Biologics are medicines made from living cells that target specific parts of the immune system to reduce psoriatic arthritis inflammation. Some options are given via intravenous (IV) influsion.

If you’re having trouble getting psoriatic arthritis (PsA) under control, it may be time to consider a biologic. “Biologics have been life-changing medications for people with psoriasis and psoriatic arthritis,” said Dr. Wu.

Read the full article at everydayhealth.com. 

Dr. Wu noted that some newer medications are likely safe for use during pregnancy.  For instance, “we know that some medications, such as certain TNF blockers, are safe for both the mother and fetus during pregnancy,” she said.

Dr. Wu emphasizes that more research  on psoriatic arthritis is needed.  Doctors know more now than a decade ago about the relationship between pregnancy and psoriatic arthritis, but there is still much work to be done. “The safety of psoriatic arthritis medications during pregnancy is one place where we need more information—we need to know if biologics are safe for women during pregnancy and what the risks and benefits of stopping or continuing those medications,” Dr. D. Wu explained .

Read the full article at healthcentral.com. 

Diagnosing psoriatic arthritis can present challenges, especially in the beginning stages of the disease, explained Dr Wu. Psoriatic arthritis symptoms can sometimes mimic the symptoms of other conditions—and other conditions may masquerade as PsA. It can take an expert in the disease to tell them apart. 

Osteoarthritis may look similar to psoriatic arthritis, but there are differences, said Dr. Wu. PsA can occur at any time (and can even affect children), but the typical age of onset is between the ages of 30 and 50, according to the National Psoriasis Foundation. 

There are ways to help your provider zero in on the source of your discomfort, said Dr. Wu. To start, organize a list of your symptoms to bring to your appointment. “It is helpful if the patient comes in with a clear timeline, including reporting any patterning of symptoms they have observed,” she says. “It can also help for patients to bring in any previous records they have which might include lab work, x-rays, cat scans, and MRIs.”

Read the full article at healthcentral.com. 

If you’re living with psoriatic arthritis (PsA), your doctor may have talked to you about what’s considered the holy grail of treatment: Remission. Remission with psoriatic arthritis means symptom-free periods with no joint pain or inflammation. That’s the goal, anyway, but achieving remission is far from easy. Working in your favor: newer treatment options, especially biologic therapies, that target the roots of psoriatic arthritis itself, not just its symptoms. It can take some trial and error, but doctors believe that with the right medication, remission today is a real possibility for most people with this disease.

It’s natural to wonder if reaching remission means the end of psoriatic arthritis treatment. That’s unlikely, said Dr. Wu. “I do not recommend treatment be discontinued when remission is reached, but if someone is on multiple medications, then sometimes treatment can be pulled back,” she explained. This is referred to as treatment de-escalation. “It’s also important to consider whether maybe the joint pain is under control, but not all aspects of the condition, such as the skin, is also under control, before pulling back on medication.” Still, Dr. Wu says, the goal at the end of the day is for patients to be on the least medication possible while experiencing the greatest symptom improvement possible.

Without a doubt, lifestyle changes can support psoriatic arthritis remission, said Dr. Wu. “No smoking, maintaining a healthy weight, not drinking alcohol in excess, and following an anti-inflammatory diet can all lead to a better outcome,” she said. A healthy lifestyle can do more than help you maintain remission. “Many with psoriatic arthritis also live with diabetes, obesity, and metabolic syndrome, so managing lifestyle issues can also lead to a better outcome for the other conditions also.”

Read the full article at healthcentral.com

She continued, “The frequent hand and wrist involvement in RA means that patients often struggle with activities of daily living. “Tasks like opening jars, turning doorknobs, turning a faucet, gripping and grasping become harder. RA also affects the fine motor skills of the hands, so patients may have difficulty unfastening buttons or fastening jewelry.”

“Poorly controlled disease can result not only in chronic joint pain and disability, but may also be associated with constitutional symptoms fatigue, malaise, loss of appetite, and weight loss, which can affect intimacy,” cited Dr. Wu.

Dr. Wu said, “Ultimately, RA might not be curable, but it is treatable, and the goal is always remission,” and noted there are many effective treatment options. “Biologics have revolutionized our ability to treat RA patients, and the treatment paradigm has shifted over the years so that we now treat patients early and aggressively when clinically warranted,” she added. 

Read the full article at Creakyjoints.org.

According to Dr. Wu, “It’s important for patients to report their symptoms accurately to their rheumatologists. From there, it’s up to the rheumatologist to determine what may be causing the flare and the best course of action.”

She explained, “When people are sick with viral or bacterial illness, that can trigger their immune system, causing a flare. And, on top of it, a lot of the patients have to stop their meds when they’re sick, which only fuels the flare.”

Dr. Wu said that flares are rarely a sign of disease progression. She continued, “[A flare] is not necessarily indicative that the disease is progressing. If flares happen frequently, then I would say, more often than not, the medication is not completely controlling the disease and there is room for adjustment.”

Finally, she advised being in touch with a doctor when experiencing a flare. “Being in touch with the doctor earlier rather than later, is, I think, the most important thing to do when you experience a flare. I usually tell my patients not to handle this on their own. I’d rather they come to me than dabble in herbal remedies and things like that,” she noted.

Read the full article at Creakyjoints.org.

Dr. Wu explained the diagnosis is based on a detailed medical history, symptoms, physical examination and the results of a blood test. She cautioned that in older adults, an internist may attribute symptoms such as joint pain and fatigue to advancing age, and it’s important to have a thorough workup by a rheumatologist who understands the nuances of blood tests and symptoms. Dr. Wu noted various medications are prescribed, such as hydroxychloroquine, based on a patient’s age and any other health conditions. Additionally, good lifestyle choices can help lupus patients feel better and help prevent flares. “I think it’s always helpful to maintain a good weight, eat well and exercise routinely. Viral infections such as a cold or the flu can sometimes trigger lupus flare-ups, so it is important to stay healthy by washing hands often and avoiding close contact with sick individuals,” advised Dr. Wu. “Smoking cessation is also critical, as it has been shown to exacerbate the disease. Smoking also increases the risk of cardiovascular disease, which is already higher in lupus patients,” she added.

The demand for the LupusLine®, a telephone peer support program offering at HSS has increased significantly during the pandemic, said Toral. “Feelings of loneliness and isolation are common in patients with lupus due to the unpredictable and invisible nature of the illness, and for many, this has been exacerbated during the pandemic,” she noted. “Identifying a support person or maintaining regular connections through a service such as LupusLine®, a community group, or a religious or spiritual organization can reduce isolation and help people cope better.”

In addition to LupusLine®, HSS has developed a mobile app for people with lupus called LupusMinder® and offers a wealth of information about lupus on its website: HSS.edu/lupus.

This article appeared in the April 2021 print edition and Omagdigital.com.

While there isn’t a universal cause of OA, there are certain things that increase a person’s risk, explained Dr. Wu. “Age is the strongest predictor,” she said. “Simply put, the chance of developing OA goes up as you get older.”

Other factors that increase the risk for OA: trauma to a joint, genetics, and gender. OA tends to run in families, though experts don’t know of a specific gene that’s responsible, noted Dr. Wu. And women are more likely than men to both develop OA and end up with more severe cases, she added.

OA symptoms may not always correlate with what you see on an x-ray. Because of this, a physician will recommend treatment based on more than just your x-ray and stage. “Clinical history is more important than x-ray, because a lot of people have damage on an x-ray but are asymptomatic,” cited Dr. Wu. The goal of OA treatment is to allow you to function normally without pain, so the way you feel and how much OA is impacting your daily life is more important than what the x-ray shows.

Read the full article at Healthcentral.com.

The initial evaluation of the patient involves determining the extent of illness both from a skin perspective and from an arthritic perspective, explained Dr. Wu. "We need to address both, ideally with a single medication.” Initial treatment particularly for patients with milder disease, can involve an oral DMARD [disease-modifying antirheumatic drug] such as methotrexate. Other oral options that can address both the skin and arthritic symptoms include apremilast and tofacitinib, noted Dr. Wu.

An important consideration when choosing a treatment is the presence of comorbidities. Patients also could have conditions such as cancer or congestive heart failure and could have contraindications to certain medications, said Dr. Wu. "There really is no set algorithm in terms of deciding on treatment because it's individualized to the patients' symptoms and their other medical conditions. You don't want to overtreat but you don't want to undertreat either, so that's where the finesse come in," she counseled.

Read the full article at MedPagetoday.com.

Dr. Wu explained OA and rheumatoid arthritis (RA) both involve joint pain and damage, however they’re very different diseases. Both lead to inflammation, but the chronic inflammation that occurs with RA is much worse, said Dr. Wu. Treatment is different and having one type of arthritis doesn’t preclude you from having another. Additionally, RA typically feels better when you move, whereas OA typically feels worse, she noted.

Weight-bearing joints like the knees and hips are under a lot of pressure during everyday activities like walking, climbing stairs, or simply standing up. With excess weight, the pressure intensifies and can speed up joint damage. The risk of knee OA, in particular, is strongly correlated with weight, cited Dr. Wu “People who are obese are 6.8 times more likely than people at a healthy weight to develop knee OA.” For those who are overweight, weight loss can help slow down OA progression, reduce pain, and improve joint function.

The form of exercise can also help improve joint function and reduce OA symptoms, “Exercise helps build muscle mass to support the joints and also contributes to a healthy weight,” said Dr. Wu. The key is keeping exercise low-impact so that you don’t contribute to wear and tear on weight-bearing joint.

X-rays are important for diagnosing OA and seeing the severity of cartilage and joint damage, but they don’t reveal much about a person’s symptoms. “There’s not a real direct correlation between how lousy X-rays look and how bad you feel,” said Dr. Wu. “Some people have bone-on-bone and minimal pain, while others have minor X-ray changes and a lot of pain.” Because OA treatment is all about managing symptoms, the way you feel is sometimes more important than what a scan can show, she noted.

Read the full article at Healthcentral.com.

Dr. Wu explained a primary difference between OA and RA, is that with inflammatory arthritis such as RA, symptoms are worse when you’ve been at rest. “You tend to feel more stiff and achy when you first get up in the morning, or if you’ve been inactive all day long. The joint will feel better with movement,” said Dr. Wu. With OA, stiffness is common after periods of inactivity, however the biggest trigger tends to be too much activity. “The more you use the joint, the more it hurts,” she cited. 

While the joints involved can overlap between the two conditions, they’re often pretty distinct. “OA is more commonly seen in large weight-bearing joints, like the hips, knees, and lower back. Areas that take on a lot of stress,” noted Dr. Wu.

Additionally, there are plenty of medications available for RA to help manage and slow progression, however that is not the case for OA. “If it’s [OA] mild and manageable with physical therapy and NSAIDs, we typically do that first,” said Dr. Wu. “Surgery is a last resort. Joint replacements will fix the problem, but surgery comes with its own risks and recovery challenges, so doctors typically try other less invasive management options before resorting to surgery. Weight loss is also proven to be helpful if it’s a contributing factor for osteoarthritis,” she added.

Read the full article at TheHealthy.com.

Dee Dee Wu, MD, rheumatologist at HSS, provided a comment to CreakyJoints.org about the importance of effective RA treatment to prevent associated comorbidities, stating, “Treating the rheumatoid arthritis effectively helps minimize long-term complications.”

Signs of potential pulmonary issues in RA include a persistent cough and shortness of breath. “If there are any red flags, I would do a screening chest X-ray and possible CAT scan of the chest. If either tests are abnormal, I’d refer you to a pulmonologist for further evaluation. Treatment depends on the severity of the complication,” said Dr. Wu.

Additionally, RA medications might be the contributing factor to a patient's difficulty sleeping, and their doctor may need to change the treatment they are on or when they take them. Dr. Wu exampled, “You could take prednisone only in the morning, rather than twice a day."

Read the full article at CreakyJoints.org.