Psoriasis is a chronic and painful multifactorial disease that manifests itself through plaques, eczema or wounds on the skin and for which there is no cure, although in up to nine out of ten cases a complete remission of the disease could be achieved. symptomatological level, for which early attention and adequate and continued treatment over time is necessary, as explained by the dermatologist and coordinator of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (AEDV), Dr. José Manuel Carrascosa, in an interview with Europa Press.
“The most recent biological treatments provide better and more persistent clinical results with very good safety. So today we can say that we can achieve, even in patients with serious diseases, up to 90 percent achieving very good results and, in “more than half of the patients achieve what we call ‘complete remission’, that is, the patient has no clinical manifestations, which does not mean that they have been cured,” he assured.
According to Dr. Carrascosa, this disease has a prevalence of 2.3 percent, that is, “there are more than a million psoriatic patients in Spain.” Furthermore, there is no cure since it occurs in individuals who are genetically predisposed to suffer from it, that is, they have various genes that cause them, after being exposed to various triggering factors, to develop certain alterations in the immune pathways that lead to psoriasis.
“Regarding this genetic predisposition, there is also a facial predisposition, but not only, when spontaneously or after some events such as infections, times of stress, as lesions appear and, from there, there are patients who have episodes occasional, but most of the time what we are going to see is a persistence for years, decades, and, sometimes, throughout life,” the expert pointed out, ensuring that “the majority of patients have chronic and persistent forms of the illness”.
With respect to the most frequent manifestations of the disease, Dr. Carrascosa has highlighted that “the most common is the formation of plaques, schematic, and red, escaping skin infections, which can appear in any location and can include, in the formations, a limited area to a very large area”. Furthermore, this can be accompanied by the psychological impact that the disease has since “there are things that the patient stops doing”, which is why it has a high impact on their quality of life.
Being a disease of genetic and skin origin, its manifestation can occur at different times in life, although the onset of psoriasis “is more common in young patients, more or less between 20 and 30 years old.” “Taking into account that in many patients this will have prolonged, persistent use throughout life, since you have patients who will spend decades with psoriasis,” stated the doctor.
Currently, the treatment of psoriasis is diverse since, if before only anti-inflammatory treatments were available that were effective “in some patients”, now research is directed at biological treatments, which are more specific for each patient since “they are based in the pathogenesis of the disease directed at more specific and concrete molecular targets”, as explained by the specialist.
“We have many types of biological therapies, the oldest being anti-TNF, anti L17, anti L23, and it is true that the latest, the most innovative, the most recent, since they provide better and more persistent clinical results with a very good safety profile,” said Dr. Carrascosa.
However, the treatment of psoriasis still has a lot of progress to make since, according to the specialist, “some molecules are now being developed that, instead of being punctured, are administered orally, but which are also based on very specific pathogenic mechanisms.” of the illness”.
Thus, the expert has especially highlighted the importance of some cell groups such as resident memory cells, which are part of the normal immune system and “are responsible for generating memory cells, that is, memory cells when you have an infection.” immune cells that remember this aggression and serve, in fact, to defend themselves.
“In chronic inflammatory diseases, these types of cells are the ones that when they do not work well, what they do is that they remember the inflammation of psoriasis since, even if you treat the patient and the lesions heal, when you stop the treatment , the lesions reappear. So, these recent memory cells have become targets for treatment because it is considered that if we manage to eliminate these resident memory cells we can achieve longer remissions, that is, the patient can go longer without lesions or In some cases we could even cure the disease,” he stated.
One of the most common complications of psoriasis is arthropathy or psoriatic arthritis, which occurs in 30 percent of patients. Psoriatic arthropathy manifests itself in people with psoriasis, with an average of five to ten years after the onset of skin lesions, although this can also occur before having manifestations of psoriasis.
“Psoriatic arthropathy consists of the inflammation of elements of the joint structure that can include enthesopathy, which is inflammation of the insertion point of the tendon into the bone, which is where it usually begins and can be accompanied by arthritis itself, that is, inflammation of the joints, but also tenosynobitis, that is, inflammation of the tendons or dactylitis,” he explained.
Thus, he has warned that psoriatic arthropathy “can affect both peripheral joints, that is, those of the hands, feet, elbows, knees, and what is known as axial arthropathy, which affects the spine , anywhere and particularly common is sacrohileitis, which is the involvement of the bones of the sacrum.
In this context, the dermatologist has stressed the importance of “early interception” of the disease, that is, “an early diagnosis and treatment of psoriatic arthritis in patients with psoriasis, with the aim of preventing or minimizing joint damage and other associated symptoms.
This early interception is possible thanks to tests such as an ultrasound or early detection test through which joint pain that does not yet have symptoms of psoriatic arthropathy can be identified. “It is important to detect it before having joint inflammation or degeneration because this can prevent patients with pre-arthropathy from developing the disease and avoid all comorbidities,” he added.
“There are studies that indicate that patients with psoriasis who receive early, biological treatment are less likely to develop psoriatic arthropathy. This is our proposal and our dream,” concluded Dr. Carrascosa.
