Understanding your psoriasis and psoriatic arthritis ... · Traveling with your medications and ongoing care.....13 To learn more ... Psoriasis and psoriatic arthritis are long-term

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Understanding your psoriasis and psoriatic arthritis medications

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Table of contents

Psoriasis and psoriatic arthritis medications: an overview....................................................................1

Staying on track with your medications.................................................................................................1

Pregnancy and breastfeeding considerations ...................................................................................... .2

Vaccine considerations......................................................................................................................... .2

Types of psoriasis and psoriatic arthritis medications...........................................................................3

Topical therapies....................................................................................................................................3

Proper application ...........................................................................................................................6

Managing topical therapy side effects ............................................................................................6

NSAIDs for psoriatic arthritis .................................................................................................................7

Managing NSAID side effects .........................................................................................................8

Disease-modifying drugs (DMDs) ..........................................................................................................8

Managing DMD side effects ..........................................................................................................10

Biologic response modifiers (BRMs)....................................................................................................10

Managing BRM side effects ..........................................................................................................10

Injection-site and infusion-related reactions .................................................................................12

Phototherapy .......................................................................................................................................12

Traveling with your medications and ongoing care ..............................................................................13

To learn more ............................................................................................................................................14

Sources................................................................................................................................................14

Resources ............................................................................................................................................15

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Brand names are the property of their respective owners.

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Psoriasis and psoriatic arthritis medications: an overview

Psoriasis and psoriatic arthritis are long-term skin conditions. Psoriasis causes the skin to become swollen and reddened, and psoriatic arthritis causes swelling in the joints of some people with psoriasis. Although there is no cure for psoriasis or psoriatic arthritis, there are a number of medications that can help control the condition and make you feel better. Some medications are applied to the skin to help clear skin lesions, while others are taken by mouth or injected to help control the disease process. The treatment that is right for you will depend on a variety of factors, such as how severe your psoriasis/psoriatic arthritis is, how much of your body is affected, the specific type of psoriasis you have and how well you respond to the initial treatment. It is important that you work with your doctor or pharmacist to find the best treatment approach for you.

The main treatment goal is to effectively and safely clear skin lesions long-term. This is a goal for many people with psoriatic arthritis as well, in addition to relieving pain and stiffness, minimizing or stopping permanent damage to joints and slowing the disease. No single treatment works for everyone, so your doctor will work with you to find the best options for your condition. Lifestyle changes and medication help most people with psoriasis/psoriatic arthritis achieve their goals.

Staying on track with your medications

Once you have been diagnosed with psoriasis/ psoriatic arthritis, it is important to take your medications to help you gain control of your disease. For the majority of people, medications are usually effective, as long as you’re taking them as your doctor has prescribed.

Here are some tips to help you get the most out of your psoriasis/psoriatic arthritis medications:

• Learn as much as you can about your medications, such as brand and generic names, what your medications look like, how to store them properly, what to do if you miss a dose and any potential side effects.

• Follow the directions your doctor or pharmacist has given you on how to use the medication and never skip or change doses of medication on your own.

• Keep an up-to-date, written list of all your medications, including prescription and over-thecounter (OTC) drugs and dietary supplements, such as vitamins and herbal products, and show this list to your doctor or pharmacist at all visits. Don’t be afraid to ask if they have had any formal training with herbal products. If not, you may need to seek out a specialist such as an herbalist, nutritionist, acupuncturist or homeopathist. If you are currently taking herbal products, let all your healthcare providers know you are taking them.

• Pay attention to how you feel, and notify your doctor or pharmacist if you are having any problems with your medications such as side effects, or if you are having a hard time paying for them.

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Psoriasis and psoriatic arthritis medications: an overview (continued)

In order to receive the most benefit from your medication, it should be taken as ordered and for as long as your doctor tells you to, even if you feel your psoriasis/psoriatic arthritis is getting better. Because taking medication on a regular basis can be overwhelming, there are many ways to help remind you to take your medication.

Here are some tips that may help you:

• Set daily routines to take your medication. It can be helpful to connect taking the medication with normal, daily activities, such as eating a meal or going to bed.

• Keep medications where you will notice them. For example, if you need to take your medicine in the morning, put it in your bathroom next to something such as a toothbrush or deodorant that is part of your morning routine. Some medications have special storage requirements, such as keeping them in the refrigerator or away from direct heat or sunlight. Read all storage instructions before use and follow these requirements closely.

• If possible, keep backup supplies of your medication at your work or in your briefcase or purse in case you forget to take them at home.

• If you are taking pills, use a pill box to organize your medication. This will allow you to keep medications in sections that are labeled with the days of the week.

• If you are using injections, be sure to keep a sharps container at home and in other locations such as work where you may be injecting yourself. This container is used for proper disposal of your injections and injection supplies and may also serve as a reminder for you to inject your medication.

• Set an alarm on a clock, watch or cell phone to remind you to take your medication, or post reminder notes in a very visible place in your home, such as on the refrigerator door.

• Keep a written or computerized schedule of your medications and the times you are supposed to take them. Once the medication is taken, you can check it off the list. If you miss a dose, contact your doctor to establish a new dosing schedule.

These are simply some suggestions. What’s important is finding ways that work for you and your schedule.

Pregnancy and breastfeeding considerations

If you are diagnosed with psoriasis/psoriatic arthritis and are pregnant or plan to become pregnant soon, talk to your doctor or pharmacist about your medications. Some medications used to treat psoriasis/psoriatic arthritis are not considered safe during pregnancy, and you may have to temporarily stop taking them. Do not stop or start any of your medications without talking with your doctor first. Before you have your baby, you should also talk to your doctor about whether you should restart therapy and which medications are safe to take when breastfeeding.

Vaccine considerations

Many of the medications used for the treatment of psoriasis/psoriatic arthritis may weaken your immune system and decrease your body’s ability to fight off an infection. Because of this, you should not receive vaccines that contain a live virus, also known as ”live vaccines.” A vaccine with a live virus contains a small amount of a weakened living virus that is able to help your body develop immunity against the specific disease. For example, the intranasal influenza vaccine, known as FluMist®, contains a weakened version of the influenza virus. This weakened version is obtained from the environment. It is changed so that it does not produce flu symptoms, but instead works with your body to build immunity against the flu. For most people with healthy immune systems, these vaccines are safe and effective, but for people with weakened immune systems, these vaccines may actually cause an infection. Before receiving any vaccines, be sure to let your doctor, pharmacist or nurse know which medications you are taking.

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Types of psoriasis and psoriatic arthritis medications

A variety of medications are used to treat psoriasis/ psoriatic arthritis. These include topical (rubbed into the skin) treatments such as moisturizers, nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying drugs (DMDs) and biologic response modifiers (BRMs). Some of these medications can be taken by mouth, whereas others are given by injection or infusion.

Mild or localized disease can generally be managed with a topical therapy. Moderate-to-severe psoriasis generally requires the use of topical therapies given together with phototherapy or oral DMDs or BRMs. The doctor or pharmacist can let you know if your medications are safe to use with phototherapy, as some medications may increase your sensitivity to light and should not be combined with phototherapy. NSAIDs are primarily used for people with psoriatic arthritis.

Topical therapies

Topical therapies include moisturizers and a variety of active topical treatments. Some of the topical treatments are listed in Table 1 (see the next page). Moisturizing treatments are applied to the skin several times per day to relieve dryness and minimize itching and irritation. These come in a variety of forms such as lotions, creams and ointments. Ointments are usually more effective than creams and lotions because they are more effective at preventing water from evaporating from your skin which is helpful for dry skin. During cold weather, a moisturizer may need to be applied several times a day.

If a topical medication is needed, a corticosteroid is the most commonly used drug. These drugs come in low strengths to high strengths and treat skin lesions by reducing swelling and itching. Lower strength corticosteroids are generally applied to more sensitive areas, such as the face, whereas higher strength corticosteroids may be used on recurring skin lesions or on the hands or feet.

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Types of psoriasis and psoriatic arthritis medications (continued)

Other topical therapies and how they work include:

• Vitamin D analogs, which slow down the growth of skin cells

• Topical retinoids, which normalize skin cell activity and may relieve swelling

• Calcineurin inhibitors, which block T-cell activity resulting in a decrease in swelling and lesion buildup on the skin

• Anthralin, which helps to normalize skin cell activity and make skin smoother

• Tar preparations, which reduce swelling, itching and scaling

• Salicylic acid, which aids in promoting removal of dead skin cells and reduces scaling of lesions

Table 1: Topical treatments

Generic name (brand name) Available forms Common side effects Other information*

Corticosteroids†

betamethasone dipropionate Cream, gel, foam, Burning, itching, • Do not apply to eyes (Diprosone®) lotion, ointment, dry skin, redness • Store at room temperature

betamethasone valerate solution

(Luxiq®)

desonide (DesOwen®)

hydrocortisone (Hytone®)

mometasone (Elocon®)

triamcinolone acetonide (Kenalog®)

Vitamin D analogs

calcipotriene (Dovonex®) Cream, ointment, Burning, itching, • Do not apply to face or eyes scalp solution skin irritation • Store at room temperature

calcitriol (Vectical®) Ointment Burning, itching, • Do not apply to face, lips, or eyes blistering, redness • Avoid excessive sun exposure

• Store at room temperature

5

Table 1: Topical treatments (continued)


Retinoid

tazarotene (Tazorac® , Cream, gel Burning/stinging, • Do not apply to eyes or mouth Avage®) itching, redness • Avoid excessive sun exposure


Calcineurin inhibitors

pimecrolimus (Elidel®) Cream Burning, itching, • Do not cover skin with bandages, skin irritation, wraps or other dressings skin infection • Avoid excessive sun exposure


tacrolimus (Protopic®) Ointment Burning, itching, • Do not cover skin with bandages, redness, skin wraps or other dressings infection • Avoid excessive sun exposure


Other preparations

anthralin (Dritho-Scalp®) Cream Burning, itching, skin • Do not apply to eyes irritation • Staining of skin, hair or fabrics

can occur • Store at room temperature

tar preparations Cream, lotion Burning, skin irritation • Do not apply to eyes ointment, oil • Staining of skin, hair or fabrics shampoo, soap can occur solution • May have an unpleasant odor

• Avoid excessive sun exposure • Store at room temperature

salicylic acid Gel, lotion, Skin irritation, • Do not apply to eyes cream, ointment, redness • Store at room temperature shampoo, soap, solution

*Definition of room temperature varies. Consult manufacturer storage information for exact temperature ranges.

†This is not a complete list of all available topical corticosteroids and not all products come in the various dosage forms.

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Proper application

Topical products should be applied sparingly to affected areas as directed by your doctor or pharmacist. Apply a thin layer and rub in gently. It is important to not cover up the area with any bandages, wraps or other dressings, unless a doctor instructs you to do so. Avoid getting these medications into the eyes or mouth or on the lips. If this occurs, rinse the area with plenty of water—see package insert for more information or ask your doctor or pharmacist for help. Wash hands with soap and water before and after applying any topical medication. Some medications such as anthralin and tar preparations may stain the skin, hair and clothing, so be extremely careful when applying these types of products.

Some of these medications are shampoos that are applied to the scalp. Lather and leave the shampoo on the hair and scalp for the amount of time instructed by your doctor or pharmacist. Be sure to wash your hands after use and avoid getting the shampoo in your eyes. Other medications for the scalp should be applied onto the lesions after parting your hair. Parting your hair away from scalp lesions will better expose these lesions and allow the medication to be applied directly to the lesions. Try not to spread these solutions onto unaffected areas or normal skin in order to avoid unnecessary side effects such as burning of the skin, stinging, irritation or redness.

Managing topical therapy side effects

Topical agents can cause irritation and burning at the application site, and should not be applied to areas of broken, burning or inflamed skin. Some of these medications also increase sun sensitivity. Avoid excessive exposure to natural or artificial sunlight, including tanning booths and sunlamps. Wear loose, protective coverings and use sunscreen if sun exposure cannot be avoided. Some of these medications can also impair the body’s ability to fight infections. Contact your doctor if burning, swelling or redness of your skin develops, if your condition gets worse or if you develop signs of an infection.

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NSAIDs for psoriatic arthritis

NSAIDs are primarily used for psoriatic arthritis to help relieve swelling in joints. NSAIDs do not control skin symptoms. Some of these medications are listed in Table 2. Lower strengths of some of these

Table 2: Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are available OTC without a prescription, but higher doses require a prescription from your doctor. Sometimes, higher doses may be needed to to control your psoriatic arthritis.


diclofenac (Cataflam® , Voltaren®)

etodolac

fenoprofen (Nalfon®)

flurbiprofen (Ansaid®)

ibuprofen (Advil®, Motrin®)

indomethacin (Indocin®)

ketoprofen

ketorolac

meclofenamate

mefenamic acid (Ponstel®)

meloxicam (Mobic®)

nabumetone

naproxen (Aleve®, Naprosyn®)

oxaprozin (Daypro®)

piroxicam (Feldene®)

sulindac (Clinoril®)

tolmetin

• Capsule • Suspension • Tablet

• Stomach upset and bleeding may occur

• May increase risk for heart attack and stroke

• May affect kidney function

• Take with food or milk to minimize stomach upset


Cox-2 inhibitor

celecoxib (Celebrex®) Capsule • Stomach upset and bleeding may occur

• May increase risk for heart attack and stroke

• May affect kidney function • Skin reactions

• Do not take with other prescription or OTC NSAIDs


Salicylate

aspirin (Bayer®, Ecotrin®) Tablet Stomach upset • Take each dose with a full glass of water


*Definition of room temperature varies. Consult manufacturer storage instructions for exact temperature ranges.

8


Managing NSAID side effects

NSAIDs can cause stomach upset and should be taken with food or milk to reduce the chances of this side effect. Use of NSAIDs can also increase your risk for more serious side effects such as a heart attack or stroke. Chest pain, pain down the left arm and back pain are examples of some classic heart attack symptoms. The risk of a heart attack or stroke increases with longer use of these products. NSAIDs can also cause stomach bleeding at any time during use and without warning. Look for blood in your stools or darker colored stools. If you are experiencing any of these side effects, notify your doctor or pharmacist right away.

Disease-modifying drugs (DMDs)

If the topical treatments do not work or your condition is more severe, DMDs, drugs which suppress the immune system to slow down the disease process, are usually started for psoriasis/ psoriatic arthritis. These drugs are usually given to people with moderate-to-severe disease. Some traditional DMDs include acitretin, cyclosporine and methotrexate; examples of some DMDs are listed in Table 3. Some of these drugs may be used alone, with topical treatments, in combination with one another or with phototherapy. The doctor or pharmacist can let you know if your medications are safe to use with phototherapy, as some medications may increase your sensitivity to light and should not be combined with phototherapy.

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Table 3: Disease-modifying drugs (DMDs)


acitretin (Soriatane®) Capsule Dry lips, mouth, nose, eyes and • Store at room skin, itching, scaling, hair loss temperature

• Protect from light

azathioprine (Imuran®) Tablet • Stomach upset • Store at room • May increase your risk for temperature

an infection • Protect from light

cyclosporine (Neoral®) • Capsule • Solution

• Stomach upset, trembling hands, excessive hair growth

• May affect kidney and liver function

• May increase blood pressure


• Do not store oral solutions in the refrigerator

• Once the oral solution is opened, it must be used within two months

hydroxyurea (Hydrea®) Capsule • Skin reactions, • Store at room stomach upset temperature


methotrexate (Rheumatrex • Injection • Stomach upset, headache, Dose Pack®, Trexall®) • Tablet mouth ulcers

• May affect liver function • May increase your risk for

an infection

mycophenolate mofetil (CellCept®)

• Capsule • Suspension • Tablet

• Stomach upset, infections • May increase your risk for

an infection




• Oral suspension may be stored in the refrigerator

• Oral suspension should be used within 60 days

Tablet Stomach upset Store at room temperature sulfasalazine (Azulfidine®)

tacrolimus (Prograf®) Capsule • Stomach upset, trembling Store at room temperature hands, trouble sleeping

• May affect kidney and liver function

• May increase blood pressure

*Definition of room temperature varies. Consult manufacturer storage instructions for exact temperature ranges.

10


Managing DMD side effects

Stomach upset is a common side effect of the DMDs. This side effect can be reduced by taking your drug in divided doses or after meals. Many DMDs can lower the levels of certain blood cells. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. To be sure your blood cell levels do not get too low, your blood levels will need to be tested on a regular basis. If you experience any unusual bleeding or bruising, these symptoms should be reported to your doctor or pharmacist right away. DMDs also weaken the immune system and can cause serious side effects, such as infections and a slightly increased risk of cancer. If you have any signs of an infection such as fever, sore throat, tiredness or chills, contact your doctor right away.

Biologic response modifiers (BRMs)

BRMs, which target parts of the immune system to control the disease and reduce joint swelling, are generally given to people with moderate-to-severe psoriasis and those with psoriatic arthritis. The BRMs, listed in Table 4, can also work for people who may not have enough success with other treatments. These drugs are given in one of three ways:

1. As a subcutaneous injection, given under the skin

2. As an intramuscular injection, given into the muscle

3. As an intravenous infusion, given directly into a vein and usually by a nurse or doctor

Some of these drugs can be used at home and you will be injecting yourself, whereas others will be given to you by your nurse or doctor. If the medication can be used at home, your doctor, nurse or pharmacist will teach you how to inject the drug. These drugs must be used with caution because they have strong effects on the immune system and may cause life-threatening infections.

Managing BRM side effects

Since BRMs weaken the immune system, these medications carry an increased risk of infection and a slight increase in the risk of cancer. Some infections can be serious and even life-threatening, so it is important to report any signs of an infection such as fever, sore throat, tiredness or chills to your doctor right away. It is also important for you to see your doctor for regular check-ups to monitor your blood counts and check for any signs of infection.

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Table 4: Biologic response modifiers (BRMs)

Generic name (brand name)

Available forms Common side effects Other information

alefacept Intramuscular Injection site pain and • Store in a refrigerator between 36ºF (Amevive®) injection inflammation, infections, chills, and 46ºF (2ºC and 8ºC)

dizziness, headache • Protect from light

adalimumab Subcutaneous Injection site reactions, infections, • Store in a refrigerator between 36ºF (Humira®) injection flu-like symptoms, headache and 46ºF (2ºC and 8ºC)

• Do not freeze • Prefilled syringes should be protected

from light

etanercept Subcutaneous Injection site reactions, infections, • Store in a refrigerator between 36ºF (Enbrel®) injection stomach upset, headache and 46ºF (2ºC and 8ºC)

• Do not freeze • Prefilled syringes should be protected

from light

golimumab Subcutaneous Injection site reactions, infections • Store in a refrigerator between 36ºF (Simponi®) injection and 46ºF (2ºC and 8ºC)

• Do not freeze • Protect from light

infliximab Injection given Infusion-related reactions (fever • Store in a refrigerator between 36ºF (Remicade®) as an infusion chills), headache, feeling tired, and 46ºF (2ºC and 8ºC)

infections, diarrhea

ustekinumab Subcutaneous Injection site reactions, infections • Store in a refrigerator between 36ºF (Stelara®) injection and 46ºF (2ºC and 8ºC)

• Do not freeze • Protect from light

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Injection-site and infusion-related reactions

One of the most common side effects of BRMs is a reaction at the place the injection was made, also known as an injection-site reaction. Signs of an injection-site reaction include redness, rash, stinging, tingling, swelling, itching, pain, bruising/discomfort in the area where you injected the drug.

Here are some tips to help you prevent injection-site reactions:

• Allow your prepared syringe to come to room temperature* before injecting it. Do this by setting it on a counter for the amount of time recommended by the manufacturer of the drug product. Some drugs can be used after five to 10 minutes, whereas others must be left on the counter for as long as 30 minutes. Do not warm your medication in any other way such as a microwave or in hot water.

• Use the correct injection technique that was taught to you by your doctor, nurse or pharmacist. If you are not sure how to inject the medication, be sure to call one of them to ask any questions.

• Change the location of your injection site regularly to reduce pain. New injections should be at least 1 inch away from previous injection sites.

• Use a new, clean, dry needle for each injection.

• Never reuse needles, syringes or other materials.

• Never inject into an area that is bruised, red, tender, hard or swollen, or where you have scars or stretch marks.

• Keep a written record of where and when you received previous injections.

• If you experience a severe reaction after an injection, contact your doctor or pharmacist right away.

Another type of reaction that can occur with drugs that are infused is called an infusion-related reaction. This type of reaction can occur when the drug is being given or shortly after the drug has been given. Symptoms of an infusion-related reaction can include hives, shortness of breath and low blood pressure. To help prevent this type of reaction, you may receive other medications before each treatment. Ask your doctor or pharmacist for more information about infusion-related reactions and how to prevent them.

*Definition of room temperature may vary. Consult manufacturer storage instructions for exact temperature ranges.

Phototherapy

In addition to your medications, your doctor may recommend phototherapy or exposure to natural or artificial ultraviolet (UV) light. There are two types of UV light, A and B, referred to as “UVA” or “UVB.” UV light from the sun reduces swelling and slows the production of skin cells that cause scaling. Brief, daily exposure to small amounts of sunlight may improve psoriasis symptoms in some people. Some medications may make you more sensitive to the sun, so ask your doctor or pharmacist about the safest way to use natural sunlight for psoriasis treatment. Artificial UVA or UVB therapy can also be used by your doctor to help control psoriasis symptoms. While receiving phototherapy, be sure to block your eyes from UV light with the use of UV-blocking goggles.

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Traveling with your medications and ongoing care

Traveling with your medications

When traveling, it is important to stay on schedule with your medications. Here are some tips to help you stay on track with your medications while you are traveling:

• Be sure to pack extra medication and bring your medication reminders with you.

• Be sure to follow recommended storage instructions for medications, such as keeping them away from heat and direct sunlight, and if they need to be refrigerated.

• Some medication manufacturers can send you special travel bags that have space for an ice pack.

• Always carry your medication with you or in your carry-on bag.

• Don’t worry about airport X-ray machines, they can’t hurt your medication.

• Keep all liquid medications or syringes in the original container with your pharmacy’s preprinted label clearly identifying the medication, unless you are using a pill box or other reminder device to help you keep track of your medications.

• Your daily routine may be different while you’re away; rely on an alarm instead of routine daily habits to help remind you to take your medications.

• If you’ll be crossing time zones, ask your doctor or pharmacist if you need to adjust your medication schedule.

Ongoing care

You should continue to see your doctor regularly to see how well your medication and other therapies are working. Regular visits will also help your doctor to adjust treatment if necessary. To monitor your progress, your doctor will likely ask you questions about the symptoms of your disease and may perform lab tests. Your doctor will also monitor any side effects you might experience from medications and make changes if needed.

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To learn more

The more informed you are, the better you can manage your health. Our specialty pharmacy Care Team provides personalized, supportive and dependable care to help you achieve the best results from your prescribed therapy.

Sources

The following sources were used in the development of this booklet and the companion piece A Patient Guide to Psoriasis/Psoriatic Arthritis.

About joints. The definitive web resource on knee and hip replacement education. Information for patients: topics. Osteoarthritis. About Joints Web site. www. aboutjoints.com/patientinfo/topics/osteoarthritis/ Osteoarthritis2.html. Accessed February 3, 2011.

Are you taking medication as prescribed? Food and Drug Administration Web site. www.fda.gov/ ForConsumers/ConsumerUpdates/ucm164616.htm. Accessed February 11, 2011.

Be a member of your health care team. Food and Drug Administration Web site. www.fda.gov/Drugs/ ResourcesForYou/ucm079487.htm. Accessed February 8, 2011.

Gladman DD. Psoriatic arthritis. Dermatol Ther. 2009;22(1):40–55.

Gottlieb AB, Dann F. Comorbidities in patients with psoriasis. Am J Med. 2009;122(12):1150e1–1150e9.

Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on biologics. J Am Acad Dermatol. 2008;58(5):851–864.

Horn EJ, Chambers CD, Menter A, Kimball AB, the International Psoriasis Council. Pregnancy outcomes in psoriasis: why do we know so little? J Am Acad Dermatol. 2009;61(2):e5–e8.

Husni ME, Mease PJ. Managing comorbid disease in patients with psoriatic arthritis. Curr Rheumatol Rep. 2010;12(4):281–287.

Iofin I, Levine B, Badlani N, Klein GR, Jaffe WL. Psoriatic arthritis and arthroplasty: a review of the literature. Bull NYU Hosp Jt Dis. 2008;66(1):41–48.

Levine D, Gottlieb A. Evaluation and management of psoriasis: an internist’s guide. Med Clin N Am. 2009;93(6):1291–1303.

Medication and pregnancy. Centers for Disease Control and Prevention Web site. www.cdc.gov/ ncbddd/pregnancy_gateway/meds/index.html. Accessed February 14, 2011.

Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826–850.

Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009;361(5):496–509.

Novak KK, ed. Drug Facts and Comparisons. St. Louis, MO: Wolters Kluwer Health; 2011.

Psoriasis. American Osteopathic College of Dermatology Web site. www.aocd.org/skin/ dermatologic_diseases/psoriasis.html. Accessed December 31, 2010.

www.aocd.org/skinhttp:www.cdc.govwww.fda.gov/Drugshttp:www.fda.gov

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Psoriasis. Lifestyle and home remedies. Mayo Clinic Web site. www.mayoclinic.com/health/psoriasis/ DS00193/DSECTION=lifestyle-and-home-remedies. Accessed January 3, 2011.

Psoriasis. Symptoms. Mayo Clinic Web site. www. mayoclinic.com/health/psoriasis/DS00193/ DSECTION=symptoms. Accessed January 3, 2011.

Psoriasis. Treatments and drugs. Mayo Clinic Web site. www.mayoclinic.com/health/psoriasis/DS00193/ DSECTION=treatments-and-drugs. Accessed February 16, 2011.

Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 7th ed. New York, NY: McGraw-Hill; 2008:1603–1617.

Think It through: a guide to managing the benefits and risks of medicines. Food and Drug Adminsitration Web site. www.fda.gov/Drugs/ResourcesForYou/ ucm079492.htm. Accessed February 9, 2011.

West DP, Loyd A, West LE, Bauer KA, et al. Psoriatic arthritis. Dermatol Ther. 2010;23(2):123–136.

X-Plain. Psoriasis. Reference summary. National Library of Medicine Web site. www.nlm.nih.gov/ medlineplus/tutorials/psoriasis/dm039104.pdf. Accessed February 14, 2011.

Resources

American Academy of Dermatology www.aad.org 866-503-SKIN (7546)

The American Academy of Dermatology is the largest association of dermatologists in the United States. Their website contains information for patients on many different skin diseases including psoriasis and psoriatic arthritis. Their site also contains a listing of foundations, institutions and support groups.

International Psoriasis Council www.psoriasiscouncil.org 212-369-0406

The International Psoriasis Council is a worldwide, non-profit organization that promotes the advancement of psoriasis research and treatment by providing a space for doctors, researchers and the general public to learn, work together and come up with new ideas regarding psoriasis.

National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov 877-22-NIAMS (64267)

Part of the National Institutes of Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases supports research on psoriasis/psoriatic arthritis and other arthritic and musculoskeletal diseases. Patients may access a registry of research studies on psoriasis or psoriatic arthritis on their website.

National Psoriasis Foundation www.psoriasis.org 800-723-9166

The National Psoriasis Foundation is the largest psoriasis patient advocacy organization in the world. Their website contains information on events that raise psoriasis awareness, information on treatment options and a searchable directory of doctors and their experience treating patients with psoriasis and psoriatic arthritis.

http:www.psoriasis.orghttp:www.niams.nih.govhttp:www.psoriasiscouncil.orghttp:www.aad.orghttp:www.nlm.nih.govwww.fda.gov/Drugs/ResourcesForYouwww.mayoclinic.com/health/psoriasis/DS00193www.mayoclinic.com/health/psoriasis

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Documents

Understanding your psoriasis and psoriatic arthritis ... · Traveling with your medications and ongoing care.....13 To learn more ... Psoriasis and psoriatic arthritis are long-term