| Psoriasis
Treatment (Part 10) Medicine For Psoriasis
3. Systemic
Therapies
Systemic drugs are medications
that are given either orally (pills) or as injections
just below the skin (subcutaneous) or into the muscle
(intramuscular). Since these medications enter the body's
circulatory system directly, they are called systemic
agents, and are usually reserved for patients with moderate
to severe psoriasis, or for those with psoriatic arthritis.
In addition, these medications are also used in combination
with other therapies, including topicals and phototherapies,
especially when a patient does not respond to a single
type of treatment. |
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Currently, the most commonly used
systemic agents for the treatment of psoriasis are methotrexate,
cyclosporine and retinoids. These medications can provide
significant benefit in clearing psoriasis, but they
can have side effects. These side effects might occur
either at the outset or shortly after starting the medication
(acute side effects) or after prolonged use (long-term,
chronic side effects). While on these medications, it
is important to be closely monitored by your doctor.
When taking any systemic agent, it is vital that the
drug is taken as directed by your doctor.
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Methotrexate
(MTX)
Methotrexate is a medication initially
developed and approved to treat different types of cancer
(chemotherapy). Methotrexate is also used to treat moderate
to severe psoriasis and disabling psoriatic arthritis.
How Does
Methotrexate Work?
Methotrexate is effective in erythrodermic,
pustular and severe plaque-type psoriasis, as well as
psoriatic arthritis. Methotrexate is effective because
it works in two major ways:
It reduces the rapid turnover
of the skin cells, an important process in producing
the thick, scaling
lesions of psoriasis.
It has an anti-inflammatory effect
on white blood cells (activated T cells), which are
important in the
development of psoriasis lesions
(and suppression of the immune system).
Patients Who May Benefit from Methotrexate
those with erythrodermic psoriasis
(entire body is covered by red scaling lesions)
those with pustular psoriasis
(generalized or localized such as palmoplantar pustulosis)
those with plaque-type psoriasis
(involving the hands, feet, face) or extensive body
areas<
those with psoriatic arthritis
those failing to respond to topical
therapies, phototherapy or other systemics (retinoids,
cyclosporine) or biologics
Is Methotrexate Right For You?
Before starting you on treatment
with methotrexate, your doctor might ask several questions,
examine you and discuss with you the benefits and risks.
As with any treatment, the risks should not outweigh
the benefits.
Your doctor will ask you about
other diseases or disorders that could prohibit you
from taking methotrexate (e.g., liver and/or kidney
disease). Because methotrexate is eliminated by the
kidneys, if they do not function properly, the drug
cannot be properly removed from the body. In addition,
with high doses of methotrexate, there is a possibility
of kidney damage— in which case the dose would
be lowered or another method of treatment considered.
One of the most significant concerns
with long-term use of methotrexate is cirrhosis (scarring)
of the liver. In general, it appears that patients at
highest risk for cirrhosis are:
obese
drinking alcohol while taking
methotrexate
diabetic (the pancreas does not
produce enough insulin)
long-term users of methotrexate
To find out if you have cirrhosis,
a liver biopsy might be performed. A liver biopsy involves
having a thin needle pass through the skin into the
liver to obtain a small piece of tissue, which is then
examined to determine if there is any scarring present.
A liver biopsy is performed before or shortly after
starting methotrexate and then again after several years
of long-term use.
Before starting treatment, certain
blood tests will also be performed to test the liver,
kidneys and blood cell counts. These tests are usually
repeated weekly for one month at the beginning of treatment
and if and when the dose of methotrexate is increased.
After this, testing will be done regularly. Regular
blood work is important because it may help in the early
detection of any signs of injury or irritation to your
kidneys, liver or blood cells, and gives your doctor
the opportunity to alter your dosage or discontinue
the treatment, if necessary.
How Do
You Take Methotrexate?
Methotrexate is available in tablets
(2.5 mg) or as a liquid that is injected into the muscle.
Your doctor will ask you to take methotrexate only once
a week.
Taking Medication Many
medications are taken daily, but it is important you
take methotrexate only once a week (not
daily), as prescribed by your doctor.
Always take only the dosage your
doctor prescribed.
If you miss a dose, take it as
soon as possible.
Because your doctor might change
your dose, check the label every time you fill your
prescription.
If you develop severe difficulty
breathing or shortness of breath, stop this medication
and contact
your doctor.
Notify your doctor immediately
if you have taken more medication than prescribed.
Methotrexate should be
kept and stored away from children.
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