Denver More Than Skin Deep Slide Set April 26 2014
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Denver More Than Skin Deep Slide Set April 26 2014



Through More Than Skin Deep, outsmart psoriasis and psoriatic arthritis. Learn how you can lower your risks for developing other serious conditions like heart disease, diabetes and depression. You ...

Through More Than Skin Deep, outsmart psoriasis and psoriatic arthritis. Learn how you can lower your risks for developing other serious conditions like heart disease, diabetes and depression. You will be armed with the information you need to live well with psoriasis and psoriatic arthritis.



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  • National Psoriasis Foundation gratefully acknowledges AbbVie, Inc., Amgen, Janssen BioTech, Inc. and Novartis Pharmaceuticals for their support. The National Psoriasis Foundation is solely responsible for all content and development.
  • Through mission related activities the National Psoriasis Foundation helps over 2 million people annually through our programs and education services that offeran opportunity to CONNECT with others, TAKE ACTION and provide HOPE for the future.
  • Education is at the core of our mission. Not only do we look towards the future but the Foundation is also dedicated to helping those who live with psoriatic diseases daily. Our goal is to continue to provide the latest information and cutting edge research. The Foundation offers a variety of programs and services such as:Psoriasis One to One Programpairs people in need of treatment advice and disease information with a trained volunteer mentor who also has psoriasis and/or psoriatic arthritis. We’ll talk more about this program later. More than Skin Deep educational events are hosted by NPF in 20 cities and feature well-respected dermatologists presenting the latest information and treatment for psoriasis and psoriatic arthritis. Free Educational Webcasts: Watch leading experts in dermatology, rheumatology and other related fields provide presentations from the comfort of your home. View current or past webcasts. Talk Psoriasis is our online message board where those with psoriasis can connect and learn from others who have psoriasis. Talk Psoriasis can be found at Health Educatoris available to ask questions or receive free information from by calling (800) 723-9166. Help is also available to provide financial assistance resources, assistance with insurance denials or receive our packet on applying for disability. E-newsletters offering healthy living tips, latest research and updates that impact people with psoriasis and psoriatic arthritis. Learn more at is a website for children dealing with psoriasis and psoriatic
  • In addition to providing education for people who have psoriatic diseases the Foundation is also dedicated to providing education about the latest trends in management to health care providers. Activities include:Annual Resident’s Meeting is a two-day program that focuses on educating dermatology chief residents about recent advances in treatments and the management of psoriasis.Physician Assistant’s Summit as well as a workshop on phototherapy for nurses are also additional educational opportunities offered by the Foundation for health care providers.Nurse Practitioners Psoriasis Symposium in partnership with the Dermatology Nurses Association offers tips on the management of psoriasis and psoriatic arthritis. Psoriasis Forum is a quarterly journal for medical professionals interested in psoriasis research and patient care.Research Symposium which invites scientists from around the world, policy makers, clinicians and individuals who have psoriatic diseases to identify key research areas that will influence the work of the Foundation. This event occurs every two years.
  • In addition to funding education services, the National Psoriasis Foundation is the largest charitable funder of psoriatic disease research and psoriasis patient advocacy efforts worldwide. The Foundation has 80,000 advocates (volunteers) who work to raise awareness among policy leaders (both state and federal) about issues relevant to access to care that impact people with psoriasis and psoriatic arthritis. Our advocacy efforts focus on: Supporting funding for research into psoriatic disease through the National Institutes of Health.Advancing the CDC’s psoriasis initiative. A position paper released in February 2013 by the CDC about psoriasis helps guide policy development. This important step helps provide recognition of psoriasis as a health issue that needs to be addressed and the shifting of funds for research funded by the NIH. Ensure access to new treatments and work to increase access to therapies. This includes policy efforts to address out of pocket expenses.
  • Current actions involving the Foundation include:-INSURANCE MARKETPLACE: Obtaining stories from those enrolled in the marketplace plans. The National Health Council (NHC) has launched website offering resources to help make decisions about purchasing marketplace health insurance plans. This website includes “Estimate My Costs” tool to help determine health care costs that meet an individuals needs. This site also includes a section “Share My Story” to help guide improvements and recommendations for the marketplace. The Foundation urges our constituents to be part of this process to ensure the needs of people with psoriasis and psoriatic arthritis are being met as we continue to work through health care reform issues. -PATA (Patients’ Access to Treatment Act):In the next couple months, the Foundation is anticipating the introduction of a Senate version of this bill that seeks to limit co-payments and out-of-pocket expenses on biologics and specialty medications. Introduction of this bill provides an opportunity to contact your federal representatives and senators about such issues. To learn more visit the new online advocacy toolkit. The toolkit includes information about our priorities, how to take action, template letters and more. Please become an advocate and join us in our efforts to continue to improve the lives of those impacted by psoriatic disease. As an advocate you’ll receive advocacy alerts and how to participate in a variety of actions to raise awareness among our policy leaders.
  • Finding a cure for psoriasis and psoriatic arthritis is at the heart of everything we do.Research grants have and continue to support studies into genetics, treatment and associated health risks. Research grants often help up and coming scientists to prove a therapy enabling them to obtain larger grants from the National Institutes of Health (NIH).
  • Research priorities include:Discovery and Translational Grants funding new and innovative studies that focus on areas addressing immunology, genetics, skin and joint biology and associated health outcomes (such as exploring the relationship to other serious health conditions.) Medical Research Fellowship Program seeks to increase the number of scientists focused on studying and treating psoriatic diseases by encouraging young scientists to become physician researchers and dedicate their careers to psoriatic diseases. Recruited from top medical schools as residents, each fellow receives a one-year grant of up to $40,000 to conduct research on questions related to the cause and cure of psoriasis and psoriatic arthritis.Victor Henschel Bio Bank contains the largest collection of psoriasis DNA samples in the world. Such samples are used by qualified scientists to further advance the study of the genetics of psoriasis and psoriatic arthritis. Increase funding via the National Institutes of Health for psoriasis and psoriatic arthritis research. Grant recipients through the Foundation have gone on to receive NIH funding for promising fields of study. Individuals interested in finding a research study or clinical trial can now do so by logging onto our website at and click on the subheader “Research”.
  • Without the efforts of many volunteers and/or service groups working together to help make a difference in the lives of people living with psoriasis and psoriatic arthritis. Without their help many initiatives or activities would not occur. -Become an Advocate and take action on the issues around health care benefits to help change local and or federal policies on behalf of all people with psoriasis and psoriatic arthritis. (Show Advocate card found on the left hand side of the packet.)-Join our Community Division as a volunteer. We have many activities for you to become involved in. Meet others who are all committed to making a difference in the lives of those affected by psoriasis. Our Community Divisions work to provide education and implement Walk to Cure Psoriasis. -Participate in Walk to Cure Psoriasis to help our efforts to find a cure for psoriatic diseases. Walk as an individual, form a team or donate to someone who has a team. Encourage others to join you. Help is also needed the day of the Walk to help implement the event (registration, set-up, route markers, etc.)Every effort helps and we invite you to be part of the psoriasis and psoriatic arthritis community. Be informed and connect with others. Take action to help improve all affected by psoriatic diseases and be part of the efforts to provide hope for the future.
  • The National Psoriasis Foundation is the world’s largest non-profit dedicated to helping people living with psoriasis and psoriatic arthritis. The Foundation’s efforts are dedicated to working to find a cure for psoriasis and psoriatic arthritis and to eliminate their devastating effects through research, advocacy and education.Walk to Cure Psoriasis is presented by Amgen. Other supporting sponsors include:AbbVieJanssenHealth MonitorLocal Sponsor: LEO Pharmaceuticals
  • To help meet the Foundation’s mission Walk to Cure Psoriasis has raised over $7 million towards provision of education, advocacy efforts and research towards a cure. Volunteers tell story or stories about why they walk.
  • Join others who have helped to raise more than $7 million to fund psoriatic disease efforts in research, advocacy and education. This year we’ve added a 5K timed Run along with the 1K and 5K Walks. Registration begins at 8am. A $25 entrance fee applies if joining the 5K Run. The Walk is free to attend. Our events are: Routes are easy and can accommodate everyone’s needs. 5 K Run or a 1K or 5K – talk about routes at Sloan’s Lake Park.Family Friendly Form a team – encourage family members, friends, co-workers to join you as part of a family, corporate or even a medical team. Encourage your doctor to walk either by forming a team you can be part of or ask them to walk on your team. Recruit fun and passionate team members.Opportunity to be creative about team spirit. Create your own name, t-shirt or other items such as hats, medals, etc.Mention entertainment and youth activities if known.
  • There are two types of inflammation.
  • Explain what occurs with Acute Inflammation
  • Explain graphic as it relates to the role of T-Cells and development of psoriasis.
  • Explain the relationship between psoriasis and whyjoint inflammation develops.
  • Research is continuing to help identify the links between psoriasis and other health conditions such cardiovascular disease, diabetes, metabolic syndrome (high blood pressure, high cholesterol and diabetes) and Crohn’s disease. In many of these cases it’s suspected that more than casual or genetic associations are a play but rather relate to the inflammation that drives the disease. Let’s take a look at research involving the use of CT imaging to capture the degree of inflammation associated with psoriasis.
  • Let’s take a look at the evidence.Nehal Mehta, MD, a preventive and nuclear cardiologist with the University of Pennsylvania Perelman School of Medicine, was lead author of a groundbreaking study, funded by the National Psoriasis Foundation, that used a sophisticated, highly advanced imaging technology to detect areas of inflammation in people with psoriasisin the patient's right knee joint and surrounding muscle and in the ankle; throughout the liver; in the wall of the aorta and arteries in both thighs that lead to the aorta; and on the skin in the lower parts of the legs, consistent with inflammation of psoriasis plaques.Images show inflamed skin and inflammation in blood vessels as well as other organs and joints in the patients with psoriasis, one of whom also had psoriatic arthritis. Mehta and his associates believe the study provides further evidence that psoriasis and other inflammatory diseases are linked.The study, published in the Archives of Dermatology, adds to a growing body of evidence that people with psoriasis are at a higher risk for heart, joint and liver disease, even when they do not have any symptoms.
  • According to a study published in the Journal of American Medical Association Dermatology. Increasing severity of skin psoriasis (especially moderate to severe) is a marker that other serious health conditions may be present.
  • It is thought that factors involved in the local and systemic inflammation in cardiovascular disease is similar to what occurs in psoriasis. These include cytokines, interleukins, TNF-alphas – which are common to both diseases. Research is continuing to explore such links
  • Sleep issues may be related to pain and itching which leads to fatigue and then more pain and itching. Research is exploring the impact of sleep as a potential trigger for psoriasis. NASH = fatty liver disease
  • Environmental factors increasing risk of the development of cardiovascular disease, cancer, diabetes and other serious health concerns include smoking, obesity and use of alcohol. Smoking has well-known links to high blood pressure, peripheral vascular disease, stroke and myocardial infarction. Studies have shown severe psoriasis is associated with higher BMI (body mass index) than in individuals with mild psoriasis.Immune abnormalities abound. Genetic factors associated with the development of psoriasis may play a role in systemic and local inflammation in cardiovascular disease especially atherosclerosis and myocardial infarction. These include cytokines, interleukins, TNF alphas – which seem to be common pathways for both diseases. The severity of psoriasis increases the risk for atherosclerosis and mortality. Mortality is increased by 50%. Degree of inflammation associated with severity of psoriasis.Treatment: The use of drugs such as corticosteroids, acitretin, and cyclosporine alter blood lipid levels thus potentially increasing risk for cardiovascular disease. Cancer, specifically use the biologics has been associated with increased risk of lymphoma. This is also dependent on severity of psoriasis and genetic factors. Risk of lymphoma is ? Psychological impact: Psoriasis is associated with a lack of self-esteem and increased prevalence of mood disorders such as depression. Increased rates of depression among people with psoriasis may be a contributing factor towards the development of cardiovascular disease.
  • Diabetes is a problem with your body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common form of diabetes.If you have type 2 diabetes your body does not use insulin properly. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time it isn't able to keep up and can't make enough insulin to keep your blood glucose at normal levels.
  • Scientists have long suspected that psoriasis and Crohn’s Disease have a number of genetic mutations in common. It’s possible the same genes could make the individual susceptible for Crohn’s disease.Crohn’s Disease is an inflammatory disease of the bowel. Causing inflammation of the intestinal wall anywhere from the mouth to the rectum. This cause the wall to thicken. Symptoms can come and go – similar to psoriasis.
  • Rates of physical and mental disability in psoriasis patients are similar to those who have other chronic illnesses.
  • There are many factors and emotions associated with psoriasis and psoriatic arthritis however there are actions you can take to impact risks associated with inflammation.
  • Learn more about your treatment options and be informed of benefits, side effects and screening.
  • New additions to biologic treatment options include Stelara and Cimzia.Cimzia: TNF:alpha. Administered by injection. Note: this medication is currently not being studied for psoriasis. Also used to treat rheumatoid arthritis and Crohn’s disease.
  • Depicts where TNF blockers impact/stop development of psoriasis and the inflammation process.
  • Otezla(apremilast), a tablet manufactured by Celgene, is approved by the U.S. Food and Drug Administration (FDA) as a twice-daily 30-milligram treatment for adults with active psoriatic arthritis.Otezla is a new type of oral treatment that inhibits an enzyme called phosphodiesterase 4, or PDE4, to regulate inflammation in people with psoriatic arthritis and help control the disease.In clinical trials, the most common side effects were diarrhea, nausea and headache, which occurred in the first two weeks and tended to lessen with continued treatment. The recommended dosing of Otezla is 30 milligrams twice a day. The first five days is a start period, where the dosage will gradually increase over five days until the recommended dose of 30 milligrams twice daily is reached.Otezla tablets should be available beginning April 2 through specialty, or mail delivery, pharmacies.Late last year, Celgene filed for FDA approval of Otezla as a psoriasis treatment pending possible approval in the fall of 2014.
  • Depicts focus of IL-17 to block the inflammation and development of psoriasis.
  • Depicts where IL-12/23 agent acts to block inflammation and psoriasis pathways.
  • Stress can cause the onset of psoriasis or aggravate existing symptoms. This may be due to changes in both the immune system and hormone levels in the body. Productive ways to control stress include mind body programs or learned techniques offered by community colleges, hospitals and recreation centers. Stress management methods include meditation, yoga, exercise and effective communication skills. Smoking, drinking, drug use and anti-anxiety medication also can trigger psoriasis symptoms. Heavy drinking may interfere with treatment causing a delay in remission of your psoriasis. Minor skin traumas can trigger a flare. This is called the Koebner phenomenon, which causes psoriasis plaques to form at the site of a skin injury. Vaccinations, sunburns, bruises and scrapes, poison ivy, poison oak or bug bites can trigger a psoriasis flare. The Koebner phenomenon is also caused by constant pressure and rubbing, skin blemishes from acne, chicken pox, herpes, acupuncture or tattoo needles. To avoid the Koebner phenomenon, be careful when your psoriasis is already active. Wear long sleeves and pants when hiking or gardening to avoid scrapes, and exposure to poison ivy or poison oak. Use sunscreen to avoid sunburn. If injured, treat the injury quickly to minimize inflammation or infection. Don’t pick or scratch at scabs or bug bites. Talk with your dermatologist before getting an immunization or vaccine.Streptococcus is known to trigger guttate psoriasis. Consult a physician to treat the infection.Starting or stopping any medication, including those used to treat psoriasis, may trigger either a flare or a remission of psoriasis symptoms. Talk with your health care provider if you suspect the medications you take are triggering a flare. Medications that can cause a flare include: Lithium, some antimalarials, Quinidine, blood pressure medications (beta-blockers (like Inderal), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers can induce or exacerbate psoriasis). Indomethacin—a nonsteriodal anti-inflammatory drug (NSAID) used to treat arthritis can make psoriasis symptoms worse. For some people gluten products aggravate psoriasis. Also dry cold weather can trigger psoriasis.
  • Also, night shade foods suspected to cause or increase inflammation include: potatoes, tomatoes and peppers.
  • Watching your portion size is a simple and easy way to control eating habits and loose weight. Use the Plate Method shown on this slide or obtain help through a dietitian, or weight loss programs that offer additional support with regularly scheduled check in’s. The Plate Methodutilizes a 9 inch or average dinner plate and is divided into sections. Half of the plate is vegetables – could be a salad or combination of vegetables. One quarter of the plate is protein meaning, beef, fish, chicken or eggs. Remaining quarter represents starch (bread, potatoes, corn, beans, peas, cereals.)Studies show a correlation between weight gain and inflammation as well as weight loss and reduction of psoriasis lesions. Fat cells release inflammatory proteins (cytokines). Excess weight puts added stress on joints. For each extra pound of excess body weight, that adds 3 times the amount of pressure on your joints. Meaning 10 extra pounds equates to 30 pounds of pressure. When going up stairs that pressure is multiplied. Losing weight can help relieve pressure on joints. Talk with your health care provider about what is your ideal weight.Free resources to help support your efforts to loose weight include:-Sparkpeople offers free services that includes a calorie counter, meal plans, recipes, personalized fitness programs and discussion boards. -MyFitnessPal offers a free calorie counter, nutritional database, recipe calculator and exercise tracker. -Choose My Plate is offered by the United States Department of Agriculture (USDA) which utilizes the plate method and offers sample menus, recipes, daily food plans, tips for eating on a budget, food and physical activity tracker. -Mobile Apps if you are always on the move: Meal Snap allows you to take a picture of your meal, receive a nutritional breakdown, tracks meals and progress.Fooducate helps you make better choices at the supermarket with nutritional analysis for a variety of products.
  • Keeping active will make a difference in the quality of life especially if you have psoriatic arthritis. Not only does exercise help joints but also helps your heart, lowers blood pressure, lowers blood sugar levels, improves bone health and sleep. Movement keeps your joints and tendons looser and more limber. When your muscles are strong, your joints have to do less work to move.If you are just beginning an exercise routine, start slow and build up. When you've been inactive, your muscles have to work harder to do the same amount of activity as an active person. This can result in sore muscles and joint pain. If you have a hard time cooling down after exercise or your joints feel worse the next day, it's time to ease up.Start to walk in 10-minute increments, building up to a half-hour of walking through the course of the day. From there, build up to an hour of walking a day. You don't have to do it all at once; breaking up your workout throughout the day can prevent injury and make starting a new habit more manageable. Watching TV? Do stretches and floor exercises or walk when commercials come on.Yoga, swimming, walking and bicycling are just a few examples of activities to try that are joint friendly. If psoriatic arthritis or other pain is keeping you from being more active, you may want to consider seeking help from a physical therapist to create an appropriate exercise plan.Help make exercise something you enjoy by asking a friend or family member to join you.
  • Be prepared for your visit with your health care provider.Before the appt think about your concerns and plan the questions you plan to ask. If needed write your questions down.Try to be clear and specific about what you want or what is worrying you. If you don’t feel comfortable asking questions, take someone with you (a relative or friend) who can ask questions for you. This person can also help you to understand and/or remember the answers. Work with your health care provider to identify the best treatment option for you and then take as prescribed.
  • Summary slide
  • In addition to the physical impact of psoriasis and psoriatic arthritis, there can also be an emotional impact.
  • Common feelings found among those with psoriasis and psoriatic arthritis.
  • Unhealthy behaviors include:-Eat comfort foods-Smoke & drink alcohol more-Become more sedentary-Sleep less-Less compliant with taking medicationsResearch also indicates that stress can have an effect on the treatments used, making them work more slowly.
  • Feeling anxious or tension results in:Physical reactions as listed.b) Feeling frightened or panic, need to escape to some place safe.Change in behavior – avoiding situations where someone may stare or make negative comments; having a drink before going out to help feel more confident.Negative thoughts such as “people think I’m disgusting” to avoid social situations.Feelings of stress and anxiety are closely linked.
  • Over-generalization: Exaggerating the effect of an unpleasant event which only happened once. You once heard rude comments while eating out. You now think this will happen every time you go to a restaurant.Catastrophic: Always thinking the worst-case scenario. Example: You think if you go to the hairdresser they won’t cut your hair because you think it looks disgusting.Personal: Feeling upset about something that doesn’t have anything to do with you.Such as feeling no one sat next to you on the bus because of your skin. Ignoring the positive: Focusing only on the negative aspects of a situation or your appearance. For example if someone pays you a compliment but you think they are only feeling sorry for yourself.Such negative feed into your self-esteem to ultimately interfere with your daily life and potentially your relationships.
  • Depression is not a passing blue mood. It isn’t a sign of weakness or a condition that can be willed away. Someone who has depression can’t pull themselves together to get better. Without treatment, symptoms can last for weeks, months or years. Professional help is needed when emotional symptoms interfere with day-to-day activities.
  • You may not have any of the feelings identified and have found successful strategies for living with psoriasis and/or psoriatic arthritis. Or you may have some of the feelings. Let’s now look at strategies to address some of the feelings associated with psoriasis and psoriatic arthritis.
  • To help reduce stress:Exercise as mentioned earlier can have a positive impact on your overall health including helping to reduce stress. Being active can help you to relax and reduce thephysical impact stress causes.-Change how you think. Frame your thoughts differently.-Find others to talk with or obtain an NPF mentor for support. -Take care of yourself and improve your lifestyle habits.-There are a number of resources to help with relaxation exercise such as meditation, guided imagery, progressive muscle relaxation or breathing exercises.
  • Guided imagery or mindfulness meditation usually asks that you envision a quiet location and walks you through a simple exercise of breathing and relaxing muscles to bring about a feeling of overall calm. A resource to access for Free guided meditations includes:UCLA Free guided Meditations = 8 pre-recorded exercises to try as a way to reduce stress. Also available is the opportunity participate in more in-depth in online classes.Meditation exercises include breathing, loving kindness, body and sound, working with difficulties, etc. Vary in time from 3 to 19 minutesOther sources include: Guided meditation videos on YouTube or you can purchaseCD’s/discs on
  • Be kind to yourself.
  • Psoriatic Diseases = psoriasis and/or psoriatic arthritis
  • UCLA Free guided Meditations = 8 pre-recorded exercises to try as a way to reduce stress. Also available is the opportunity participate in more in-depth in online classes.Meditation exercises include breathing, loving kindness, body and sound, working with difficulties, etc. Vary in time from 3 to 19 minutes.
  • Psoriasis and psoriatic arthritis volunteer mentors are available through the National Psoriasis Foundation. Mentors can provide for support over a period of time as needed. Mentors offer an opportunity to voice concerns, ask questions and the disease and treatment options. (However medical advice is not given.) They also offer resources, help you find experts when needed and emotional support when you need it most.Mentors can also assist with setting health goals if you feel that will be helpful. To sign up for a mentor go to to find a mentor you would like to connect with. Mentors are across the country so if you have a friend who needs help in another state please share this information.
  • Webcasts provide an additional opportunity to learn more about research, treatment options and lifestyle tips, and more from experts in psoriasis and psoriatic arthritis. Recent webcasts topics include: -Most recently “Dealing with the aches and pains of psoriatic arthritis” given by a physical therapist -Psoriasis and Stress -Treating Psoriatic Itch -Biologics: Are They Right For You -What you eat, or don’t eat, may improve your psoriasisSessions include Q&A with dermatologists, rheumatologists and other health care experts. To sign up for a live event or to view past webcasts in our archives visit:
  • Now that you’ve heard about the physical and emotional impact of having psoriasis and/or psoriatic arthritis along with potential strategies to address both, in small groups let’s discuss what key issues you may have and then come back as a large group.
  • At 11:45 am, small group discussion begins using questions provided as a base. (Each group will have the questions on a handout at their table.) Questions identified by group will be used for Q & A session.
  • Within your group, address each of these questions to identify common issues and feelings about psoriatic diseases within your group.Guidelines for discussion:No answer is the wrong answer.Respect each other and their feelings. Be sure everyone has an opportunity to contribute. Assign a scribe (someone to take notes) and someone to share with the larger group your results of discussion. Be sure to take time to answer both questions. Perhaps assign a time keeper to ensure questions are answered. Remember within this room we are all impacted by psoriasis and/or psoriatic arthritis in some way. This is a safe place to share how you feel. Questions or issues you’ve identified will be discussed in 20 minutes during our large group discussion.
  • At 12:00 pm show 5 minute warning slide.At 12:05 p.m. bring group back for large group discussion. Using flip chart, write down key issues common to the groups. Based on the identified issues offer appropriate answers or potential strategies or to positively address common issues, barriers or needs.

Denver More Than Skin Deep Slide Set April 26 2014 Denver More Than Skin Deep Slide Set April 26 2014 Presentation Transcript

  • WELCOME TO MORE THAN SKIN DEEP Outsmart psoriasis and psoriatic arthritis from the inside out
  • Thanks to our sponsors The National Psoriasis Foundation is solely responsible for all content and development of this program.
  • Reminders • Cell phones • Restrooms • Questions • Evaluation form View slide
  • Our mission National Psoriasis Foundation mission is to find a cure for psoriasis and psoriatic arthritis and to eliminate their devastating effects through research, advocacy and education. View slide
  • Our mission: Connection Outreach programs and activities focus on individuals and health care providers to best manage psoriasis and psoriatic arthritis and improve overall health. Such education programs include: • Psoriasis One to One Program • More Than Skin Deep education events • Free education webcasts • • Health educator • Free E-newsletters • for children and parents
  • Our mission: Connection Education programs for medical professionals designed to enhance the quality of health care received by psoriasis and psoriatic arthritis patients. Such programs include: • Annual Dermatology Resident’s Meeting • Physician Assistant’s Summit • Nurse Practitioner’s Psoriasis Symposium • Psoriasis Forum journal • Research Symposium
  • Our mission: Action The Foundation’s advocacy priorities include: • Growing and supporting federal funding for psoriasis and psoriatic arthritis research. • Advancing the psoriasis and psoriatic arthritis public health efforts at the Centers for Disease Control and Prevention. • Reducing out-of-pocket treatment expenses. • Ensuring affordable access to new treatments.
  • Our mission: Action TAKE ACTION! Have you enrolled in the Marketplace? Share the good and the bad of your experience at Urge Congress to help lower out-of-pocket costs for medication by passing the Patients’ Access to Treatments Act (PATA).
  • Our mission: Hope In 2013, the National Psoriasis Foundation invested $2 MILLION in psoriatic disease research
  • Our mission: Hope The Foundation’s research priorities include: • Fund Discovery and Translational Grants. • Increase the number of scientists doing psoriatic disease research through the Medical Research Fellowship Program. • Provide scientists with DNA samples through the Victor Henschel BioBank. • Work with federal policymakers to increase government investment in psoriatic disease research. • Promote patient involvement in research studies and clinical trials.
  • Join us. Be involved. • Become an advocate • Volunteer • Help find a cure • Participate in 5K to Cure Psoriasis
  • 5K to Cure Psoriasis Sloan’s Lake Park Denver Saturday, June 14, 2014 Help find a cure - please join us To register, visit
  • Why? Through special events the Foundation has raised nearly $8 million towards improving the lives of people with psoriatic diseases and accelerating a cure.
  • It’s Fun and Easy • 5K Run • Easy 1K or 5K Walk routes • Family Friendly • Form a team • Be creative • Entertainment & food Registration begins at 8:00 a.m. 5K Run/Walk begins at 9:00 a.m.
  • How can you start? Register Today To register, visit
  • What You Will Learn Today • The relationship between psoriasis, psoriatic arthritis and inflammation. • Risks associated with psoriatic diseases and other serious health conditions such as heart disease, diabetes and depression. • How to lower risks, reduce pain and other symptoms while taking a holistic approach to care.
  • The Role and Impact of Inflammation April Armstrong, M.D., M.P.H., F.A.A.D. Vice Chair of Clinical Research, Director, Psoriasis Program, Director, Clinical Trials and Outcomes Research Associate Professor of Dermatology, Department of Dermatology, University of Colorado Denver Aurora, Colo.
  • Psoriasis is a noncontagious, chronic, inflammatory disease of the immune system that affects the skin and/or joints PsoriasisGenetic Predisposition Triggers Trauma, infection, drugs, stress Skin cell proliferation Inflammation Itch Immune Dysregulation
  • What is Inflammation? Inflammation is a natural part of the body’s immune process which is designed to protect the body from infection, bacteria and viruses.
  • Acute vs. Chronic Inflammation • Normal T-cell (white blood cell) response to injury or infection • Characterized by: redness, heat, swelling and pain • Duration self-limited  short-term damage • Body recovers Acute Inflammation Chronic Inflammation • Immune cells overact inside the body • Is persistent • Duration NOT self- limited  Damage does not repair • Can contribute to development of serious health conditions
  • Acute Inflammation
  • The Role of T-cells in Psoriasis T cells can become activated in the absence of an identifiable antigen Activated T cells (“Th1” and “Th17”) release cytokines (biological chemicals) prompting inflammation and recruitment of other inflammatory cells (neutrophils) Such inflammation leads to the overproduction of skin cells Overproduced skin cells do not mature and build up forming red plaques with piles of white scales
  • Psoriasis Inflammation Cycle
  • How Inflammation Shows Up In Psoriasis
  • Plaque Psoriasis The most common form of psoriasis. Characterized by raised patches called lesions or plaques which are covered by silvery white scale.
  • Guttate Psoriasis Sudden onset, raindrop lesions, often preceded by a sore throat
  • Inverse Psoriasis Found in skin folds: armpits, groin, under the breast. May lack scale.
  • Pustular Psoriasis Lesions with sterile pus. May require hospitalization.
  • About Psoriatic Arthritis
  • Psoriatic Arthritis and Inflammation • Psoriatic arthritis is caused by abnormal activity of the body’s immune system • Persistent warmth and swelling (inflammation) around a joint can lead to damage if not treated
  • Relationship Between Skin and Joint Inflammation (Psoriasis and Psoriatic Arthritis) Nograles KE et al. (2009) New insights into the pathogenesis and genetics of psoriatic arthritis Nat Clin Pract Rheumatol doi:10.1038/ncprheum0987
  • Psoriatic Arthritis and Inflammation
  • Psoriatic Arthritis and Inflammation
  • Psoriatic Arthritis • Pain and stiffness • 50% have morning stiffness greater than 30 minutes, improved with activity • Neck pain, back pain, heel (Achilles) pain • Needs to be distinguished from osteoarthritis, gout, rheumatoid arthritis (see a rheumatologist)
  • Psoriasis is More Than Skin Deep
  • Psoriasis, Psoriatic Arthritis and Inflammation Results in: • Chronic inflammation of the skin and sometimes joints (psoriatic arthritis) • May cause inflammation elsewhere in the body leading to serious health conditions such as heart disease, diabetes, Crohn’s disease, depression
  • Psoriasis and Inflammation The image at left shows increased inflammation: (A) in the patient's right knee joint and surrounding muscle and in the ankle; (B) throughout the liver; (C) in the wall of the aorta and arteries in both thighs that lead to the aorta; and (D) on the skin in the lower parts of the legs, consistent with inflammation of psoriasis plaques.
  • Severity of Psoriasis Definite link between the severity of psoriasis and the odds of developing other serious health conditions
  • Potential Impact of Psoriasis and Inflammation Having moderate to severe psoriasis increases risks by up to: • 28 percent for coronary heart disease • 30 percent for development of psoriatic arthritis • 43 percent for having a stroke • 46 percent for the development of Type 2 diabetes • 58 percent for having a major cardiac event • 85 percent for developing peripheral vascular disease
  • Other Serious Health Conditions Associated with Psoriasis and Psoriatic Arthritis • Sleep apnea • Crohn’s Disease • Cancer/lymphoma • Nonalcoholic steatohepatitis (NASH) • Chronic obstructive pulmonary disease (COPD) • Increased mortality
  • Why increased risk? • Environmental factors (smoking, stress, obesity, alcohol) • Genetic factors associated with psoriasis, cardiovascular disease and diabetes (PSORS 2,3,4; CDKAL 1; ApoE4; TNF-AIP 3, Il-17, IL-18) • Degree of inflammation (external & internal) • Treatment choices • Psychological impact
  • Psoriasis vs Atherosclerosis: Common inflammatory pathways Atherosclerosis
  • Shared pathway: Diabetes TH-1 cytokines are molecules in the immune system known to promote inflammation and insulin resistance.
  • Shared pathway: Crohn’s Disease IL–12 and IL-23 are cytokines believed to be responsible for overstimulating the immune system and causing at least two autoimmune diseases – psoriasis and Crohn’s Disease
  • Psychological Impact • Depression is 2.7 times more likely in those who have psoriasis • More than 50% of those who have psoriasis have anxiety which may increase risk of a flare Creates a cascade of physiological changes that increase risk of other diseases
  • It’s complicated Psoriasis and/or Psoriatic Arthritis Autoimmune Disease Psoriasis Inflammation Pain Chronic Disease Fatigue Depression Stress Painful Joints Joint Damage Treatments Risk Factors / co-morbid conditions I want a cure
  • How to Outsmart Psoriasis and Psoriatic Arthritis from the Inside Out
  • Treat Your Psoriasis and Psoriatic Arthritis Treating your psoriasis and psoriatic arthritis will: • Improve your physical and emotional well being • Help reduce inflammation and potential risks associated with serious health conditions • Help reduce symptoms associated with pain, swelling and potential joint destruction
  • Treatment Options for Psoriasis Systemics Acitretin Methotrexate Cyclosporine Retinoids Phototherapy UVB Narrowband PUVA Excimer Laser Biologics Etanercept (Enbrel) Adalimumab (Humira) Ustekinumab (Stelara) Infliximab (Remicade)Topicals Corticosteroids Vitamin D analogs Tazarotene Tar Anthralin Emollients Monotherapy Combination Therapy Rotational Therapy Sequential Therapy
  • Treatment Options for Psoriatic Arthritis Corticosteroids Antimalarials Systemics Methotrexate Leflunomide Sulfasalazine Biologics Etanercept (Enbrel) Adalimumab (Humira) Ustekinumab (Stelara) Infliximab (Remicade) Golimumab (Simponi) Apremilast (Otezla) Certolizumab pegol (Cimzia)NSAIDs Non-prescription and Prescription Adjunct Therapy Hot/cold packs Acupuncture Vitamin D Fish Oil
  • The “Autoimmune” System: block TNF: Naïve helper T- cell, TH0 TH-1 CD4 cell Activ- ated LHC TH-17 Cell Keratinocyte (Normal) Keratinocyte (Psoriasis) LHC IL-23 IL-12 IL-17 TNF-α TNF-α INF-γ IL-23 TNF-α Adalimumab (Humira) Etanercept (Enbrel) Infliximab (Remicade) Golimumab (Simponi) Certolizumab (Cimzia)
  • New Treatment Option Apremilast (Otezla)  Oral drug - Phosphodiesterase-4 inhibitor (Celgene®)  Anti-inflammatory Results may be limited by nausea, diarrhea, and effectiveness  Available April 2nd through specialty or mail order pharmacies
  • Upcoming Treatments Anti IL-17/IL-17R Secukinumab (Novartis), Ixekizumab (Eli Lilly), Brodalumab (Amgen) Monoclonal antibody blocks IL-17 (AIN457, LY2439821 or IL-17 receptor (AMG 827) Phase III for psoriasis Phase II for psoriatic arthritis
  • The “Autoimmune” System: block IL-17 (coming soon) Naïve helper T- cell, TH0 TH-1 CD4 cell Activ- ated LHC TH-17 Cell Keratinocyte (Normal) Keratinocyte (Psoriasis) LHC IL-23 IL-12 IL-17 TNF-α TNF-α INF-γ IL-23 TNF-α Key: IL = interleukin INF = interferon LHC = Langerhans cell TNF = Tumor necrosis factor TH = T-helper CD = cluster of differentiation
  • Upcoming Treatments Anti IL-23 (MK 3222 Tildrakizumab (Merck), Guselkumab (Janssen)  Monoclonal antibody blocks IL-23  Phase II  Pathway is also blocked by Stelara®
  • The “Autoimmune” System: block IL-12/23 (ustekinumab) Naïve helper T- cell, TH0 TH-1 CD4 cell Activ- ated LHC TH-17 Cell Keratinocyte (Normal) Keratinocyte (Psoriasis) LHC IL-23 IL-12 IL-17 TNF-α TNF-α INF-γ IL-23 TNF-α Key: IL = interleukin INF = interferon LHC = Langerhans cell TNF = Tumor necrosis factor TH = T-helper CD = cluster of differentiation
  • Learn What Triggers Your Psoriasis Known triggers for a psoriasis flare include: • Stress • Smoking, alcohol and drug use • Injury to the skin (Koebner Phenomenon) • Strep infection • Medications • For some – diet, weather
  • Get Screened for other health conditions Visit your primary care provider regularly to check: • Blood pressure (at every visit pending frequency of visits and other health conditions) • Blood sugar (> age 45, every three years) • Cholesterol (at annual physical) If you already have other health conditions, see a specialist for treatment and care.
  • Screening Guidelines Other Health Condition Screening Criteria High blood pressure* ≥ 120/80 mm Hg Pre-diabetes** (at increased risk for diabetes) FPG 100 – 125 mg/dl Diabetes** FPG ≥126 mg/dl Cholesterol* (pending risk for heart disease from low to very high risk) Total cholesterol: < 200 mg/dl HDL: Women 50 mg/dl or higher Men 40 mg/dl or higher LDL: < 160 mg/dl to < 70 mg/dl Triglycerides: < 150 mg/dl BMI (Body Mass Index) < 25 kg/m Smoking and alcohol use If you smoke, stop. Reduce or eliminate alcohol use. *American Heart Association Screening Guidelines 2011 **American Diabetes Association Clinical Practice Guidelines 2013
  • Lifestyle Choices: What You Can Do Lifestyle choices you can make to help reduce your risk factors include: • Maintain a well-balanced diet and a healthy weight • Increase activity levels • Get plenty of rest • Stop smoking and limit alcohol intake • Address stress issues • Maintain a positive attitude If you need help, look for resources to help support your efforts.
  • Foods That May Promote Inflammation • Processed foods (snacks) • Sugary foods • White flour, white rice • Omega-6 fatty acid (found in various meats, cow’s milk) • Processed meats (corn/grain fed) • Vegetable shortening (high Omega-6) • Alcohol
  • Foods That May Reduce Inflammation • Omega 3 fatty acids: cold water fish (salmon, mackerel, sardines, herring), walnuts • Seeds (flax, pumpkin, sunflower) • Foods rich in monounsaturated fatty acids (avocado, olive oil, nuts) • Leafy greens and colorful vegetables (Squash, spinach, kale, broccoli, carrots) • Fresh fruit (strawberries, blueberries mangoes, figs)
  • Tips to Help Improve Your Eating Habits • Use the “Plate Method”, a 9” plate consisting of: - Half vegetables - Quarter protein - Quarter starch • Free resources to help with weight loss include: -SparkPeople -My Fitness Pal -Choose My Plate -Mobile apps:
  • General Exercise Recommendations • Start slow with 10 minute increments and work up • Consult a health care provider before beginning an exercise program • Work up to 30 to 60 minutes of moderate to intense exercise, 5 days a week into your daily routine • Try yoga, swimming, walking, bicycling • Seek help and support when needed • Find a friend or family member to join you
  • Work with Your Health Care Team • Communicate with your health care providers about your health care needs • Be prepared for your provider visits – identify your question before your visit • Be informed about risks and benefits for treatment options • Take medication as prescribed • Seek help and support when needed
  • To Help Outsmart Psoriasis and Psoriatic Arthritis • Be aware of risks associated with inflammation • Treat your psoriasis and/or psoriatic arthritis and learn what your treatment options are • Seek to identify your triggers • Be screened for other health conditions • Make lifestyle changes if appropriate • Communicate with your health care team
  • 11:00 – 11:15 a.m. Break
  • The Emotional Impact of Psoriasis and Psoriatic Arthritis Darren Lish, M.D., F.A.P.A. Clinical Psychiatrist, Private Practice Lakewood, Colo.
  • Psychosocial Impact of Psoriasis Key findings from the National Psoriasis Foundation: • 28% have another chronic inflammatory disease • 59% experience physical pain with their psoriasis • 63% said psoriasis negatively impacts their overall well being • 71% said they feel helpless • 73% feel angry or frustrated Results based on 6 years of summarized data from nearly 5,000 survey participants with psoriasis and/or psoriatic arthritis.
  • Common Feelings • Stress • Anxiety • Low self-esteem • Anger • Rejection • Embarrassment • Alone or isolated • Low mood or depression
  • Stress and Psoriatic Diseases • Creates a cascade of physiological changes that increase risk of disease • Thoughts become more negative • Causes psoriasis to flare • Psoriasis causes stress • Relieving stress doesn’t always stop a flare • Stress increases unhealthy behaviors
  • Stress and Psoriatic Diseases Can Impact Family Members • Can be hard to deal with a person who is physically uncomfortable, emotionally down or irritable • Financial impact if a spouse is unable to work • Financial impact of medical bills • Parental stress if a child is having issues coping or being bullied • Other stressors (i.e. aging parents, lack of employment)
  • Anxiety and Psoriatic Diseases Feeling anxious or tension results in: • Physical reactions (heart racing, palpitations, stomach churning, muscle tension, dry mouth) • Feeling frightened or panic, need to escape • Change in behavior • Negative thoughts
  • Low Self-Esteem and Negative Thoughts Common negative thought patterns include: • Over-generalization • It’s “catastrophic” • It’s all personal • Ignoring the positive
  • Depression Depression is a “whole body” illness, involving the body, mood and thoughts. It can affect how you eat and sleep, how you feel about yourself and how you think.
  • Signs of Depression There are many signs related to depression. They include feelings of: • Fatigue • Persistent sadness, anxious, or empty mood • Hopeless and pessimistic • Guilt, worthlessness and/or helplessness
  • Other Signs of Depression • Sleep problems (either inability to sleep or sleep too much) • Change in eating habits (under or overeating) • Persistent physical symptoms that don’t respond to treatment • Loss of interest in activities previously enjoyed • Restlessness and irritability • Difficult concentrating • Diminished self-esteem • Thoughts of suicide
  • Does everyone with psoriasis and psoriatic arthritis feel this way? No
  • Take Charge of Your Life
  • Coping and Stress Relaxation Tips • Exercise (walking, swimming, bicycling, etc.) • Stop negative thoughts midway • Talk with friends, family or a mentor for support • Self-care (change lifestyle habits: improve eating, obtain adequate sleep, etc.) • Try relaxation exercises (Ex. meditation, guided imagery, progressive muscle relaxation, breathing exercises)
  • No Guided Meditation Exercises
  • No Stress Relaxation Tips: Try Yoga • Improves muscle tone, joint mobility, sleep and mood • Choose a gentle yoga class if you have psoriatic arthritis • Check with a health care provider or physical therapist before beginning any exercise program • To find a yoga instructor near you: International Association of Yoga Therapists at
  • Strategies to Address Negative Thoughts Challenge your negative thought patterns by asking yourself: • What is the evidence that this thought is true? • Am I predicting the future negatively? • Are there alternative interpretations which are more realistic? • Am I making things worse than they are? • Does this thought help me succeed? • Does it really matter?
  • What to Do if People Stare or Say Something Rude • Nod or smile at the person to indicate you are aware of them • If staring persists, frown to indicate your displeasure • If not effective, say a comment such as “I have psoriasis. Don’t worry it isn’t contagious.” • Quick effective comments works best.
  • Emotional Impact of Psoriatic Diseases If you are experiencing feelings of sadness, depression, anger, frustration, hopelessness, etc. because of your psoriasis and/or psoriatic arthritis, talk with a health care provider and consider seeking psychological help.
  • Where to Obtain Help (Anxiety, depression, negative thoughts) • Ask your health care provider for a referral -PHQ-9 (Patient Health Questionnaire) • Look for mental health providers in your area -American Psychological Association Find a psychologist feature Find a psychiatrist (physician or nurse)
  • Other Resources to Help You • National Psoriasis Foundation / • UCLA Free Guided Meditation Exercises • Nutrition Resource: SparkPeople • MyFitnessPal
  • Resources to Help You: One to One Mentor Program Improve your health with a support system Voice concerns and get answers to your questions about psoriasis and psoriatic arthritis To request a mentor visit
  • Resources to Help You: Webcasts
  • What are Your Issues About Psoriasis and/or Psoriatic Arthritis?
  • Small Group Discussion 20 Minutes (11:45 a.m. to 12:05 p.m.) No
  • • Identify treatment issues that impact your psoriasis and/or psoriatic arthritis. • What are your group’s most prevalent feelings about having psoriasis and/or psoriatic arthritis? • What barriers, issues or fears are contributing factors? Within your group discuss:
  • Large Group Discussion and Q & A in Five Minutes No
  • Questions for Dr. Armstrong & Dr. Lish Large Group Discussion (12:05 – 12:25 p.m.)
  • Please Complete Your Evaluation Form
  • Our thanks to:  Dr. April Armstrong & Dr. Darren Lish  To all of you for attending  Our sponsors: AbbVie, Amgen, Janssen Biotech and Novartis Please Complete Your Evaluation Form