Why sticking to a treatment plan is important
Pills, lotions, syringes and infusions. Caring for psoriasis and psoriatic arthritis can seem like a chore at best, which makes it all that much harder to stick to a treatment plan.
Dr. Steven Feldman, a dermatologist with Wake Forest University, said his office recently tracked the compliance rate of seven patients using adalimumab (Humira) and found that only one of the seven used the drug exactly as directed.
Stopping a drug, administering it incorrectly or reducing the dosage without a physician's advice can results in flare-ups or cause the medicine to stop working, Feldman said. And increasing the dosage without a doctor's guidance can result in very serious consequences — even death.
Still, there are many reasons why people with psoriasis and psoriatic arthritis have trouble following a treatment plan. Here are some of most common reasons — and how to overcome them:
They fear side effects.
Patients hear the word "steroid" — a common ingredient in topical creams and ointments — and picture balding men and beefy women, Feldman said. But the steroid used in most creams is cortisone, which is the same hormone the human body naturally creates. It's common for people to be wary of systemic drugs, such as methotrexate or a biologic. Feldman said he urges patients to weigh the real risk of a side effect, such as the extremely small risk of developing lymphoma from a biologic, with the potential for relief from psoriasis or psoriatic arthritis. If the risk of side effects is too much, patients should work with their doctor on an alternative treatment plan.
Treatment is messy/inconvenient/uncomfortable.
For people with mild to moderate psoriasis, treatment often consists of an ointment or cream. However, topical ointments can be messy or inconvenient to apply to certain parts of the body, such as the scalp. Patients and doctors need to agree on a treatment that the patient is willing to use as directed, Feldman said.
Confused by or forget dosing instructions.
It's human nature to forget the details, which is why Feldman makes a point of writing down dosage instructions for his patients. "If you don't give it in writing, it's almost as if you didn't tell the person." If you can't remember if you should take a drug once a week, or daily for a week, don't guess. Taking too much of a medicine can result in serious consequences. Taking too little could trigger a flare or make the drug less effective. Call the doctor's office and get the correct information, Feldman said.
Treatment is too expensive.
It may be tempting to cut back or stop taking a medicine when costs go up or when your insurance status changes, but don't. Low-income people and those without insurance usually can contact the drug companies for help, Feldman said. Those who don't qualify for help should work with their doctor to find a less-expensive treatment.