Here is an interesting large cohort study that looked at the use non-steroidal anti-inflammatory drugs (NSAIDs) and the increased risk of psoriatic arthritis, it suggests that long term use may increase the risk of psoriatic arthritis.  

Quote:

---

Study population:
The NHS II was established in 1989 when 116,430 registered female nurses aged 25–42 years were enrolled using a mailed baseline questionnaire which inquired about medical history and lifestyle practices. Biennially, cohort members receive a questionnaire enquiring about diseases and health-related factors. The follow-up rate exceeds 90% for each cycle. The institutional review board of Partners Health Care System approved this study. The completion and return of the self-administered questionnaire was considered as informed consent.

Ascertainment of psoriasis and psoriatric arthritis cases:
In 2005, women in the NHS II were asked if they had personal history of clinician-diagnosed psoriasis and the date of diagnosis (before 1991, 1991–1994, 1995–1998, 1999–2002, or 2003–2005) on the biannual questionnaire. During 2008–2011, we confirmed self-reported psoriasis using Psoriasis Screening Tool (PST) questionnaire, which inquired about the type of clinicians making the diagnosis and phenotypes (23). A pilot study using the PST showed 99% sensitivity and 94% specificity for psoriasis screening (23). Diagnosis of psoriasis with concomitant PsA was confirmed using psoriatic arthritis screening and evaluation (PASE) questionnaire, which includes a symptom scale with 7 items and a function scale with 8 items (24). Women chose one of 5 categories relating to agreement (strongly agree to strongly disagree) for each item. A total score of 47 or greater has been shown to identify PsA with a high sensitivity and specificity in our pilot study (24, 25). PASE has good test–retest reliability (25), and has been shown to be an effective tool in identifying PsA cases with 77% sensitivity and 79% specificity in the present cohort (26).

Assessment of medication use:
Cohort participants were asked about regular use (defined as ≥ 2 times/week) of aspirin, other NSAIDs, and acetaminophen (paracetamol) on baseline questionnaire in 1989. Since 1993, regular use of these medications during the past two years was assessed biennially. Information on average weekly dose (0, 1–2 tablets/week, 3–5 tablets/week, 6–14 tablets/week, and ≥ 15 tablets/week) of these medications during the past two years was first collected in 1999, and updated biennially thereafter. In 2001 and 2003, we also asked women about weekly dose of low-dose (baby) aspirin. Intake of 4 baby aspirin was converted to 1 adult standard-dose tablet (325 mg) as previously documented (27). We estimated duration of use by using the starting duration in 1989 and updating this variable according to the duration of use on each subsequent biennial questionnaire (18). We categorized medication use according to regular use status, duration, and weekly dose (27–29).

Results:
During 1,321,280 person-years of follow-up from 1991 to 2005, we documented a total of 646 incident psoriasis cases and 165 concomitant PsA cases. Regular acetaminophen users were at a higher risk of developing psoriasis (age-adjusted HR 1.29, 95% CI: 1.08–1.54) or psoriasis with concomitant PsA (age-adjusted HR 2.23, 95% CI: 1.63–3.07) when compared to non-regular users. Regular NSAIDs users were also more likely to develop psoriasis (age-adjusted HR 1.26, 95% CI: 1.06–1.49) or PsA (age-adjusted HR 1.74, 95% CI: 1.26–2.40) when compared to non-regular users.

Conclusion:
In this large, prospective cohort study, we found that regular acetaminophen (paracetamol) use may be associated with an increased risk of psoriasis with concomitant PsA in women, and women who used this medication more than 10 years were at a substantially increased risk of developing PsA. Although the association between regular NSAIDs use and risk of PsA was of marginal significance, analysis by duration suggested that women who used NSAIDs for long durations were also more likely to develop PsA. The efficacy of NSAIDs in treating PsA may need to be assessed more thoroughly, and special attention on psoriasis and PsA screening may be needed for those who are prescribed for acetaminophen and NSAIDs for long-term periods.

We are deeply indebted to the participants and staff of the Nurses’ Health Study II for their valuable contributions. This work was supported by the Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts and NIH grant R01 CA50385. The funding sources did not involve in the data collection, data analysis, manuscript writing and publication.

Competing interests: AAQ serves as a consultant for Abbott, Centocor, Novartis and the Centres for Disease Control and Prevention. The other authors declare no conflict of interest.

I'm curious as to why some members play with their own psoriasis treatments, I think most of us at sometime have fell for some of the rip-off's and scams out there and believed all the hype about how this will cure you. But how many of you have played with your own treatments and why?

I've noticed on Psoriasis Club that most members that seem to play with their own treatments are from the USA or the Far East, whereas those in Europe tend to stick with their professional for treatment. What is the reason for this? is it the way the healthcare systems work, out of pocket costs, or trust?

Although I am British I live in France so will let the British residents give their opinions on their system, and I will talk about the French system and why I don't play with my own psoriasis treatments.

First off in France Psoriasis and Psoriatic Arthritis are classified as a long term illness, this means that as long as your GP signs a piece of paper every 5 years to confirm you have either or both and you get treated by a dermatologist you will get 100% of the cost of your treatment. Should you not want to go that way you can still get prescriptions for basic treatments from your GP and pay around 30% of the cost but you may as well get refereed to a dermatologist and get 100% (those on low incomes get 100% off all treatments)  

Now I would imagine those of you in the USA and Far East are now saying how lucky we are, but wait it's not that easy. We pay around 40% of our earnings to the social system this covers us for all sorts of things medical social pensions etc, not sounding so good now is it? (I should point out that that those on low income still pay but they get money back by way of social payments, don't ask This is France and they love paperwork) Most French people also pay a small top up insurance that covers the 30% but that is not relevant in the case of psoriasis if you go the long term illness rout.

So we have an excellent well funded health care system and this means someone like me can have Stelara at no cost, this does mean I am tied into the healthcare system and should I want to go it alone with something like what Bill is doing with his own DMF treatment, or I want Fumaderm which is not available I would have to pay for my own treatment. It would also mean I would now be out of the long term illness certificate and should things go wrong I would probably find it very difficult to get back in to the 100% again.

I'm not tempted to play with my own treatments mainly because I have a huge trust in the French system, and I prefer to use something that has been tried and tested as well as being regulated. I'm also thinking that because there is no option and we have to pay 40% of our earnings this makes us use the system, if we didn't pay 40% and it was optional I would imagine most would opt out and then the French would be like the USA and the Far East and start trying to find their own treatments.

I would like to know what others think about their health care systems and if or why you would be prepared to use your own treatment for psoriasis.

Hi a little about me I'm 31 and have had psoriosis since the age of 13 (scalp) which came on very quickly after the first scab appeared on my scalp within a week my whole head was like a tortoise shell. My GP had no idea what it was and my mother was advised to keep me isolated from my siblings incase it was contagious it was only when we went tho the pharmacy that the pharmacist told us it was psoriosis. Unfortunately after trying every treatment under the sun nothing came close to clearing it. At the age of 17 after years of suffering from bullying and the embarrassment from school I restored to using a metal nit comb and scrapping of the plaques and using dovonex this as you can imagine was very bloody and painful but was at breaking point. This helped me a little but things only got worse as from about 18 after years of untreated depression I started getting psoriosis on my torso I was prescribed cream after cream none helped unfortunately it spread all over my body still even after seeing a dermatologist they wanted to keep using creams until about the age of 26 they decided it was time to try uva treatment two years I had light treatment to no avail I was close to giving up I moved back to dorset to be closer to family and was finally getting treatment for my depression got back to the hospital but to my horror they wanted me to have uva again I explained that it didn't work for me and as I had had talks with my old dermatologist about biological treatment was keen to try this there answer was nope not til I had done a full cause of uva with them so did so but then came the news that as that had not worked they would try puva which is uva with pills to increase the effect of the light again this never effected me so finally they decided to try Acitretin 50mg a day this was December 2014 3 months ago 18 years after first getting psoriosis it took about 8 weeks for all of the plaques on my entire body to go completely and the redness is finally starting to fade at the point of starting Acitretin I had a coverage of about 60/70% I now am at 0% plaque except my scalp which has still a thin layer all over. I am happier than I hav ever been and even whent abroad and stayed in a hotel even using the pool. I have had some side effects which include in order of getting them dry lips, dry and scabby nostrils, peeling skin on hands all over and soles of feet, sticky skin all over but hands and skin folds the worst all of these I can cope with but there is one side effect that it really starting to get to me and that is intense itching of the tops of my arms I have been prescribed an antihistamine but the only thing that seems to help is ice I actually give myself frostbite trying to relieve the painful itching. If anyone els has gone through this have you any advice I hope I didn't bore anyone by going on but feels good to open up thanks for reading my story.

Hello, have been looking online for some years now for all things p but this is first time joining a board. A little bout me and my journey with p is I have had it for 11 yrs now, started with a little on my legs but within a year they were pretty covered arms started, scalp, ears, feet and then my hands think that was the hardest for me, everything else could be covered. I have tried steroid creams, light treatment 4 times and fumaderm for a year also a gluten free diet for about six months. Next step is the one I'm currently doing trying to decide to take stelera injections this is what has been recommended by dermatologist. I'm in 2 minds one day I'm gonna go for it next day I'm not and the indecision is very annoying. Im actually annoying myself! Have not in the eleven years ever had full clearance from any treatment and the comeback from any I've tried is always worse so this always in my mind too. Anyway that's my p storey so far I guess u have joined to see if I can make some sort of decision as to what next... Thanks

Good day , ok a headline post very misleading I am not of course a hero . But the post does have a serious point . Today was my second week on humira and today was my third injection . I have been stressed about this all week long and not looking forward to today , yes I know "get a grip" I hear you cry . The good news is I did it , ok no big deal to some but a nightmare for me . I only share this because being new to the club I have noticed other people with a worry about self injection . Just to say if I can do it anyone can .It's very early days and i'm not expecting miracles BUT I think i'm showing about a 5% improvement . Good luck to all .

Now a may not deserve a medal but I do deserve a posh coffee and fancy cake . Cheers

This small study ahead of publication looked at the importance of a multidimensional approach in the management of psoriasis.

Quote:

---

Background:
Psoriasis has a negative impact on health-related quality of life (HRQoL) and may favour mental comorbidity.

Objective:
To investigate the contribution of chronic stress and burnout experience to HRQoL and how mental health influences the efficacy of an inpatient rehabilitation measure in psoriasis patients.

Methods:
Eighty-four psoriasis patients taking part in a 3-week inpatient rehabilitation measure participated in the study. Severity of psoriasis was assessed with the Psoriasis Area and Severity Index (PASI) and by patients' self-evaluation at the beginning and end of treatment. The following aspects of mental health were explored using validated questionnaires. Symptoms of chronic stress and burnout experience: Trier Inventory for the Assessment of Chronic Stress (TICS) and Shirom Melamed Burnout Measure (SMBM). Symptoms of depression: depression scale of the Patient Health Questionnaire in the German version (PHQ-D). HRQoL: Dermatology Life Quality Index (DLQI) and Short Form Health Survey-8 (SF-8).

Results:
Linear regression analyses revealed that chronic stress, burnout experience and perceived symptom severity but not clinician-assessed severity of psoriasis had independent negative effects on HRQoL. Patients who achieved a PASI reduction of <75% at discharge from the rehabilitation measure had lower baseline QoL and showed more symptoms of depression, chronic stress and burnout than patients who achieved a PASI improvement of ≥75.

Conclusion:
Chronic stress and burnout have appreciable influence on HRQoL and may adversely affect treatment success in psoriasis patients. Our data underscore the importance of a multidimensional approach in the management of psoriasis.

This little study ahead of publication looks at the increased risk of post-operative complications whilst using Bio treatments for psoriasis and psoriatic arthritis.

Quote:

---

Background:
There is limited evidence as to whether biologic therapy should be stopped or continued in patients with psoriasis and/or psoriatic arthritis (PsA) who are undergoing surgical procedures. Current guidelines of care recommend a planned break from biologic therapy in those undergoing major surgical procedures.

Objective:
To audit current practice of managing biologic therapy peri-operatively in a tertiary referral psoriasis clinic against guidelines of care and to investigate the effects of continuing/stopping biologic therapy in psoriasis and PsA patients.

Methods:
A retrospective audit of psoriasis and PsA patients who had a surgical procedure whilst on biologic therapy. A proforma was used to collect information on the biologics used, whether they were stopped peri-operatively and whether patients developed post-operative complications and/or disease flare.

Results:
A total of 42 patients who had 77 procedures were identified. Procedures ranged from skin surgery to orthopaedic and cardiothoracic surgery. Biologic therapy was continued in the majority of procedures (76%). There was no significant difference in post-operative risk of infection and delayed wound healing between those patients who continued and those who stopped biologic therapy, including those undergoing major surgery. Interrupting biologic therapy peri-operatively was associated with a significant (P = 0.003) risk of flare of psoriasis or PsA.

Conclusion:
Continuing biologic therapy in psoriasis and PsA patients peri-operatively did not increase the risk of post-operative complications. Interrupting biologic therapy peri-operatively significantly increased the risk of disease flare. This study is limited by cohort size and requires replication, ideally in a prospective randomized controlled manner.

More good news for Cosentyx as Canada follow USA, Europe and Japan and gives approval for it's use in the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy.

Quote:

---

Novartis announced today that Health Canada has approved Cosentyx (secukinumab) for the treatment of moderate to severe plaque psoriasis in adult patients who are candidates for systemic therapy or phototherapy. Offering a new treatment option for Canadians living with plaque psoriasis, Cosentyx is the first approved human monoclonal antibody (mAb) that selectively binds to interleukin IL-17A.

"An unmet need exists in the treatment of moderate-to-severe plaque psoriasis in achieving clear to almost clear skin and not all treatments are effective in all patients." said Dr. Richard Langley, Professor in Dermatology of Medicine, and Director of Dermatology Research at Dalhousie University in Halifax, Nova Scotia. "Achieving clear skin is the ultimate treatment goal for patients with psoriasis; 50% of psoriasis patients are not content with current therapies. The approval of Cosentyx, a therapy targeting IL-17A for moderate-to-severe plaque psoriasis, offers a new treatment option for physicians in treating this condition."

"About 2% of Canadians are estimated to be diagnosed with psoriasis, and nearly half of them are dissatisfied with their current therapies, including biologic treatments, demonstrating a high unmet need for patients," said Tim Maloney, President of Novartis Pharmaceuticals Canada Inc. "We are excited about the Health Canada approval of Cosentyx and the potential opportunity to offer a new treatment option to these people."

I am a retired Science Teacher and I have plaque psoriasis. My old Army buddy is a retired Orthopedic Surgeon. We both suffer from Osteoarthritis in the knees. He suggested that I try a prescription topical anti-inflammatory treatment named PENNSAID that he had had good results from. I did, and also found a great deal of relief from knee pain. The problem for me was that the prescription was not covered by my insurance plan and the out-of-pocket cost was hideously expensive.

Stay with me. I'm getting to the good part.

We noticed that the two active ingredients of PENNSAID are Diclofenac Sodium and DMSO (Dimethyl Sulfoxide). We did some research and discovered that another prescription topical gel named VOLTAREN is nothing more than Diclofenac Sodium and is rather cheap at $20 per tube. We also found that DMSO in gel form is cheap and readily available at any tack shop (those stores that sell horse and equestrian equipment), where it's sold as a horse liniment.

We both began using VOLTAREN and DMSO mixed half-and-half and had the same pain relief as we'd had with PENNSAID at much less than a tenth the cost.

Now the good part:

My plaque psoriasis is on the top of my left foot. Covered with a sock and shoe it itched constantly. I have been to several dermatologists and I have tried everything except the systemic medications.

Out of desperation, I began treating my plaque psoriasis with the same mixture of VOLTAREN and DMSO I've been using on my knees and IT HAS DISAPPEARED! I have been in remission for four months, now, plaque- and itch-free.

I am not suggesting that this is a cure, and I am not suggesting that you try it yourself before consulting with a physician. I am suggesting that you and your physician both read the cautionary notes on PENNSAID, and that you apply the mixture as instructed on the PENNSAID website. You will need a prescription for the VOLTAREN, but not for the DMSO. If you can't find a local tack shop, you can find DMSO for sale on Amazon. Buy the small jar of DMSO in gel form. I apply the VOLTAREN first, enough to cover the plaque, and then apply about the same amount of DMSO. Luckily, my German wife can buy double-strength VOLTAREN FORTE over-the-counter in Germany and bring home a few tubes for me. It's possible that you may also be able to buy VOLTAREN on Amazon, but use caution if you don't trust the supplier.

Good day folks . First time on any forum so here goes . Had P for about 40 years or more and like most people have tried every flipping thing good and bad . Puva has been my number one choice and it always worked like a dream normally for 6 to 12 months . Sadly the doctors are getting nervous about how much sun I have accumulated over the years so change of tactic . Today I have started a course of treatment using Humira 80 mg today , then down to 40 mg . Had a bad time with the self injection but will have to get used to it . It took a long time to get on this treatment "penny pinching" in my mind £7000 a year a read . My big concern is a whole list of side effects . Are any of you guys on the medication and if so any advise . Fingers crossed it goes well . Thanks for the invite .

well as the title really looking at what works for other people, i'm a 45 yr old male and suffred with psoriasis for quite a few years now, currently got patches on my face, scalp, behind my ears, 2 large patches on my knees, bottom of my belly. most of it is plaque psoriasis apart from my scalp, the problem i find is whatever i use only works for about a week, then i need to change.
i've now also got patches appearing under my nails.

i was using neutragena thereaputic shampoo which worked for a while even cleared the patches on my knees for 3 or 4 years until the patches came back recently and now nothing seems to work. i changed shampoo recently to capsal theraputic shampoo this seemed to work again for about a week, now it's making no difference.

i've also tried exorex treatment, worked wonders for me before now just dries my skin out (even with moisteriser) several different 'dermo' shower gels, i'm now using a pure coconut oil gel, i've also tried e45, several over the counter creams from the chemist, cider apple vinegar both drinking diluted or applying to the legions with no effect. currently the itching is getting really bad i just want to scratch myself to bits.

tried going to my local doctor on several occasions (they are quite useless around here) first one said it was ringworm and gave me a cream, within 24 hours i was back at the doctors because the cream he prescribed made the psoriasis spread like wild fire. he then said he would send a skin sample off to be tested and i never heard another word. last doctor i saw told me to change my diet and cut out all sweet food, anything with caffine in and all red meat.

so i'm now at the point to try suggestions of best next course of action.

hi guys & gals hopefully this forum will help me with my various types of psoriasis.

Hi guys, I have bern suffering from psoriasis just over 10 years now. I have been prescribed everything from steroid creams, UV, puva etc. Spending a fortune on this debilitating disease. So after so many different derms I have finally found one who is listening to me!! Might be due to the fact that im seeing him privately, but hey its worth it. So, he has prescribed me Fumaderm which I started yesterday! All good so far just some tingling going on through my body. Il be taking the second tab tonight with dinner. Really find this group so helpful and accommodating!! Will keep you all updated with progress. If anyone has any tips please share them with me as I am nervous after reading up on the side effects. However all the good stories of relief and keeping clear have me motivated to get passed that and keep going. I am getting married in August and really hoping to be clear.

Hi I'm Karen and new on here today

As i have said i only have mild ps to some of you, and i asked in a previous post about tablets. I have never been offered tablets, and it was said my doctor probably wont´put me on them, because i haven´t got it severe enough. Surely taking tablets is a lot easier than putting cream, and ointment on every day. So if you think my doctor won´t prescribe fudamern, will he give me something milder.

I am in Tenerife for another two months and as was mentioned, using dovonex, and being in the sun it says don´t mix. I come over here for six months of the year for the sun which helps a lot, so i don´t want any creams or ointments that will be detrimental to my ps. I would still like to know what creams, or ointments other members have found to keep it under control.Thanks

Hello my name is Janet and would like to hello. I have struggled with psoriasis for at least 4 years. I can`t use the common treatments for it because of the damage it does to my kidney. Had to have one removed in 2003 and everything i`ve tried reduces my kidney function. Am looking forward to talking to someone with similar problems and hope for a  treatment besides creams and oils.

HELLO MY NAME IS MANUEL RODRIGUEZ . I DO JUST GET PSOREASIS IN ALL MY BODY IS SO BAD FOR ME I NEED HELP

How have you managed to deal with having psoriais mentally? I don't think anyone really questions this or how you cope everyday? So I would like to ask.

What does it feel like having psoriais?

I have moved Karaokekings question to its own thread  here rather than take ccar's thread off topic

Karaokeking wrote

Quote:

---

Hi Jim. Here is my question. As i said in my introduction i am at the moment in Tenerife. I will be going back to the U/K at the end of April, so when i go back i am going to see my doctor and as about Fumaderm. Will i have to ask him to see a Dermatologist or can he prescribe them himself.
You also mention about being firm with the doctor, so can i insist on seeing the Dermotologist, if he won´t prescribe Fumaderm. Now i only have it mildly, so will that be relivant, on getting it prescribed.. Thanks again.

Lots of psoriasis biosimilar treatments coming forward these days and here is good news from another one. Oncobiologics ONS-3010 adalimumab (Humira®) biosimilar candidate met the primary endpoints in its first clinical study.

Quote:

---

Oncobiologics, Inc.,a biotherapeutics company focused on developing and commercializing biosimilars,announced today that ONS-3010, its adalimumab (Humira®) biosimilar candidate met the primary endpoints in its first clinical study.

A 3-arm single-dose pharmacokinetic (PK) study was performed in healthy volunteers to compare ONS-3010 to both the US- and EU-sourced Humira® reference products, and the two reference products to each other.  All of the PK endpoints met the bioequivalency criteria of the geometric mean ratios within 90% confidence interval of 80-125%.  These included: maximum serum concentration (Cmax), area under the time-concentration curve from first time point extrapolated to infinity (AUC0-inf), and area under the time-concentration curve from first to last time point measured (AUC0-t).  Safety and immunogenicity were similar across the three arms.  An exploratory ex vivo pharmacodynamic study also showed encouraging results between ONS-3010 and the reference products on TNF-α blockade and the induction of specific inflammatory responses.  This first-in-human study was conducted by the Centre for Human Drug Research (CHDR) in Leiden, The Netherlands.

ONS-3010 is being developed as a biosimilar to adalimumab, an anti-TNF-α monoclonal antibody, which is approved in many countries for the treatment of multiple inflammatory diseases that include rheumatoid arthritis, plaque psoriasis, polyarticular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease and ulcerative colitis, as well as several pediatric indications.  ONS-3010 has the same amino acid sequence, pharmaceutical dosage form, and strength but contains a formulation of different composition.

“The clinical PK similarity study is a required regulatory milestone for biosimilar development.  We are excited to report that ONS-3010 has met the PK endpoints, which strengthens our confidence in achieving the global development of ONS-3010 as a biosimilar to Humira®,” stated Claude Nicaise, M.D., Chief Medical Officer at Oncobiologics.