We will simply need to wait for possible future properly powered trials comparing MTX monotherapy to "New Therapeutic" monotherapy to "New Therapeutic + MTX" to truly learn about its efficacy in joints and skin, as well as in domains such as enthesitis, dactylitis, nail disease
, and structural damage.
Other treatments that were found effective are psoralen and UVA/ UVB for skin and nail disease
, physiotherapy for axial disease, intra-articular steroids for peripheral arthritis, and NSAIDs for peripheral arthritis and axial disease (J Rheum.
In terms of patient management, "not only do we have to worry about peripheral arthritis, but we also have to be concerned with skin and nail disease
, axial disease, dactylitis, and enthesitis," said Dr.
Furthermore, some patients have thickened, discolored, or dystrophic nails for reasons unrelated to nail infection--for example, changes related to chronic microtrauma, aging, or concomitant psoriatic nail disease
One third of people with athletes foot develop fungal nail disease
However, this is no longer considered the ideal practice, given what is now known about the potential sequelae of onychomycosis, the importance of selecting the most appropriate treatment, and the possibility of misdiagnosis of nail disease
from other causes (such as immune dysfunction (8) or psoriasis (9)).
Elewski said that she also finds it useful in white superficial onychomycosis and in minimal nail disease
The prevalence of onychomycosis, the most frequent cause of nail disease
, ranges from 2% to 13%.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), which has 250 members from North America, Europe, and elsewhere, performed a formal literature review for the symptoms of peripheral arthritis, skin and nail disease
, axial disease, dactylitis, and enthesitis, and formulated treatment guidelines based on this systematic review and consensus opinion.
For concurrent skin and nail disease
without joint involvement (defined as skin disease on at least 8% of the body surface and moderately to severely painful dystrophy of at least 5 of 10 nails), the board strongly recommended adalimumab, etanercept, and ustekinumab, and also recommended methotrexate, acitretin, infliximab, and apremilast.
For moderate to severe nail disease
, he prescribes oral terbinafine (Lamisil) on a pulse therapy basis: 30 days of once-daily therapy, then 30 days off, and finally another 30 days on.