be joint smart tampa slides june 27 2015
TRANSCRIPT
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
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