Monthly Archives: February 2022

What Is Psoriasis?

Psoriasis is a chronic (long-lasting) skin condition. People with psoriasis have a skin rash and, sometimes, joint problems or nail changes.

There's no cure for psoriasis, but treatment can help most people who have it control its symptoms.

The main symptom of psoriasis (seh-RYE-eh-siss) is red, thickened patches of skin called plaques. These can burn, itch, or feel sore. Often, silvery scales cover the plaques.

Plaques can happen anywhere. In children, they're most common on the:

Other symptoms of psoriasis include:

In children, common types of psoriasis include:

Plaque psoriasis. This is the most common type of psoriasis. It causes plaques and silvery scales, usually on the knees, elbows, lower back, and scalp. They can be itchy and painful and may crack and bleed.

Guttate (GUT-ate) psoriasis. This type often shows up after an illness, especially strep throat. It causes small red spots, usually on the trunk, arms, and legs. Spots also can appear on the face, scalp, and ears.

Inverse psoriasis. This causes smooth, raw-looking patches of red skin that feel sore. The patches develop in places where skin touches skin, such as the armpits, buttocks, upper eyelids, groin and genitals, or under a woman's breasts.

The exact cause of psoriasis isn't known. But experts do know that the body's immune system, which fights germs and diseases, is involved. Overactive immune system cells make skin cells grow faster than the body can shed them, so they pile up as plaques on the skin.

Some genes have been linked to psoriasis. About 40% of people with psoriasis have a family member who has it.

Anyone can get psoriasis and it may begin at any age. It can't spread from person to person.

Symptoms of psoriasis can go away completely, then suddenly come back. When the symptoms are worse, it's called an "outbreak" or "flare-up." Symptoms of psoriasis can be brought on or made worse by:

Doctors usually diagnose psoriasis by examining the skin, scalp, and nails. They'll also ask whether someone else in the family has psoriasis and if the child recently had an illness or started taking a new medicine.

Rarely, doctors might take a skin sample (a biopsy) to check more closely. A biopsy can tell the doctor whether it's psoriasis or another condition with similar symptoms.

Psoriasis is usually treated by a dermatologist (skin doctor). A rheumatologist (a doctor who treats immune problems) may also help with treatment. Treatments can include:

A doctor might try one therapy and then switch to another, or recommend combining treatments. It's not always easy to find a therapy that works, and sometimes what works for a time stops helping after a while.

For some children, psoriasis is just a minor inconvenience. For others, it is a difficult medical condition.

To manage symptoms and make outbreaks less likely, your child should:

Kids and teens with psoriasis may feel uncomfortable with the way their skin looks. Help your child understand that psoriasis is common and treatments can help.

Whether your child's psoriasis is mild or severe, learn about the condition together. Offer to help find a therapist or join a support group if that might help. Talk to your doctor or check websites like:

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Psoriasis (for Parents) - Seattle Children's Hospital

By now, most of us know the major risk factors that increase the odds of a life-threatening case of COVID-19.

Obesity. Lung and heart disease. Being over 65.

And while those factors are among the conditions front-line health care providers have reported seeing in high numbers among intensive care patients during the pandemic, there are many lesser-known threats that make people vulnerable, experts say.

They range from the logical (smoking, including those who quit years earlier) to the curious (stroke, pregnancy and kidney disease) to the surprising (rheumatoid arthritis, psoriasis, Alzheimers and a wide range of mental health conditions).

About four in 10 U.S. adults 92.6 million people have a higher risk of developing serious illness if they become infected with the coronavirus due to a health condition or their age, according to a 2020 Kaiser Family Foundation analysis. More than 41 million alone are at risk due to an underlying medical condition.

Many of them might be taking medication that weakens their immune system, said Dr. Jonathan Shammash, an internal medicine specialist at Hackensack University Medical Centers COVID-19 Recovery Center.

Medications like corticosteroids can create a risk factor, Shammash said. Immune-modulating medicines can target aspects of our immune system. There are so many of these medications.

Patients with chronic illnesses such as rheumatoid arthritis or psoriasis, aside from the medications they may take which may affect the immune system, we also have the issue of the disease itself and how its affecting the immune function.

The Centers for Disease Control and Prevention says the impact of medications such as corticosteroids which include cortisone and prednisone on the immune system depends on the dose and length of time theyre taken.

While the highly contagious omicron variant that swept through New Jersey in December and January was thought of as a milder strain, it was lethal for thousands of residents, especially the immunocompromised and those with multiple underlying comorbidities.

New Jersey reported 2,380 confirmed coronavirus deaths in January, the highest monthly total since May 2020 during the first wave of the pandemic. And through the first 17 days of February, the state has announced another 1,188.

But the Garden States seven-day average for confirmed daily positive tests continues to fall.

Here are some additional risk factors that make a case of COVID-19 even more dangerous.

Pregnant women face an increased risk of severe COVID-19 as well as complications in childbirth, such as preterm deliveries or stillborn babies, according to CDC data released last fall.

Disturbing in its own right, the coronavirus is even a threat to some women after pregnancy.

Nationwide, nearly 160,000 pregnant women have been infected since the onset of the pandemic in early 2020 26,672 have been hospitalized and 259 died, according to the CDC. Deaths reached a peak in August, September and October 2021, when delta was the dominant variant.

During pregnancy, a womans immune system shifts to protect the fetus including preventing the mothers body from rejecting or attacking it. That pivot can make the mother-to-be less able to fight off a virus.

That elevated threat remains even after childbirth, the CDC says. Certain underlying medical conditions and other factors, including age can increase the risk for developing severe COVID-19 illness just following or even weeks after the end of a pregnancy.

One of the more unusual underlying risk factors is the broad umbrella of mental illness.

Examples range from attention-deficit/hyperactivity disorder (ADHD) and mood disorders to schizophrenia, according to the CDC.

Such conditions can make you more likely to get very sick from COVID-19, the national health agency reports.

COVID-19 patients with mental illness were almost two times as likely to die as other coronavirus patients, according to a study last year in JAMA Psychiatry. Those with severe mental illness such as schizophrenia had an even greater chance of dying from COVID-related illness.

One explanation, experts say, is that people with mental illness often have other underlying conditions, perhaps because of their health habits such as a poor diet and lack of exercise as well as difficulty accessing medical care.

Theyre at higher risk of getting infected, higher risk of being hospitalized and higher risk of dying from COVID, said Dr. Annette C. Reboli, an epidemiologist and dean of Cooper Medical School of Rowan University. One of the things about mental illness that lends itself to a higher risk is first and foremost mental illness can change behavior. People may be less likely to protect themselves against infection.

They may be more fearful of getting a vaccine. They may be suspicious of a vaccine. They may be more likely to go out and about without a mask or less likely to pursue other protective measures.

The reasons are as varied as they are complex because of the myriad conditions mental illness covers, Reboli said.

So, if someone has attention deficit disorder, they may just forget to use the mask because they get distracted, Reboli said. There is other data that shows that those who have chronic mental illness have a shortened lifespan compared to the general population, maybe because theres an element of medical neglect, lack of access to health care.

There are also studies that found a relationship between state of mind [and] stress and the bodys ability to fight infection, she noted.

Many studies show that any type of stress affects our immunological response and causes inflammation, Reboli said.

You stopped smoking? Kicked the habit for your health?

Thats great. Just one thing: Even being a former smoker can make you more vulnerable to a severe case of COVID-19, the CDC says.

Health experts say smoking often leads to lung problems and chronic inflammation that affects blood vessels, which in turn increases the likelihood of becoming seriously ill with COVID-19.

Some studies indicate that smoking in and of itself, without an underlying medical condition, is not a risk factor, Reboli said.

Smoking can affect not only the lungs, but also your cardiovascular health, she said. Those smokers are at higher risk for a heart attack and things like that.

Health experts say people with high-risk factors can reduce their odds of severe illness if they get fully vaccinated. Some may need a fourth shot, or second booster, they add.

Its important for those who have these risk factors, even if theres only a moderate association with high risk, to go get the vaccine, Reboli stressed. Really, everybody who is eligible should get the vaccine.

But its especially important if you have a risk factor. The vaccines have been shown to prevent bad outcomes hospitalizations, ICU usage and death.

CDC spokeswoman Kanta Sircar, an epidemiologist, said scientists are trying to understand how different coronavirus variants affect the body, and whether some underlying medical conditions pose higher risks with one variant but not another.

Theres still so much we need to understand about COVID, Sircar said.

People with underlying conditions should talk to their doctor about how to best protect themselves against the coronavirus and avoid serious symptoms.

Your health care provider knows best about your current situation if you have more than one underlying condition and if you take different medications, Sircar said. They can work with you to get your condition under control. Then they can help you or work with you to make sure, if youre a patient whos immunocompromised, that you get not only your regular vaccines, but a booster and an extra booster.

Gov. Phil Murphy says 49% of eligible New Jersey residents still have not received a vaccine booster shot, and announced a new push Wednesday to encourage people to get the extra jab during his latest coronavirus briefing in Trenton.

Murphy said cases of the omicron variant are plummeting. He recently announced plans to lift mask mandates for schools and childcare centers next month.

Our numbers are clearly headed dramatically in the right direction, Murphy said.

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NJ Advance Media staff writers Steven Rodas and Brent Johnson contributed to this report.

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Some COVID risk factors may surprise you. Why psoriasis and ADHD can boost the threat. - NJ.com

The Global Psoriatic Arthritis (PsA) Treatment Market is slated to top US$ 10.3 Bn in 2022. Expanding at a +7% CAGR, the market size is projected to total US$ 15.6 Bn by 2028.

Psoriatic joint pain isnt perilous, however, impacted patients in all actuality do have a decreased future of around three years contrasted with individuals without the condition. The fundamental driver of death seems, by all accounts, to be respiratory and cardiovascular causes. Nonetheless, treatment can significantly assist with working on the drawn-out anticipation.

Stress, can set off indications and aggravate them. Drugs, like lithium, antimalarials, beta-blockers quinidine, and indomethacin. Actual weight on the joints, for instance, through heftiness, can aggravate irritation.

The best perseverance practices for individuals who have psoriatic joint pain are strolling, swimming, and trekking, Lindsey says. On the off chance that youre capable, running is fine as well. Simply make certain to run on gentler surfaces to keep away from any dreary, hard effect on your joints.

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Key Players-

Psoriatic arthritis is categorized into five types:

The base of Regional, the world market of Psoriatic Arthritis (PsA) Treatment has segmented as follows:

Each Regional Psoriatic Arthritis (PsA) Treatment area is painstakingly considered to comprehend its current and future development situations. This assists players with fortifying their position. Use statistical surveying to improve your viewpoint and comprehension of the market and interest group and guarantee you stay in front of the opposition.

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In addition, the rising R&D consumption by vital participants, rapid endorsements of organic medications for psoriasis, and expanding government backing to direct clinical preliminaries to find novel treatment choices for psoriatic joint inflammation avoidance, are expected to support the market in the U.S.

In December 2021, for example, Amgen Inc., which is a rumored biopharmaceutical organization situated in California, sacked the U.S. FDA endorsement for the extended utilization of Otezla. It can now be utilized to treat grown-ups with gentle to direct plaque psoriasis. The endorsement empowered the organization to showcase Otezla as the main oral treatment choice for grown-up patients. Prodded by the improvement of such inventive medications for the treatment of psoriasis orthotics is probably going to drive the market in the U.S.

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Psoriatic Arthritis (PsA) Treatment Market size is projected to total US$ 15.6 Billion Forecast by 2022-2028|| Pfizer Inc, Johnson & Johnson,...

For a study, researchers conducted a longitudinal open-label trial to analyze if extending the intervals between etanercept (ETN) delivery may be beneficial in sustaining remission with a steady dosage in psoriatic arthritis (PsA) patient group that has achieved persistent remission with ETN 25 mg biweekly.

Fifty-four patients with PsA were recruited from the Azienda Ospedaliera Universitaria Seneses Rheumatology Unit. Patients in clinical remission with biweekly ETN 25 mg at weeks 12 and 16 were moved to a weekly regimen. If clinical remission was maintained at weeks 24 and 28, patients were transferred to an every-other-week regimen, with this administration schedule continuing for the rest of the research if clinical remission was maintained at weeks 36 and 40. If, on the other hand, disease activity increased in one of the checks, the treatment plan was reverted to the prior one.The outcome of the study showed that a consistent percentage (72%) of patients with PsA who achieved sustained remission with ETN 25 mg biweekly maintained remission after a year of starting therapy, despite a progressive dose reduction by increasing the dosing interval, 21% with a weekly regimen and 51% with an every-other-week regimen.

Findings indicated that peripheral polyarthritis pattern and aggravation of cutaneous symptoms were the key factors preventing ETN dosage interval increase in patients with PsA in prolonged clinical remission at regular doses.

Reference:journals.lww.com/jclinrheum/Abstract/2018/04000/Low_Doses_of_Etanercept_Can_Be_Effective_to.4.aspx

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Low Etanercept Doses May Be Effective in Maintaining Remission in Psoriatic Arthritis Patients - Physician's Weekly

For a study, it was determined that certain therapeutic microorganisms, such as Bifidobacteria infantis (B. infantis) 35624, mimic commensal-immune interactions and had favorable immunoregulatory effects. However, the utility of these effects in patients with non-gastrointestinal inflammatory disorders was unknown. The researchers observed the effects of taking B. infantis 35624 orally for 6-8 weeks on inflammatory biomarker and plasma cytokine levels in patients with ulcerative colitis (UC) (n=22), chronic fatigue syndrome (CFS) (n=48), and psoriasis (n=26) in 3 separate randomized, double-blind, placebo-controlled interventions. The impact of B. infantis 35624 on immunological indicators in healthy persons (n=22) was also investigated. Comparable to healthy volunteers, both gastrointestinal (UC) and non-gastrointestinal (CFS and psoriasis) patients exhibited significantly higher plasma levels of C-reactive protein (CRP), as well as the pro-inflammatory cytokines tumor necrosis factor (TNF-) and interleukin-6 (IL-6). Comparable to placebo, B. infantis 35624 feeding resulted in lower plasma CRP levels in all three inflammatory illnesses. In CFS and psoriasis, plasma TNF - was lowered, whereas IL-6 was reduced in UC and CFS. Furthermore, after eight weeks of feeding, LPS-stimulated TNF - and IL-6 release by peripheral blood mononuclear cells (PBMCs) in healthy subjects was significantly reduced in the B. infantis 35624-treated groups compared to placebo. According to the findings, this microorganism can lower systemic pro-inflammatory biomarkers in gastrointestinal and non-gastrointestinal disorders. Finally, it was revealed that the microbiotas immunomodulatory effects in humans were not restricted to the mucosal immune system, but also extend to the systemic immune system.

Link:www.tandfonline.com/doi/full/10.4161/gmic.25487

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Beyond the Gut, Bifidobacterium infants 35624 Regulates Host Inflammatory Processes - Physician's Weekly

AbbVie ( ABBV -0.65% ) has taken an important step toward replacing the revenue decline that will result from Humira's patent protection expiration in the U.S. next year.

That step is approval from the U.S. Food and Drug Administration (FDA) to use AbbVie's Skyrizi to treat patients with active psoriatic arthritis, a disease that impacts around 1.5 million Americans.

Let's dive into the phase 3 clinical trial results for Skyrizi and the U.S. psoriatic arthritis market to get a feel for how valuable this approval could be for AbbVie.

Image source: Getty Images.

Psoriatic arthritis is a type of inflammatory arthritis that occurs when the immune system attacks healthy tissue. This can cause joint pain, stiff joints, and fatigue. If psoriatic arthritis is left untreated for long enough, the condition can result in irreversible joint damage.

One treatment option that could now make a difference in the lives of countless psoriatic arthritis patients is Skyrizi, which works by controlling the release of interleukin-23 (IL-23) proteins, a different method than other drugs on the market.

AbbVie conducted two phase 3 clinical trials with patients who weren't able to achieve meaningful improvement or were unable to tolerate biologic therapies or non-biologic disease-modifying anti-rheumatic drugs. Tumor necrosis factor (TNF) inhibitors like AbbVie's blockbuster Humira are often the first-line therapy for psoriatic arthritis patients. While this drug class is highly effective in treating patients, it doesn't work for everyone. In fact, 19% of patients on TNF inhibitors don't greatly benefit from taking them. Those patients could benefit from Skyrizi.

Up to 57% of patients taking Skyrizi experienced at least a 20% improvement in their tender/swollen joint count and pain scale at week 24. This was statistically superior to the 34% of patients receiving placebo who experienced similar levels of improvement.

The maximum rate of serious adverse events in patients taking Skyrizi across both clinical trials was just 4%, which was lower than the placebo rate of 5.5%. This demonstrates Skyrizi to be safe and effective.

Since Skyrizi will mostly be prescribed to patients who didn't experience improvement on TNF inhibitors, I think the drug's biggest strength is its safety profile. Unlike Janus kinase (JAK) inhibitors like Pfizer's (NYSE: PFE) Xeljanz and Eli Lilly's (NYSE: LLY) Olumiant, which come with increased risk of heart attack, cancer, and blood clots, Skyrizi hasn't been found to elevate the risks of these events. That should allow Skyrizi to be prescribed ahead of JAK inhibitors, which will lead to greater market share.

Sykrizi looks like it will be a game-changer for many psoriatic arthritis patients. But how much of a growth catalyst could the indication be for AbbVie?

The Johns Hopkins Arthritis Center estimates that psoriatic arthritis impacts around 1.5 million Americans. If you consider that 19% of psoriatic arthritis patients don't benefit from TNF inhibitors, that would put approximately 285,000 patients in a group that need alternative treatments.

Due to Skyrizi's exceptional safety profile and efficacy, my guess is that the drug can seize 10% of the market or about 28,500 psoriatic arthritis patients in a base-case scenario. Skyrizi has an annual list price of $73,000. Negotiations with health insurance companies and drug assistance programs for eligible patients mean that the net price will be significantly cheaper than the list price. I estimate the annual net price could be $40,000 per patient. Below is a range of market shares using that $40,000 that demonstrates the blockbuster potential of the drug.

My estimate of 10% market share at $40,000 annual cost would lead to over $1.1 billion in annual sales potential for Skyrizi. Against the $60.3 billion in sales analysts expect for AbbVie this year, this would be a 1.9% bump in total revenue. For Skyrizi, $1.1 billion in additional sales would be a nearly 40% boost over the $2.9 billion in revenue that the drug generated last year.

Skyrizi's psoriatic arthritis indication could be a slight growth catalyst for AbbVie as a whole. But it will be a huge boost for the the drug since it is Skyrizi's second approved indication.

Aside from Skyrizi, AbbVie has dozens of drug indications that are in different stages of development. AbbVie's next-generation immunology drugs Skyrizi and Rinvoq each have indications for Crohn's Disease and ulcerative colitis that are either in phase 3 clinical trials or that have already been submitted to regulatory authorities.

Approval could add up to billions of dollars in annual sales and could be approved this year or next year. Thanks to recent regulatory approvals and more that are expected to come, AbbVie believes that Skyrizi and Rinvoq will generate more than $15 billion in combined sales by 2025. This would be more than triple the $4.59 billion in combined sales that the two drugs produced last year. Factoring in a 50%, or nearly $9 billion, decline in Humira's U.S. sales by 2025 from biosimilar drug competition starting next year, Skyrizi and Rinvoq should be enough to replace the revenue loss from Humira. Analysts are expecting 4% annual earnings growth over last year in the next five years.

AbbVie's 41% dividend payout ratio last year and decent growth prospects should lead to strong dividend growth in the future and investors can getAbbVie's 4% dividend yield at a current price-to-earnings ratio of 10. This makes AbbVie a stock to consider buying right now.

This article represents the opinion of the writer, who may disagree with the official recommendation position of a Motley Fool premium advisory service. Were motley! Questioning an investing thesis even one of our own helps us all think critically about investing and make decisions that help us become smarter, happier, and richer.

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AbbVie Snags FDA Approval for Another Indication. Will It Become Another Blockbuster? - Motley Fool