• Alcohol

Tips to Help Improve Your Eating Habits

• Eat plenty of fruits and vegetables (more than five a day)

Eat foods that promote health vs promote disease:

• Avoid most saturated and trans fats Choose low fat food choices (monounsaturated fatty acids or polyunsaturated fats (avocado, olive oil, nuts)

• Limit refined grains, choose whole grains and eat more fiber

Watch Portion Sizes

• Try the “Plate Method”, a 9” plate consisting of:

- Half vegetables - Quarter protein - Quarter starch

• Reduce intake by 100 calories

can = 10 pounds in one year

• Free resources to help with weight loss include:

-SparkPeople.com -MyFitnessPal.com -ChooseMyPlate.gov -Mobile apps: MealSnap.com Fooducate.comEvery extra pound adds three times the

amount of pressure on your joints

Tips To Help Improve Disease Management

• Try to maintain a positive attitude (Negative thoughts reduce pain thresholds)

• Reduce stress through:

-Regular exercise (walking, swimming, everyday opportunities, etc)

-Relaxation techniques/ meditation

-Yoga, Tai Chi

- Massage therapy

- Talk with a mental health counselor

Tips To Help Improve Disease Management

• Assess your sleeping habits

• Find a support system Involve a friend or ask for professional support

• Make a plan – write it down• Start small, make one change at a time• Set SMART goals to help initiate change. Goals that are Specific, Measurable, Attainable, Realistic and Timely

Lifestyle Changes:Be Active and Joint Smart

• Incorporate 30 to 60 minutes of moderate to intense exercise, 3-5 days a week into your daily routine

• Consult a health care provider before starting an exercise program

• Start slow and work up

Do what you can to take control to reduce your risk factors and prevent or limit joint damage

11:40 a.m. Short break

11:45 a.m. “Be Active and Joint Smart”

“Be Active and Joint Smart”

Shayne Tarrance,

P.T., W.C.S., B.C.B.-P.M.B.

Physical Therapist,

Optimal Performance and Physical Therapies

Tampa, FL

Potential Benefits To Increasing Activity

• Improves flexibility, range of motion and

strengthens muscles

• Improves heart health

• Lowers blood pressure and blood sugar levels• Reduces weight and pressure on joints• Improves bone and joint health• Improves sleep

Protect Your Joints

Tips to help Be Joint Smart include:

• Avoid holding the same position for prolonged periods of time

• Avoid performing repetitive activities

• Avoid grasping things tightly

• Maintain proper posture and be mindful of how you move

• Check with your doctor before beginning an exercise program

Safety Guidelines

Tips to be active safely include:

• Move slowly and gently – no jerking

• Stretch only to the point where you feel tension

• If pain becomes worse, STOP

• Don’t forget to breathe

• Listen for any cautions (i.e. fall prevention)

Types of Exercise Low impact / endurance exercises

• Strive to exercise 20 minutes or more, 3-5 times a week

• Consider: -Walking -Tai chi -Biking -Exercising in the water

• Exercising in a pool can be effective and not as demanding on joints

Types of ExerciseRange of motion exercises

• Help maintain and improve mobility of the joints

• Guidelines: -Frequency: 2-3 sets -Intensity: 8-10 repetitions -Duration: daily

• Move joint through its normal range of motion

• Gently move joint as far as comfortable

• If stretching hold for 25-30 seconds, repeat 2-3 times

Strengthening exercises

• Help ensure joints have as much stability as possible

• Guidelines: -Frequency: 2-3 sets -Intensity: 8-10 repetitions -Duration: 2-3 times a week, alternating days

• Perform with slow and controlled motion

• Hold for 3-5 seconds

• Use light weights with more repetitions

• Avoid use of heavy weights

Do not exercise through pain

Exercises (adapted from VH1 PC-kit)

HAND AROM: Finger Flexion / Extension

• Actively bend fingers of hand. Start with knuckles furthest from palm, and slowly make a fist. Hold 2 seconds. Relax. Then straighten fingers as far as possible.

• Repeat 10 times per set. • Do 3 sets per session. • Do 1-2 sessions per day.

Safety Guidelines:• If you feel pain, Stop!• Remember to breathe• Move slowly, no jerking• Listen for cautions Copyright VH1

Exercises (adapted from VH1 PC-kit)

SHOULDER ROM: Abduction (Standing)

• Bring arms straight out from sides and raise as high as possible without pain.

• Repeat 10 times per set.

• Do 2 sets per session.

• Do 1-2 sessions per day. Copyright VH1

Exercises (adapted from VH1 PC-kit)

SHOULDER ROM: External/Internal Rotation (Standing)

• With upper arms parallel to floor and elbows bent at right angles, gently rotate arms up then down as far as possible without pain.

• Repeat 10 times per set. Do 2 sets per session.

• Do 1-2 sessions per day.

Copyright VH1

Exercises (adapted from VH1 PC-kit)

SHOULDER: Resisted Horizontal Abduction - Bilateral

• Sit or stand, tubing in both hands, arms out in front. Keeping arms straight, pinch shoulder blades together and stretch arms out.

• Repeat 10 times per set. Do 2 sets per session.

• Do 1 session per day.

Copyright VH1

Exercises (adapted from VH1 PC-kit)

SHOULDER PNF Strengthening: Resisted

• Standing with resistive band around each hand, bring arm up and away, thumb back. Perform on both sides.

• Repeat 10 times per set. Do 2 sets per session.

• Do 1 session per day.Copyright VH1

Exercises (adapted from VH1 PC-kit)

HIP / KNEE – Knee Extension: Resisted (Sitting)

• With band looped around ankle and under other foot, straighten leg with ankle loop. Keep other leg bent to increase resistance.

• Repeat 10 times per set. Do 2 sets per session.

• Do 1 session per day.Copyright VH1

Exercises (adapted from VH1 PC-kit)

HIP / KNEE – Knee Flexion: Resisted (Sitting)

• Sit with band under foot and looped around ankle of supported leg.

• Pull unsupported leg back.

• Repeat 10 times per set.

• Do 2 sets per session.

• Do 1 session per day.

Copyright VH1

Exercises (adapted from VH1 PC-kit)

HIP / KNEE – Functional Quadriceps: Chair Squat

• Keeping feet flat on floor, shoulder width apart, squat as low as is comfortable. Use support as necessary.

• Repeat 10 times per set.

• Do 2 sets per session.

• Do 1 session per day.

Copyright VH1

Exercises (adapted from VH1 PC-kit)

ANKLE / FOOT – 20 Heel Raise: Bilateral (Standing)

• Rise on balls of feet. Hold onto firm counter top for safety.

• Repeat 10 times per set.

• Do 3 sets per session.

• Do 1 session per day.

Copyright VH1

Example of a Potential Goal

Who: I will do What: 1 set (8 repetitions) each of range of motion and strengthening exercises When: every other day for two weeks in the evening Where: in my home to Why: help reduce joint pain/stiffness and improve my joint health

To Help Find the Right Treatment Plan

• Physical therapy and rehabilitation A potential physical therapy plan for psoriatic arthritis could include:

-General aerobic conditioning -Proper positioning of joints -Coping strategies (ex. job accommodations)

For more information about a plan for you, talk with your doctor, a physical oroccupational therapist, or the Job Accommodation Network

12:15 p.m. Snack break

12:30 p.m. “The Why and How to Treat Psoriatic Arthritis”

“The Why and How to TreatPsoriatic Arthritis”

Ernesto Rodriguez-Velazquez, M.D.

Rheumatologist, Florida Medical Clinic

Land O’Lakes, FL

Affiliate Assistant Clinical Professor,

Division of Rheumatology, USF Health

Tampa, FL

Disclosures – Dr. Rodriguez-Velazquez

The National Psoriasis Foundation is solely responsible for all content and development of this program.

I have the following financial relationships to disclose:

• Consulting Agreement/Advisory Board Member: Amgen, Inc.

• Speaker’s Bureau:

AbbVie, Inc.

Celgene Corporation

Psoriatic Arthritis – Why Treat?

• Relieve pain• Reduce swelling• May help limit

further joint damage

• Improve quality of life

What’s Your Pain Level?

Pain FreeModerate PainSevere PainExcruciating Pain

Psoriatic Arthritis

• Can affect a few or many joints – including the spine

• May be asymmetric

• Risk of joint damage

• Anti-inflammatory and immune modulating medications used

How Do I Know?Rheumatoid Arthritis vs. Psoriatic Arthritis

Rheumatoid Arthritis Psoriatic ArthritisChronic inflammatory arthritis Yes – flares & remission Yes – flares & remission

Symptoms can include: • Morning stiffness• Joint pain, swelling, warmth• Limited motion and function• Affects any joint (hands/feet

mostly), can also affect organs – same joints on both sides of the body

• Loss of energy, appetite• Low fever• Firm lumps (rheumatoid nodules)• Damage to cartilage and bone

• Morning stiffness• Joint pain, swelling, warmth• Tender entheses• Limited motion and function• Can affect peripheral joints (arms,

legs, elbows, hands, feet – “sausage digits”) and/or the spine

• Generalized fatigue• Nail changes• History or presence of skin disease

(psoriasis)Focus of inflammation Tissue that lines the joints (synovium) Joints; where tendons and ligaments join

bone (enthesitis)Diagnosis • Physical exam

• Blood tests – rheumatoid factor, mild anemia, anti-CCP, SED rate

• X-rays, MRI or ultrasound scanning

• Physical exam, patterns of arthritis• Skin and nail changes• Blood tests - No presence of RF, Gout

or OA; anti-CCP, SED rate, mild anemia

• X-rays, MRI, ultrasound or CT scan

Classification of Psoriatic Arthritis

• Oligoarticular (four or fewer joints)

• Polyarticular (four or more joints)

• Spondylitis

• Enthesitis

• Dactylitis

Dactylitis (Sausage Digit )

Inflammation of the tendons of the fingers and toes occurs in 30-50% of people with psoriatic arthritis

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Enthesitis• Inflammation

involving tendon and ligament insertions into bone - occurs in

1 of 3 people psoriatic arthritis

• Heel tenderness common

• Elbow and the bottom of the foot are often involved

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SpondylitisInflammatory Disease of the Spine and Pelvis

• Occurs in ~40% of people with psoriatic arthritis

• Inflammatory back pain

-Morning stiffness ≥ 30 minutes

-Improvement with exercise

-No improvement with rest

-Gradual onset

-Pain at night, improves upon

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Treatment Decisions

Goal: relieve pain, reduce swelling, limit joint damage and the potential for disability

• Severity of your psoriatic arthritis• Use of other medications• Overall health• Other individual considerations

“What You Can Do”

Lifestyle choices:

• Pace exercise to reduce fatigue

• Rest joints when stressed

• Choose healthy food options

• Reduce stress

• Practice positive self talk

• Physical therapy / protective devices (i.e. splint or brace)

Treatment Options

Which Is Best – Hot or Cold?

Hot or cold: Use no longer than 10-15 minutes

Heat is best for:

• Painful joints

• Decreases joint stiffness

• Decreases pain signals

• Never apply to hot, red, irritated areas

Cold is best for:

• Warm swollen joints

• Burning sensation(s)

• Minimizes inflammation

• Decreases pain with swollen joints

• Never apply to stiff joints or if you have circulatory problems

Pharmacologic Treatment Options for Psoriatic Arthritis

• Pain Relievers and NSAIDs (Nonsteroidal anti-inflammatory drugs)

• DMARDs (Disease-modifying antirheumatic drugs)

• Biologic agents (also DMARDs)

• Other treatment options

• Help decrease inflammation, joint pain and stiffness

• Improve range of motion

• Taken by mouth or applied to the skin

• Prescription strength and nonprescription (over-the-counter)

Treatment Options: NSAIDs

Treatment Options: Pain Relievers & NSAIDs

Type of Treatment Benefits Concerns / Side Effects

Aspirin (OTC) Reduce pain, swelling, stiffness

To be effective must be taken in high doses which can result in bleeding ulcers and tinnitus

Acetaminophen(Tylenol - OTC)

Pain relief, does not relieve inflammation

Potential for liver damage in excessive doses

Ibuprofen (Advil, Motrin, Nuprin – all OTC)

Reduces pain, inflammation stiffness, improves range of motion

Stomach irritation/bleeding, ulcers, increased risk of cardiovascular events

Naproxen sodium(Aleve -OTC, Anaprox-Rx)

Reduces pain, inflammation, stiffness, improves range of motion

Stomach irritation, ulcers, increased risk of cardiovascular events

Prescription NSAIDS(Mobic, Celebrex, Indomethacin and others)

Reduces pain, inflammation, stiffness, improves range of motion

Stomach irritation, ulcers, increased risk of cardiovascular events

OTC = Over-the-CounterRx = By prescription

Treatment Options: DMARDs

• Help reduce joint inflammation and limit damage

• Taken by mouth, injection or infusion

• Available by prescription

(Disease-modifying antirheumatic drugs)

Treatment Options: DMARDS Corticosteroids and Antimalarials

Type of Treatment

Corticosteroids Antimalarials

Benefits Relieves acute, severe joint inflammation and swelling. Can improve range of motion.

Relatively mild side effects but may take months to see improvement

Delivery By mouth or injection By mouth

Side effects Psoriasis lesions may become worse after discontinuing use. Increases blood sugar levels, risk of infection, cataracts, risk of cardiovascular disease and osteoporosis.

May cause severe flare of psoriasis, vision changes, headache, dizziness, nausea and vomiting.

Cautions Avoid large doses. Not recommended for long-term treatment.

Regular eye exams necessary

Treatment Options: DMARDsSystemics

Treatment Type:

Methotrexate Leflunomide Sulfasalazine

Benefits Relieves symptoms, helps limit joint damage

Relieves symptoms, helps limit joint damage

Mild psoriatic arthritis

Delivery Pill, liquid or injection Pill Pill

Frequency Once a week Daily Up to 6 pills/twice a day

Side effects

Potential liver damage, compromised immune system, mouth ulcers, hair loss

Potential liver damage, low blood counts, diarrhea

Nausea, rash, headache, abdominal pain, fever, dizziness

Monitoring Complete blood count, liver function

Complete blood count, liver function

Complete blood count, liver function

Cautions Bactrim, NSAIDs with care, pregnancy

Other liver toxic meds

Sulfa allergies

Treatment Options: DMARDs Biologics

• Block overactive immune activity

• Reduce inflammation and inhibit joint damage in psoriatic arthritis

• Clear psoriasis skinlesions and improve nail disease

• Injection, infusion

Treatment Options: DMARDs Biologics: TNF blockers

Treatment Type Benefits

Delivery Frequency

Etanercept(Enbrel)

Inhibits progression of joint deterioration, reduces inflammation and psoriasis skin lesions

Self-injection 1-2 times a week, use continuously as prescribed

Adalimumab(Humira)

Inhibits progression of joint deterioration, reduces inflammation and psoriasis skin lesions

Self-injection Every other week, use continuously as prescribed

Infliximab(Remicade)

Reduces inflammation and psoriasis skin lesions. May reduce progression of joint deterioration

Intravenous infusion by health care provider

2 hours, three times in first six weeks, then every eight weeks. Use continuously as prescribed

Golimumab(Simponi)

Relieves pain, stiffness, swelling of joints and skin symptoms of psoriasis

Self-injection Once a month, use continuously as prescribed

Certolizumab pegol (Cimzia)

Inhibits progression of joint deterioration, reduces inflammation and swelling of joints

Self-injection After initial dosing, every other week, use continuously as prescribed

Treatment Options: DMARDs Biologics: TNF-alpha Blockers

Treatment Type

Side Effects Monitoring

Etanercept(Enbrel)

Injection site reactions, headaches, respiratory infections, severe infections, liver function abnormalities, low blood counts, risk of lymphoma, MS like syndrome and others

Tuberculosis, hepatitis, blood count and liver function tests

Adalimumab(Humira)

Injection site reactions, headaches, respiratory infections, severe infections, liver function abnormalities, low blood counts, risk of lymphoma, MS like syndrome and others

Tuberculosis, hepatitis, blood count and liver function tests

Infliximab(Remicade)

Respiratory infections, headache, risk of acute allergic infusion reaction, liver function abnormalities, severe infections, low blood counts, risk of lymphoma, MS like syndrome and others

Tuberculosis, hepatitis, blood count and liver function tests

Golimumab(Simponi)

Injection site reactions, upper respiratory infections, liver function abnormalities, severe infections, low blood counts, risk of lymphoma, MS like syndrome and others

Tuberculosis, hepatitis, blood count and liver function tests

Certolizumab pegol (Cimzia)

Respiratory infections, headache, rash, liver function abnormalities, severe infections, low blood counts, nausea, risk of lymphoma, MS like syndrome and others

Tuberculosis, blood count and liver function tests

Treatment Options: DMARDs Biologics: TNF-alpha Blockers

Treatment Type

Concerns To Talk With Your Doctor About(In Some Cases Do Not Use)

Etanercept(Enbrel)

If you have an active infection If you are scheduled to have major surgery Have had cancer or heart failure Pregnancy

If taking Kineret, Orencia, Rituxan, Actemra Live vaccines

Adalimumab(Humira)

If you have an active infection If you are scheduled to have major surgery Have had cancer or heart failure Pregnancy

If taking Orencia, Kineret, Rituxan, Actemra Live vaccines

Infliximab(Remicade)

If you have an active infection Experience an allergic reaction Have had cancer or heart failure Pregnancy

If taking Orencia, Kineret, Actemra, Rituxan Live vaccines

Golimumab(Simponi)

If you have an active infection Have had cancer or heart failure Pregnancy

If taking Orencia, Kineret, Rituxan, Actemra Live vaccines

Certolizumab pegol (Cimzia)

If you have an active infection Have had cancer or heart failure Pregnancy

If taking Orencia, Kineret, Rituxan, Tysabri Live vaccines

Treatment Options: DMARDs Other treatment options

Treatment Type

Interleukin 12/23Ustekinumab (Stelara)

Phosphodiesterase-4 Inhibitor Apremilast (Otezla)

Benefits Reduces inflammation and psoriasis skin lesions, relieves pain, stiffness and swelling around joints

Reduces joint tenderness, swelling and psoriasis skin lesions

Delivery Self-injection Pill

Frequency Initial week, week four and then every three months

Twice daily

Side effects Injection site reactions, headaches, respiratory infections, severe infections, back pain, Reversible Posterior Leukoencephalopathy Syndrome

Diarrhea, nausea, headaches, respiratory infections, upper abdominal pain, unexplained weight loss

Monitoring Tuberculosis Signs of depression

Concerns - talk with your doctor

Live vaccines, pregnancy Pregnancy, severe renal impairment, known allergic reaction to apremilast or its components, Rifampin (enzyme inducer)

Adjunct Therapy Options: CAM (Complimentary & Alternative Medicine)

Nutrition:

• Vitamin D

-Contributes to strong bones and healthy joints

• Fish oil (Omega-3 Fatty acids)

-Relieves joint pain and morning stiffness

Adjunct Therapy Options: CAM (Complimentary & Alternative Medicine)

Acupuncture:

• May relieve pain

• Decreases stimulation of pain receptors in the brain

• Few known side effects

Adaptive Tools and Assistive Devices

• Number of tools available to help manipulate small objects and/or perform repetitive motions

• Assistive devices help reduce stress on joints. Devices include arthritic grip canes, crutches, walkers, etc.

• For more information talk with your doctor, pharmacist, physical or occupational therapist, or the Job Accommodation Network for Assistance

Other Treatment Options

• Physical therapy and rehabilitation • Surgery – when joint damage severely limits

motion and function despite medical treatment

Types of surgery: - Joint replacement - Joint fusion (arthrodesis)

In Summary: What You Can Do

• Work with your health care provider

• Be active in treatment decisions

• Consider: Benefits vs. risks

Fears vs facts

Quality of life

• Lifestyle changes© Ju

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Resources to Help You

Access support: One to One Program

Voice concerns and get answers to your questions about psoriasis

and psoriatic arthritis

To request a mentor visitwww.psoriasis.org/one-to-one

Improve your health with a support system

Resources to Help You

• National Psoriasis Foundation www.psoriasis.org

Patient Assistance Information:

www.psoriasis.org/financial-help • American Academy of Dermatology

www.aad.org (Find a dermatologist)

• American College of Rheumatology

www.rheumatology.org (Find a member)

• American Physical Therapy Association

www.apta.org (Find a PT)

Resources to Help You

• Nutrition Resource: SparkPeople www.sparkpeople.com

• MyFitnessPal www.myfitnessPal.com

• International Association of Yoga Therapists

www.iayt.org

• UCLA Free Guided Meditation Exercises

www.marc.ucla.edu/body.cfm?id=22

• American Psychological Association

www.apa.org/helpcenter/

Find a psychologist feature

Join us

Team NPF Walk Tampa occurs

Saturday, October 24, 2015

at Al Lopez Park

Visit: www.teamnpf.org/walktampa

Be Joint Smart

Q & A Session:

Dr. Norman &Dr. Rodriguez-Velazquez

Presenting Sponsor:

National Sponsors:

Our Thanks to:

Our thanks to:• Dr. Robert Norman

Shayne Tarrance, PT, WCS, BCB-PMB Dr. Ernesto Rodriguez-Velazquez

• To all of you for attending

Please Complete Your Evaluation Form