PHYSICIAN VOICES

Meet the Rheumatologist: Psoriatic Arthritis

Dr. Douglas Lienesch is a board-certified rheumatologist in Pittsburgh, PA.

In our "Meet the Specialist" series, we highlight the unique perspectives of various medical specialists on the types of patients they see and what they find rewarding and challenging in their daily practice.

I’ve been a practicing physician since 1993. While working as a general internist, I realized the most rewarding part of my job was treating patients with chronic arthritic conditions. Eventually, I decided to go back for specialty training in rheumatology. A rheumatologist takes care of people with  musculoskeletal diseases, which are disease affecting joints, muscles, tendons, and bones, as well as other parts of the body.  

Some musculoskeletal diseases are caused by abnormal function of the immune system. Our immune system’s job, among other things, is to protect our bodies from attack by  bacteria, viruses, and other infections. When our immune system detects such invaders, it attacks them and rids the body of them.

Occasionally, the immune system becomes misdirected. In those cases, it seems to be attacking an uninfected part of the body and in doing so, it causes illness and damage. In psoriatic arthritis, the immune system attacks the skin, joints, tendons, and sometimes other parts of the body, causing inflammation that leads to swelling, pain, and the potential for irreversible damage.

The diseases I take care of tend to be chronic, long-term conditions, so I develop relationships with my patients that can last for many years. While we can’t cure many of these conditions, research has led to great breakthroughs in treatment over the past few years. It’s very rewarding to see my patients respond so well to these new options. Today, we have tools that allow us to take someone who’s very sick and quite debilitated by an illness and return the patient to full function.

In psoriatic arthritis specifically, research has led to improved understanding of how the disease works, and the subsequent development of several new therapies. In fact, there’s a significant number of new drugs that have come out for both the joint and skin components of the disease, and they’re helping patients get back to normal. Thanks to this research, we have new, effective ways to block inflammation, resulting in dramatically improved outcomes.  Even five years ago, we didn’t have the options we do now.

I believe the effects of psoriatic arthritis are on a spectrum of severity. There are people with mild disease, there are people with very disabling disease, and there are people in between. Those with mild disease may do well with nonsteroidal anti-inflammatory drugs (NSAIDs). People with moderate disease may use medications like methotrexate or sulfasalazine, and a significant proportion of them will respond well.

Patients with more severe disease may find their condition is not well controlled with those options and these people are at risk for progressive damage to their joints. To prevent this, I’ll prescribe newer drugs called biologic agents, or biologics. Biologics are drugs developed to specifically target a key component of the inflammation. We often see significant improvement in patients with moderate or severe disease when we use biologics. And fortunately, ever since biologics were first introduced back in the early 2000s, more and more have come on the market, adding to the list of available options should one medication not work. Although not all patients get back to full function, the vast majority see marked improvements with these treatments.

I think it’s important that patients with psoriatic arthritis be evaluated by a rheumatologist. A rheumatologist is best equipped to confirm the diagnosis, assess how severe the disease is, and make recommendations on the safest and most effective treatment. Patients with psoriatic arthritis are at risk of inflammation affecting other areas of their bodies, like their eyes and bowels, and rheumatologists know to monitor for these symptoms and prevent these complications. 

A rheumatologist will have a more thorough understanding of the lifestyle changes that can help patients control the disease. Find a rheumatologist who takes a team approach and who works together with you and your other health care team members to find the right treatment path to manage your psoriatic arthritis. With the right support, education, and therapy, you can live a full life with your psoriatic arthritis under control.