In this feature video, Dr Kristina Callis-Duffin shares what she'll be presented during her session, “Psoriasis & Psoriatic Arthritis - So Now What Do I Do?”, at the 2023 Fall Clinical Dermatology Conference. 

Kristina Callis Duffin, MD, MS, is professor and chair of the department of dermatology at the University of Utah in Salt Lake City, UT. She is also vice-chair/chair-elect of the National Psoriasis Foundation Medical Board and past president of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis).
 

Transcript: 

The Dermatologist: What major points do you hope attendees can take away from your session?

Dr Callis-Duffin: My talk is about psoriasis and psoriatic arthritis. What do you do next related to tumor necrosis factor alpha, or TNF-alpha, inhibitors? I'm going to present a case of a patient who has been on four of the five available, so four of them that have the indication for psoriasis and psoriatic arthritis, to make the point that he's tried all of them and the one he is on now, which is certolizumab, each time he... Maybe I'll step back.

He's been on a teeter-totter of his skin getting worse and his joint's getting worse, and so much of the switching between drugs that were aimed at his skin and drugs that were aimed at his joints relate to how TNF-alpha inhibitors don't work especially well in patients with skin relative to the joint, but sometimes when you get the joints controlled, the skin will worsen. And although he did switch to a non-TNF agent, he's now on one, which is certolizumab, which now, at the double dose psoriasis dosing has him pretty clear.

The Dermatologist: What are the latest updates in treating psoriasis and psoriatic arthritis?

Dr Callis-Duffin: I have a 7-minute timeframe. The case is just illustrating that certolizumab pegol, which is an older drug available, I think, almost 10 years now, 9 or 10 years, was then studied for psoriasis, and that the higher dose can be effective for the skin and the joints. And a lot of people don't know about that. It's really to review. And then I'll review on what the new GRAPPA guidelines say about the different domains of psoriatic arthritis with TNF agents.

That's the latest thing, is that this past year we published the domain, the GRAPPA recommendations, which splits psoriatic disease into eight domains. So I'll give a little bit of an update there.

The Dermatologist: What best practices should physicians implement in their practice when treating psoriasis and psoriatic arthritis?

Dr Callis-Duffin: The presentation will drive home that we have to treat the whole patient. Especially when the patient's sitting in the office, as a dermatologist, our goals are skin efficacy and safety. We want to keep our patients as safe as possible, but if their psoriatic arthritis is really the bigger problem, then we have to collaborate with our rheumatologists and sometimes other specialties. So that's really the first best practice, is to collaborate with rheumatology when patients have active psoriatic arthritis and that we have an open discourse on, okay, if the skin's worse, then the dermatologist might take the lead while the psoriatic arthritis treatment is still... while the drug may still be available.

I love the two birds with one stone approach. Find the drug that works best for both patients at that situation to think about psoriatic arthritis in terms of multiple domains. The other point that I'll make here, is that sometimes patients will develop axial disease, so they'll get spinal arthritis, and in that case, TNF agents are still very effective for that. Also, sometimes people forget about this class, that it's okay to switch to another TNF agent, even if they, one, didn't respond to another one, or they had a reaction. So I'm going to point out that too. And then with safety, I think I'll weave that in, best practices for safety are always be asking questions about infection, multiple sclerosis, drug induced lupus, and things like that.

The Dermatologist: Are there any tips or insights you would like to share with your dermatologist colleagues regarding your session to be presented at Fall Clinical 2023?

Dr Callis-Duffin: My insights are, oftentimes we jump to a different class of drug when the skin is worsening or the joints aren't responding to a TNF agent. Sometimes we go to another class because of an adverse reaction within a class. For example, with him, he had infusion reaction with his infliximab, but it doesn't mean that he will have the same kind of problem with other TNF agents, that there are enough variations in these that you can stay within class when psoriatic arthritis is driving the train.