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Are we able to fight it? Absolutely. We have better and better therapies for patients with this disease. However, what is most important from the point of the therapy success is the complete individualization of the treatment course for each patient. Joanna Lewandowska, the editor-in-chief of the Warsaw Press, talks to prof. Joanna Narbutt from the Department of Dermatology and Venereology, Medical University in Łódź.
Joanna Lewandowska: Professor, psoriasis is considered not only a dermatological disease, but a systemic disease, what is it characterized by? What are the consequences of an untreated disease?
Prof. Joanna Narbutt: Psoriasis is not only a skin disease, about 1/3 of patients also have psoriatic arthritis, which, if left untreated, may lead to impaired mobility and permanent disability of the patient. In addition, we know that patients with psoriasis are at risk of developing other diseases, such as metabolic syndrome, diabetes, atherosclerosis, ischemic heart disease, but also depression. Some patients have suicidal thoughts, some even make suicide attempts. Thus, a patient with psoriasis, a systemic disease, should be looked at very holistically, and as soon as possible, in the case of moderate to severe disease, general treatment should be undertaken in order to inhibit inflammation and try to inhibit the development of severe complications. It is extremely important to treat psoriasis and patients with psoriasis individually. Each patient should learn about treatment and disease control options. No psoriasis patient is currently able to live with severe lesions as this results in impaired quality of life. Currently, we are able to control the disease and restore patients to a really good quality of life. At the same time, we can try to modulate inflammatory and immune processes so as to minimize the development of other systemic diseases.
Often, patients suffering from psoriasis are excluded from social life, stigmatized – why is this happening? What is the scale of this problem from the individual patient’s perspective?
Every psoriasis patient feels stigmatized. Due to the fact that the disease cannot be completely cured, patients often stop fighting and withdraw from treatment as a result of ineffective therapies. The presence of skin lesions makes them feel rejected, inferior, less attractive, they have problems with arranging their private and professional lives. A large part of the society considers skin lesions to be contagious. And those who do not think so, because of the “ugly” appearance of the lesions, they do not want to maintain contact with patients with psoriasis. As a result, psoriasis patients do not take advantage of many daily activities, such as going to a swimming pool. They often wear unattractive clothes that cover as much of their body as possible for fear of showing their skin. Thus, due to the disease picture, patients with psoriasis often feel a lack of social acceptance. The role of the doctor is not only to find the path of the message, explain to the patient how he can find his way back to himself, but above all, to provide him with information about the possibilities of therapy and to establish a therapeutic process scheme in such a way as to finally reach biological therapy.
Can psoriasis be successfully treated? What is modern biological treatment?
Currently, due to the development of pharmaceuticals, we can effectively treat psoriasis, achieving clinical remission, i.e. clean skin. The idea of modern dermatology is to control the psoriasis process, i.e. to conduct treatment in such a way that the patient remains without skin changes as long as possible.
Biological treatment is based on the use of monoclonal antibodies against the key proteins involved in the pathogenetic process of psoriasis, ie TNF-alpha, IL12 / IL23. We now know their mechanism of action and safety profile, therefore we consider them extremely effective and safe for patients. The most modern of them – IL17 are still not reimbursed. Some of the registered biological drugs are available under the NHF drug programs, and we are waiting for the most modern ones.
Who is it for? Do patients undergoing effective therapy have a chance for a normal life?
Biological treatment is an opportunity for patients with severe and moderate forms of psoriasis vulgaris and psoriatic arthritis. Before qualifying for biological treatment, the patient must undergo treatment with conventional general medications such as methotrexate, cyclosporine, acitretin, or PUVA. In the event of failure of these therapies and a correspondingly severe disease process, a patient suffering from psoriasis in Poland has a chance for biological treatment. Patients undergoing biological therapies in most cases achieve very good therapeutic results. During the therapy, patients regain clean skin, as well as significant, and sometimes complete resolution of joint ailments.
Where, in your opinion, is the result of the situation that the drug program in Poland treats less than it could, and that patients constantly complain about the lack of access to biological treatment?
In Poland, fewer patients are treated than provided for in the drug program, as some patients, but also, which is unpleasant, doctors, are not aware of the therapeutic possibilities. We can currently treat it effectively, only please refer patients with severe disease to our dermatological clinics. The development of medicine has allowed us to treat the sick not only with ointments, but we also have tablets and biological drugs at our disposal.
Jaman kuna wagonjwa wengi wa psoriasis wasio jiweza mnatusaidiaje ?