All NHS patients suffering from psoriatic arthritis to use daily pill

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All NHS patients with a painful type of arthritis triggered by the skin condition psoriasis will now be able to benefit from a drug that dramatically reduces symptoms in more than half of cases.

The drug is upadacitinib, which tackles the debilitating condition by halting the immune system’s mistaken attack on healthy tissue in the joints.

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It is already approved by the NHS to treat the 400,000 Britons with rheumatoid arthritis.

And psoriatic arthritis sufferers in Scotland have had access to upadacitinib since a review by the Scottish Medicines Consortium in April last year.

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Now the UK’s prescribing watchdog, the National Institute for Health and Care Excellence, has decided the daily pill can be extended to all NHS patients.

Professor Laura Coates, a rheumatologist at the University of Oxford, praised the move, saying: ‘This will have a big impact for this patient group.

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‘Living with two chronic conditions at once is massively difficult, so having another drug which can help reduce their symptoms is really welcome.’

Psoriatic arthritis affects about 150,000 Britons, causing joints to become painful, swollen and stiff.

Sufferers first develop psoriasis, which causes red, flaky and itchy patches of skin all over the body, and then – usually several years later – joint problems affect the knees, hands, feet and lower back which get progressively worse.

The condition cannot be cured, and at its most severe a person’s joints can become permanently damaged, meaning joint replacement surgery may be needed alongside the ongoing and uncomfortable skin problems.

In September 2019, reality TV star Kim Kardashian revealed she had been diagnosed with the condition, which she described as ‘painful and scary’.

In her case it began with a rash on her stomach and legs, and led to severe pain in her hands that meant she was unable ‘even to pick up a toothbrush’.

One in three people who suffer from psoriasis will go on to develop psoriatic arthritis. Joint issues tend to occur five to ten years after the psoriasis is diagnosed, which can begin at any age.

There are a number of anti-inflammatory drugs that combat the condition, including steroids.

However, for many sufferers these become ineffective and stronger medications are needed.

Upadacitinib is one of a new class of drugs known as JAK inhibitors. These work by blocking the effects of enzymes known as janus kinase, which normally help activate the immune response when the body is under attack from diseases.

By blocking these enzymes in sufferers with so-called autoimmune diseases such as psoriatic arthritis, the drugs stop the immune system from mistakenly destroying healthy tissue.

JAK inhibitors have been highly successful in treating a number of autoimmune disorders, including Crohn’s disease in which inflammation affects the digestive tract.

All NHS patients suffering from psoriatic arthritis to use daily pill
© Provided by Daily Mail One in three people who suffer from psoriasis will go on to develop psoriatic arthritis. Joint issues tend to occur five to ten years after the psoriasis is diagnosed, which can begin at any age. [File image]

In 2020, a large US trial found that more than 70 per cent of psoriatic arthritis patients responded to upadacitinib. More than half saw their arthritis symptoms disappear, while two-thirds found their psoriasis cleared up.

Upadacitinib pills will now be available to NHS patients who have failed to respond to other treatments and have arthritic symptoms in three or more joints.

Julie Morrish, 51, was one of the first psoriatic arthritis patients in Britain to access upadacitinib after she was granted compassionate use due to the severity of her symptoms last April.

The marketing manager from Wantage, Oxfordshire, developed psoriasis and arthritis at the same time seven years ago.

She says: ‘The joints in my knees and ankles swelled up and I struggled to walk. It became difficult to get out of bed in the morning, and at its worst I was literally crawling to the bathroom.’

To add to that, Julie developed severe psoriasis on her hands and feet.

‘The patches got infected and it was incredibly painful. I had to be signed off work it was so bad.’

Julie, who until her diagnosis was a competitive weightlifter, tried a number of medications but these either became ineffective or left her with debilitating side effects.

Last April she was started on upadacitinib and noticed a difference within a couple days.

She says: ‘Immediately my joints were better and I had more energy. I had really stubborn psoriasis patches but these went away, and now it doesn’t feel like I even have it.

‘Sometimes I’m a bit sore here and there, but my arthritis is basically gone too. It’s quite amazing.’

What is psoriatic arthritis?

Psoriatic arthritis is a chronic, autoimmune form of arthritis that causes joint inflammation. It results from the skin condition psoriasis.

Left untreated, it can cause irreversible joint damage. It can affect large or small joints, and less commonly, the spine.

About a third of people with psoriasis develop psoriatic arthritis.

The condition causes the immune system to attack itself, primarily the joints and skin, but also organs.

Scientists believe genes and an environmental trigger, like a trauma or virus, might play a role in the development of psoriatic arthritis.

Fingers and toes may swell, and nails might become pitted or separate from the nail bed. The heel or sole of the foot may also ache.

Psoriatic arthritis affects everyone differently. Symptoms may be mild or severe, affect just a few or many joints, and can come and go. A sudden onset of symptoms is called a flare.

If the condition goes unchecked, it can cause myriad health problems including damage to the lining that covers the ends of bones in a joint and the bones themselves. This means it becomes harder to move joints, leading to disability.

Other side effects include redness, irritation and disturbed vision, redness and pain in tissues around the eyes, diarrhoea and bloating, shortness of breath and coughing, and damage to blood vessels and the heart muscle.

Source: Arthritis.org

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