Hello,

My name is Daniel and I started taking Cosentyx on 3/26/15.  I have tried Raptiva, Enbrel, Humira, Remicade, Stelara, and Soriatane (did not stay on too long because it severely chapped my lips) and the only thing that has ever worked for me was Raptiva (almost all clear with it) but that was pulled years ago.

I took my third set of shots last Thursday and am starting to see some results.  The plaque on my elbows, knees, and legs is less thick so it is starting to work.  I still have quite a ways to go but I am finally encouraged by a psoriasis treatment.  I have not suffered any side effects that I am aware of and think the injection pen is a lot better than other prior treatments; it doesn't hurt as much overall.  The first two weeks it was a little pinch and then nothing.  This past week it actually stung a bit more and left a small bump on each leg that went away the next day.  I don't know if that was due to the placement of the shots or something else, so I will have to see if that continues.

Overall I am cautiously optimistic that this might work.  Its been almost 6 years since I stopped taking Raptiva and started the merry-go-round of treatments that did not improve things (I know those help some people, just not me).  I look forward to the next couple months.

-Daniel

Currently I have psoriasis in various places on my body mostly on my legs and arms. I have seen short term results with Humira and Stelara but it never sticks more than 3 months. I just started Cosentyx last week after trying Humira, Stelara, and every other product on the shelf. So far the only side effect I have seen has been a stuffy nose.

This study looks at the sexual health and quality of life issues in psoriasis patients with genital psoriasis, it concludes that genital psoriasis dose indeed have a profound impact on sexual health issues.

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Objective:
This study was designed to ascertain factors associated with the development of genital psoriasis and its impact on quality of life and sexual functioning.

Methods:
This was an observational, multicenter study of 354 consecutive psoriasis patients.

Results:
One hundred thirty-four patients (38%) had current genital involvement while 224 (63%) had a current and/or previous history of genital involvement. Eighty-seven percent reported itch, 39% pain, 42% dyspareunia, 32% a worsening of their genital psoriasis after intercourse, and 43% a decreased frequency of intercourse. Younger age of onset of psoriasis, male sex, more severe disease, and involvement of the scalp, flexures, and nails were associated with the presence of genital disease. There was no association with circumcision or obesity. Patients with genital psoriasis had more impairment in quality of life and sexual health as determined by the Dermatology Life Quality Index (P < .0001), the Center for Epidemiological Studies-Depression Scale (P = .01), and the Relationship and Sexuality Scale (P < .0001).

Limitations:
This was a descriptive study from 2 tertiary referral centers where patients were likely to have more severe psoriasis.

Conclusion:
This study highlights the high prevalence of genital psoriasis and its profound impact on quality of life and sexual health.

I've read about a new skin conditioner for P. from a Norway Pharmacuidiucal company. It was designed for excema and psoriasis to help moisturize & many other issues p. suffers have. It claims to be successful in their studies in Norway,France.& England. It's called Ganodex. Has anyone heard of it or used it? It also claims the following.

Immune-modifying ingredient which can reduce scaling, itch and irritated skin. What's that? Some antiinflammatory?
100% natural ingredients with no detected side effects. No detected side effects? YIKES ! No allergies from the ingredients in other words. No cortisone and parabenes, which can cause thin, damaged and irritated skin.
Quickly absorbed. No fatty, greasy skin after application. It claims to contains triple helix beta glucons? What's that ?

I have had this disease all my life. Scars from head to toe. Tried many creams and moisturizers that have really helped not greasy no cortisone or steroids, waxes, or Laural sulfates etc. in conjunction with prescription meds. I have three great moisturizers that will help keep my skin from drying and flaking. Which in my case is a precursor to a p. outbreak in most cases. It's another way to manage the disease. There is really only managing this disease and knowing your triggers.  Keeping the skin from drying out is a big trigger for me.

The main ingredients in Ganodex are Coconut fat, paraffin, stearic acid, honey, glycerol, cetyl alcohol, beta glucan, sorbate, benzoate. Nothing new there! I use lavender parifin wax & glycerin in my hand & foot spa then wrap in Baggies /occlusion treatment/ and put socks on over nite. Especially in winter. This is maintance , management not to let the skin dry out and keep the cracks moisturized. This is a huge trigger for P. for me Dryness.

Heck I'll just thro it all in the blender add bees wax or paraffin wax.. Walla !   Home made hand cream for P. Or grab a few herbs from the garden and my fav kudzu tea! LOL
Or just use coconut oil and glycerin. After all glycerin is in the DERM layers of skin.
It's not in the US yet. THATS why I asked if some of you across the seas have heard of it or tried it?

Coal tar has been another biggie for my P. It's OTC and cheap. Another hand made help to stop the itching is i mix NON-ALCOHOL-Witch Hazel ( a natural anti inflamatory ) with Glycerine,50/50 % in a small spray bottle. Cuts down the built up plaque and stop the itching. Also sunburn spray stops the burn and the itch!

Quest4Cure

59 year old male suffering from psoriasis for 30 years. Tried everything, as most have, started Cosentyx today. Fingers crossed.

I've had psoriasis on and off for a number of years this particular 'attack' has lasted for 2 years so far and started when I stopped breastfeeding my little girl.

My entire torso is one big patch and my arms and legs are covered in spots of varying size but I try not to let it bother me but today my hairline was really bad and covered in really obvious flakes which after 4 washes with capasal I have finally got rid of.

I was meant to take my daughters to street dance but instead I cracked, burst into tears and my wonderful hubby (who was meant to be working from home) took them instead.

I have an emergency appointment with my gp in an hour to get more cyclosporin as a short term stop gap until my next dermatology appointment which could be any time as the hospital is in chaos cos all the dermatologists left in the same month. Cyclosporin doesn't work well for me but combined with epidermis and dovobet it's better than nothing.

So how many of you have hidden from you children in the bathroom crying....or is it just me? ;-) xxx

Hi everyone, I've come here for some help, some hope and some answers. Hopefully I find one or all of those things. My story starts just recently, about a month and a half ago. I begin getting one stop on my stomach. It was perfectly round and very itchy. Then I noticed several more spots over the course of a month: two on my shoulders, about 7 on my neck. They are all the same: they start as tiny little red bumps, almost like a pimple and itch like crazy. Then over the course of a few days they begin to expand out and raise up. They begin to flake on the top of the bump. They are never more than a dime in circumference. They usually last about 2-3 weeks then reduce in size and itch, leaving a bit of a mark.

I went to the doctor twice about this. The first time she suspected ringworm and gave me a fungal cream. That actually seemed to help, but my 2 week skin scraping test for ringworm came back negative. After, I got some more spots so I went to a different doctor who said it looked like psoriasis. I've looked at pictures on the internet of psoriasis and mine doesn't really look like it.

the Doc gave me a steroid cream to put on, and I feel like it's not helped at all, but it's only been 2 days. According to me story does this sound like psoriasis? I do also have another autoimmune disorder and I've heard that usually if you have one AID you'll have another.

I'm getting really stressed about this as every day I wake up and find a new stop in a totally random place! And they itch SO MUCH. Any thoughts? Does my issue sound like psoriasis?

Hi! Am new and appreciative of finding this site via google.
Think I am lucky to have only lived with psoriasis since I turned 40, am 44. It coincided with job difficulties and heavy drinking. I have it on the palms of my hands and soles of my feet, also my lower legs. A week ago the scales which often split turned into puss blisters and my diagnosis is now palmer-plantar pustular psoriasis, I was still prescribed dovobet. I had to go a walk in clinic rather than my GP. My  knuckles are alsoswollen.
Previously I have pretty much used under foot blisters to ease the pain of the cracks on my feet, which helped. But this time when I changed the blisters to keep them clean, the skin peeled off too leaving raw soles and making it impossible to walk on one foot and painful on the other. Does anyone have any suggestions how I might relieve this pain. Am used to thick scales with cracks, not large patches of raw skin?
Also has anyone's psoriasis disappeared when they have stopped heavy drinking (and not come back)?
Excuse  me for asking questions on my very first post.
Hope this finds a lot of you well and coping.
Kind  regards

Hi all

I would like to share another clinical study. It's about palm Psoraisis and Dupuytrens contractore. I have it very bad palmoplantar P. and have managed to contol it thru a constant regime. If anyone is interested I will be happy to share. It's on the bottoms of my feet too!

What the clinical study I read about actually found a connection between Dupuytrens Contracture & a high % of the patients had DC also had palm Psoriasis. Much is not understood by many doctors about treatment of DC.

Dupuytrens is the thickening of palm tendons & nodules pulling the tendons in while also pulling the fingers into a curl. There is no cure. It's the collagen constantly attacking the tendons as the antibodies send out signals to the tendons the same way that plaque psoriasis is in overdrive building up skin before shedding can occur. Thru the interluken pathway found in psoriasis, a lot of new drugs block that pathway the IL-17 or the
IL-23 both for Psoriasis and psoriatic psoriasis. Both which are the same pathways extra collagen is building up on tendons causing Dupuytrens Contracture. That was the connection in the clinical study.

I have had surgery, needle apenuroctomy and biologic drug injections in the fingers called XIAFLEX. The bio drug opened the 4th & fifth fingers from a closed position that surgery caused. At the time of surgery palmoplanter psoriasis flared and also the Dupuytrens flared in all four fingers.

Long story short the XIAFLEX also removed all the scar tissue from the surgery to open my frozen shut fingers. Now the bio drug is in another study to help burn victums and removing scar tissue from burn victims, surgeries etc. This is not a bio drug for the faint of This bio drug has many painful side effects. My fingers are still painful after 2 months and swollen. A splint is worn nightly for a year. Hand therapy for use to strengthen fingers is important for continued use, hopefully. my hand is still in a claw position and does not lay flat on a table with limited movement.

The bad news my fingers are curling again. I am suspicious that there could be another issue in my case at work here.

The Keobner Phenomenon. This is when anything can set off a reaction such as surgery, insect bite with DC & Psoriasis in my case then causes a flare . In my experience every time I try something to help my claw hand, it just makes it flare and far worse. However, at least the XIAFLEX a enzyme totally eliminated the thicken scar tissue and now my two fingers are not curled in a fist like position. I can put on my garden gloves. and shake hands.

If you have hand P. & you have nodules on the tendons & thickened tendons that predominantly show up in your palm or both it could be DC.

I hope this makes sense. Please google the psoriasis & Dupuytrens contracture clinical study for more info.

Have a good day !

Hi everyone, I used to post on Psoriasis-help, but the website just randomly disappeared one day.

I suffer from plaque psoraisis, PPP and Psoriatic Arthritis.  I'm currently on Cyclosporine, and just about to begin Stelera.

Not much else to say, any questions feel free to ask

Humira is now available in the EU for the treatment of severe chronic plaque psoriasis in children and adolescents from four years of age who have had an inadequate response to or are inappropriate candidates for topical therapy and phototherapies.

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AbbVie announced today that the European Commission (EC) has granted marketing authorization for HUMIRA® (adalimumab) for the treatment of severe chronic plaque psoriasis in children and adolescents from four years of age who have had an inadequate response to or are inappropriate candidates for topical therapy and phototherapies. With the EC decision, HUMIRA now has approval for use in this indication in all member states of the European Union.

"Several treatments have been shown to be effective in subgroups of patients with pediatric psoriasis. However, a limited body of supporting data is available. The approval of adalimumab is an important milestone in particular for children with severe disease because it extends the armamentarium of the physicians who are working to reduce the burden of this chronic disease in this sensitive young patient population," said Marieke M.B. Seyger, MD, PhD, Associate Professor of Dermatology, Radboud University Medical Center in Nijmegen, Netherlands.

The marketing authorization is based on the positive results of a Phase 3 study, which will be presented at an upcoming medical meeting. Since first gaining approval 12 years ago, HUMIRA has been approved in more than 87 countries. It is currently being used to treat more than 851,083 patients worldwide1 across 11 globally approved indications.2

"With the approval from the European Commission, HUMIRA is now the only biologic approved in Europe to treat children with this condition starting at four years of age, offering an important new option for physicians treating pediatric plaque psoriasis," said Michael Severino, M.D., executive vice president, research and development and chief scientific officer, AbbVie. "This new indication contributes to the increasingly broad spectrum of indications for HUMIRA, and supports its strong record of efficacy and safety in treating pediatric populations who are managing challenging chronic diseases."

Good news for people with Psoriatic Arthritis in the Haverhill area as West Suffolk Hospital announce Haverhill's rheumatology clinics will increase from one per month to four per month.

The first rheumatology clinic for Haverhill was set up in September 2012 and caters for all types of inflammatory and non-inflammatory rheumatic disorders, including rheumatoid arthritis, psoriatic arthritis, polymyalgia rheumatic and osteoporosis.

They will be held on the first and third Wednesday of every month, and staffed by a consultant rheumatologist and specialist nurse. They accept referrals from local GPs, and new patients will now wait just two weeks for an appointment.

As I live in France I found this study albeit small interesting as I have never experienced any prejudice against people with psoriasis, but then again I do live in the country where people don't tend to judge each other on the appearance or worth.

The survey looked at misconceptions, negative prejudice and discriminatory behaviour towards psoriasis patients in France, and I found some of the percentages in the results shocking to be honest.

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Background:
The perception of stigmatization of patients with psoriasis is largely due to misconceptions and negative prejudice about this skin disease. ‘Uneducated’ judgements can give rise to discriminatory behaviours.

Objective:
Evaluate the prevalence, in France, of misconceptions, negative prejudice and discriminatory behaviour towards psoriasis patients.

Methods:
Online survey conducted in June 2011, aimed at 1005 persons aged 16–64 years, representative of the French population. The representativeness of the sample was ensured by quota methodology (gender, age, occupation of the interviewed person) after stratification by region and location category. The respondents were asked to respond to a questionnaire on their knowledge of psoriasis, their attitude and main feelings/perceptions towards psoriasis patients.

Results:
About 62.4% of respondents recognize a lack of information about psoriasis and 19.7% have misconceptions about this disease. About 16.5% believe that psoriasis is contagious, 6.8% believe this skin disease is related to personal hygiene and 3.2% believe that it affects more people with low personal hygiene. About 50.0% of respondents show discriminatory behaviour towards psoriasis patients, reflected by reluctance to maintain friendship ties/a relationship of friendliness (7.6%), to have lunch or dinner with a person with visible manifestations (17.9%), to give a kiss on the cheek in greeting (29.7%), to shake hands (28.8%) and to have sexual relations/intercourse (44.1%). Patients with negative prejudice about the psoriasis frequently have misconceptions towards psoriasis patients. About 52.8% of respondents do not know anyone with psoriasis. Socio-demographic indicators such as gender, education level and rural or urban way of life are not associated with an increased prevalence of misconceptions and/or discriminatory behaviour.

Conclusion:
The lack of knowledge about psoriasis in France is important. There is an urgent need to strengthen information campaigns about psoriasis intended for the General Public.

Can psoriasis spread to your eyes? Currently have psoriasis in then lashes of my right upper eye lid. It is very flakey and sore. In the 23 years that I have had psoriasis I have never had it that close to my eye.

Do you know that Psoriasis is the beginning of Zombie? And we are the lucky one, the founder        
If you started to feel that you want to bite the people next to you that is the sign of being a Zombie...
So come and start to rock the world            






This is just a joke...      Just want to laugh and forget our problems hahahaha

Can-Fite BioPharma Ltd have announced they are disappointed that their results from the Phase II/III trial of CF101 for psoriasis as it did not meet its primary endpoint after seeing no real benefit over placebo, but they will continue the analysis of secondary endpoint and sub-group analysis and intend to complete it in the near future.

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Can-Fite BioPharma Ltd, a biotechnology company with a pipeline of proprietary small molecule drugs that address inflammatory and cancer diseases, announced today that its Phase II/III psoriasis trial for the Company's drug candidate CF101 did not achieve its primary endpoint.

This Phase II/III double-blind, placebo-controlled study was designed to test the efficacy of CF101 in patients with moderate-to-severe plaque psoriasis. Can-Fite enrolled a total of 326 patients through 17 clinical centers in the U.S., Europe, and Israel. The first study segment was comprised of three arms with 103 patients who received either 1 mg of CF101; 2 mg of CF101; or placebo. All patients receiving placebo were switched to either 1 mg or 2 mg of CF101 after 12 weeks and continued receiving treatment until week 24. Following a positive interim analysis, Can-Fite continued to enroll patients to the second segment of the study. The second study segment was comprised of two arms with 223 patients receiving either 2 mg of CF101 or placebo. All patients receiving placebo were switched to 2 mg of CF101 after 16 weeks and continued receiving treatment until week 32. The primary efficacy endpoint was  a statistically significant improvement in the Psoriasis Area Sensitivity Index (PASI) score relative to placebo treatment, and the secondary endpoints were, among others, the Physicians' Global Assessment (PGA) score as well as various safety parameters.

The proportion of patients treated with CF101 who achieved at least a 75% improvement from baseline in disease severity at week 12, as measured by PASI 75 was 8.5% vs. 6.9% in the placebo group. With respect to PGA, 6.4% of patients treated with CF101 achieved clear or almost clear skin at week 12 compared to 3.4% of the placebo patients. CF101 was found to be safe and well tolerated.

"We are disappointed that our trial did not meet its primary endpoint. Regretfully, in the PASI 75 and PGA we did not see any real effect in patients over placebo. We have not yet completed our analysis of secondary endpoint and sub-group analysis and intend to complete it in the near future. Can-Fite is continuing its research and development efforts in relation to its drugs and indications in the pipeline." stated Can-Fite CEO Dr. Pnina Fishman.    

I started writing here about what I believe triggered my Psoriasis & what I've discovered helps but it soon became a rival to War & Peace  
I really think I'm on to something and tho' I'm sure it won't help every one I do think it might resonate with some.
One sorry sad sack day late last year I realised I needed to pull my finger out and stop whining. I wrote down every event that could possibly be connected to my Psoriasis. This is how it went. I've have the P on my scalp, in my ears, a good dose on my hands and fingers. I also have it on each elbow but I have that area under control with Daivobet 50/500 ointment. Every joint in my hands and fingers were always swollen and stiff and the pointer fingers were becoming crooked.  I've had it for over 3 years.  
In October I went to my doctor desperately looking for relief, all I left there with was a box of tissues. Next day I started eating totally gluten free and I felt so much better just 3 days later that I've kept with it and have I lost 10 Kg with no effort but it didn't ease my P.  In September it had suddenly dawned on me that the cycle of flare ups (it never went away just wasn't as bad) matched my monthly cycle (or what had been) I also out of nowhere started getting a bad tummy after I had eaten food with dairy in it (and now I suspect eggs), mayonnaise, aioli and especially cream and ice cream, it became a pattern that within 30 minutes of eating I'd have to break the one mile minute to get to the ladies.  Now I know what some people say about the 8 hour digestion cycle but I don't believe a word of it. It also occurred to me that 3 times in a row of going to the movies and eating an icecream that the meaty area of my palms were burning and blisters under the skin were trying to erupt thru the skin after about an hour. It had happened many times over the years, I just didn't put the pattern together. I am in the early stages of full menopause now but my bloods showed only a small dip in numbers, I felt like crap but I thought the only symptoms I had was minor hot flushes just thru the day. It was like a light bulb being switched on, a diary entry every day for the next 4 weeks tied hot flushes with my psoriasis flare ups. 90% of the month I was having to wear 20 band aids on my fingers just to be able to use cutlery, write with a biro and do my job. At it's worst I would only have to straighten my pointer finger and the skin would split and it was like having 100 paper cuts.  My scalp was unbearable, I'd pour vinegar on it just to change the feel of the itching to stinging. Resting my hands on a hot kettle almost felt so good it tickled.
After going to a new lady doctor who was right up on the latest HRT info I had bloods and scans done and after getting results started on HRT on Feb 17th. Today is the 27th March and I can tell you that I have not had one eruption or flare up for 2 weeks. The band aids were making it worse and I started getting plaques on my knuckles but they are looking better. My hands are dry but I am so happy they are feeling so much better, it will be some time before the hard plaques are gone. The splits are healing and I haven't had a bleed for weeks.
Another thing I know gave me relief within a day was scrubbing my whole body with chlorhexidine and scrubbing my scalp with a product containing ketoconazole (that was for you jiml... not giving you a spanking opportunity    )  in fact I used the keto on every area there is hair, particularly the eyebrows, they itched like mad and the plaques were ugly. I had also had a reoccurring crazy itching inflamed area down the right side of my entire nose. I know from being a nurse that humans develop skin bacteria, we use microshield at work, it comes from warmth, sweating and just living. I must have been in denial! I smelled funny! I blamed the water coming out of the taps, I had collected water in a container intending to take it to be tested. I really smelled generally off. By the time I had scrubbed twice in a  week the smell disappeared.  For 3 weeks I have also cut milk products and eggs. I checked my calendar and am not surprised that my cycle would have started yesterday for this month. Last night my left pointer finger started itching and it became inflamed, exactly in the same area I believe the first signs started after continually opening and closing a spring water bottle for 3 weeks. I am a strong believer now about petrochemicals in plastic causing skin disorders and I know this is where mine started 3 years ago. I also notice now that if I become stressed/ over tired/ my anxiety levels pitch that my hands and scalp start heating up and become itchy. Sorry for the book length story. I hope it helps some body.  

Following on from the report about Leo Pharma submitting their new aerosol for psoriasis to the FDA, today they announced they have also submitted a Marketing Authorisation Application to 30 European Health Authorities for Enstilar.

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LEO Pharma today announced it submitted a Marketing Authorisation Application to 30 European Health Authorities for Enstilar (calcipotriol/betamethasone dipropionate 50 micrograms/g / 0,5 mg/g) cutaneous foam for the treatment of psoriasis vulgaris, a chronic, inflammatory skin disease that can significantly impact quality of life for patients. Enstilar has the potential to be the first fixed combination cutaneous foam approved for the treatment of psoriasis vulgaris.

The new cutaneous foam formulation is a fixed combination of calcipotriol and betamethasone (as dipropionate) developed with the aim of improving treatment for patients with psoriasis vulgaris the most common form of psoriasis.

The European submission is based on the phase 3a trial, the PSO-FAST trial, which evaluated the efficacy, safety, itch relief and improvement of itch-related sleep loss across a four week period with Enstilar as well as the phase 2 maximum use systemic exposure safety study of Enstilar.

Kim Kjøller, Senior Vice President, Global Development at LEO Pharma, commented:

“We believe Enstilar has the potential to provide a new, topical treatment option for patients living with psoriasis. Helping people suffering from skin conditions is at the heart of what we do and this regulatory submission, along with our existing treatment portfolio and patient support offerings such as QualityCare, reinforces our commitment and takes another step toward improving quality of life for people living with psoriasis.”

Hi - I'm about to start using magnesium chloride flakes (mixed with water and put in a spray), as I've read encouraging things about it on another website.  Has anybody here been using it?  If so, good results?

Thanks,
Mary

They are still often recommending using methotreaxte with bio treatments in some cases, this large study of 95,941 patients suggests you may also need to take a herpes zoster preventive vaccine too.

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Importance:  
The risk for herpes zoster (HZ) in patients with psoriasis treated with biologic medications or other systemic treatments has been given little attention to date.

Objective:  
To describe the risk for HZ in patients with psoriasis and its relation to treatment.

Design, Setting, and Participants:  
A cohort study was performed using the administrative database of Clalit Health Services, the largest public health care provider organization in Israel, in the setting of general community clinics, primary care and referral centers, and ambulatory and hospitalized care. We extracted information for all patients who received a psoriasis diagnosis from January 2002 to June 2013. Follow-up was conducted until the end of July 2013. The study included 95 941 patients with psoriasis in the analysis, with 522 616 person-years of follow-up. Incidence of HZ events was calculated for each systemic antipsoriatic medication provided, during a follow-up period of 11 years and 7 months. We used a generalized estimating equation Poisson regression model to examine the effect of each systemic treatment for psoriasis on HZ incidence, adjusting for age, sex, psoriasis severity, Charlson comorbidity index, steroid treatment, and socioeconomic status.

Main Outcomes and Measures:  
Incidence of HZ associated with systemic therapies.

Results:  
In a multivariate analysis, it was observed that treatment with phototherapy (rate ratio [RR], 1.09 [95% CI, 0.62-1.93]; P = .99), methotrexate (RR, 0.98 [95% CI, 0.78-1.23]; P = .83), cyclosporine (RR, 1.16 [95% CI, 0.48-2.80]; P = .49), and biologic medications as a single agent (RR, 2.67 [95% CI, 0.69-10.3]; P = .14) was not associated with HZ. The use of combination treatment with biologic medications and methotrexate was significantly associated with an increased incidence of HZ (RR, 1.66 [95% CI, 1.08-2.57]; P = .02). The use of acitritin was associated with decreased incidence of HZ (RR, 0.69 [95% CI, 0.49-0.97]; P = .004).

Conclusions and Relevance:  
Physicians may need to consider offering an HZ preventive vaccine to patients receiving combination treatment with biologic medications and methotrexate, particularly if they have additional risk factors for HZ.