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The Ministry of Health, Labour and Welfare in Japan has given full marketing authorisation to the oral selective inhibitor of PDE4 (phosphodiesterase) product from Celgene, known as OTEZLA. OTEZLA has been approved for marketing for providing treatment for plaque psoriasis in adult patients who have responded inadequately to topical therapies, as well as to adult patients who are suffering from psoriatic arthritis.

 Psoriasis, of which plaque psoriasis is the most common form, is a chronic inflammatory. Psoriatic arthritis is a chronic and painful inflammatory disease resulting in swollen, tender and stiff joints, tendons and ligaments. The chairman and professor of the Department of Dermatology at Jichi Medical University, Mamitaro Ohtsuki, MD, PhD, says that the approval of OTEZLA is the first time such approval has been granted in Japan to an oral treatment for psoriasis in a quarter of a century. OTEZLA does not need to be monitored prior to administration, is easy to tolerate, and comes with a novel action mechanism.

 OTEZLA

OTEZLA is the first example of a whole new kind of medicines that have been given approval in order to treat the diseases known as psoriatic arthritis and psoriasis, both of which involve dysregulated activity in the immune system. Plaque psoriasis is a systemic inflammatory condition that affects around 430,000 people in Japan alone, and around 125 million people all over the world. It is characterized by the appearance of raised scaly skin lesions.

 The approval given to OTEZLA by the Japanese government was based upon the safety and efficacy results from a Japanese phase 2b study, as well as two international phase studies – phase 2b and phase 3 – in adult patients suffering from psoriatic arthritis conditions. These ranged from moderate to severe. There were also three international phase 3 studies that were conducted in adult patients afflicted with psoriatic arthritis. Clinical studies found that the most common side effects of OTEZLA were nausea, headache, tension headache, upper respiratory tract infection and nausea.

Approval

 According to the president of Celgene Inflammation and Immunology, Scott Smith, OTEZLA receiving approval in Japan represents another crucial milestone for the company, in its attempt to create innovative medicines that can address the needs of patients all over the world who have been suffering from chronic inflammatory diseases. Smith says that Celgene believes that the oral administration and novel mechanism of action with OTEZLA will offer patients suffering from psoriatic arthritis and plaque psoriasis in Japan a very welcome new option.

 As of December 2016 OTEZLA has now been given approval in 37 countries, including parts of Europe and the United States.

 Details of OTEZLA

OTEZLA is a small-molecule phosphodiesterase 4 inhibitor that can be taken orally, and is specific to cyclic adenosine monophosphate. The inhibition of phosphodiesterase 4 causes an increase in intracellular cAMP levels that are believed to be responsible for indirectly modulating inflammatory mediators production. The specific way in which the therapeutic action of OTEZLA is exerted in psoriatic arthritis and psoriasis patients has not been well defined.

Warnings, precautions and safety information

 OTEZLA is contraindicated in patients who have a known apremilast hypersensitivity, as well as hypersensitivity to any of the other excipients found in the formulation. The benefits and risks of OTEZLA treatments on patients suffering from suicidal thoughts or depression, or who begin to suffer them while on the treatments, need to be carefully weighed. Barely 1 percent of patients on OTEZLA suffered from any form of depression during the period they were taking the medication. It is also a good idea to regularly monitor body weight, and to consider discontinuing the use of OTEZLA in the event of clinically significant or unexplained weight loss.

Less than five percent of psoriasis patients also reported adverse reactions to OTEZLA, ranging from diarrhoea to nausea, headache, tension headache and upper respiratory tract infection. The same reactions were also experienced by less than 2 percent of psoriatic arthritis patients on the medication. The effect of OTEZLA on pregnant women has not been studied, and it should therefore not be used during pregnancy – unless the potential benefit is justified in comparison to the potential risk for the foetus. Caution is also advised for nursing women using OTEZLA. Patients suffering from renal impairment should have their dosage of OTEZLA reduced.

According to the American Academy of Pain Medicine, more than 1.5 billion people suffer from chronic pain. In the US, it is one of the most common causes of long-term disability, affecting more than a 100 million people.

What is Chronic Pain?

Chronic pain is a medical condition, which means ever-lasting pain, or a pain, which has persisted for a long time. It can affect any part of your body and can be characterised by various degrees of pain. Chronic pain doesn’t have to have an apparent cause and can occur after an injury, due to the malfunctioning of the nerve signals. Although chronic pain is incurable, the painful sensations can be minimised by medications and therapies. Some common ways to minimise chronic pains is proper medications, lifestyle transformations and other medical treatments and procedures.

Almost everyone experiences pain at some point of their lives, however, after a while these pains and aches subside. This type of pain is the reaction of the nervous system to warn your body that the body has sustained an injury. When the body suffers from an injury, the brain alerts the nervous system, by sending pain signals from the injured part to the brain through the spinal cord. As the injury heals, the pain becomes less severe. On the other hand, chronic pain persists and continues to send pain signals to the brain, even after the injury has healed. This can last from months to years, can severely affect your mobility, normal functioning of a body part, and can drastically reduce your flexibility, endurance and strength, which can sometimes cause difficulty for you to attempt or complete daily tasks or activities.

How to Identify Chronic Pain

Chronic pain is characterised as a pain which can persist and lasts up to at least 12 weeks. It can be severe or a dull numbing ache or a burning sensation. It can be a steady kind of pain or intermittent pain, coming and going at different intervals for no apparent reason. Some of the most common chronic pains are given below:

• Lower back pain
• Headache
• Post-trauma pain
• Cancer pain
• Post-surgical pain
• Neurogenic pain (a kind of pain caused by nerve damage)
• Psychogenic pain (pain that is not caused by any disease, injury, or nerve damage)
• Arthritis pain

Causes of chronic pain

Chronic pain is generally caused by an initial injury, such as a pulled muscle. According to medical scientists, chronic pain manifests after the nerves suffer from damage, which makes pain unbearable and long lasting. In most cases of chronic pain, treating the initial injury might not be a solution for eliminating the chronic pain. Moreover, in some cases, chronic pain might not be caused by an injury but due to a medical condition such as chronic fatigue syndrome, fibromyalgia, endometriosis, inflammatory bowel diseases, vulvodynia, temporomandibular joint dysfunction (TMJ) and interstitial cystitis.

Who Can Be Affected By Chronic Pain?

Chronic pain can affect people from all walks of lives, any gender or age. However, it is much more common in older people and females. Here are some factors that increase your chances of having chronic pain:

• Injury
• Surgery
• Being overweight or obese

Treatment of Chronic Pain

It is not quite possible to completely eliminate chronic pain, yet. However, most treatments have two primary objectives: to reduce pain and to elevate strength and mobility. This can help individuals carry out their daily tasks without any discomfort or difficulty. The treatment can also differ from person to person, depending on the frequency or severity of pain. Depending on these two factors, a medical practitioner can design a customised treatment plan for a patient. This pain management plan will depend on the underlying health conditions of the person and on their symptoms. Here are some treatment strategies for chronic pain.

Medications

To treat chronic pain, doctors sometimes prescribe their patients with several types of medications such as:

• Over-the-counter pain relievers like aspirin, NSAIDs (non-steroidal anti-inflammatory drugs) and acetaminophen
• Opioid pain relievers, such as morphine, hydrocodone and codeine
• Adjuvant analgesics, like anticonvulsants and antidepressants

Medical Procedures

Here are some medical procedures that can drastically improve the condition of a patient suffering from chronic pain.

• Acupuncture: A process in which the skin is punctured lightly with thin needles to reduce pain.
• Nerve Block: An injection that stops the nerves from sending pain signals to the brain.
• Electrical Stimulation: Mild electric current is used to shock the muscles to alleviate pain.
• Surgery: Any injuries that have healed improperly or not at all can be corrected by undergoing a surgical procedure to eliminate the injury, which has been causing the chronic pain.

Lifestyle Modifications

To ease chronic pain, patients can try:

• Physical therapy
• Meditation
• Tai chi
• Pet therapy
• Massage
• Indulging in art or music therapy
• Psychotherapy
• Yoga

How Do You Cope With Chronic Pain?

The first step is to accept that there is no apparent cure for eliminating chronic pain completely. However, there are several ways to reduce and manage that pain, if the patient chooses to follow the pain-management plan religiously. Physical pain can have a direct affect on your emotional health and can be a common cause for stress. To cope with a condition of chronic pain, take care of your body by indulging in a healthy lifestyle, eating balanced meals, doing exercises and getting enough sleep. Seek support from friends, family and support groups to increase your motivation. Chronic pain can force you to isolate yourself, but it is crucial to take part in your daily activities, as you would normally. Socialise with your friends and peers and carry out your daily tasks to eliminate any negative emotions and to decrease your sensitivity to pain.

You can find out more about pain management here.

Not too long ago, Arthritis was a condition that was only diagnosed in individuals aged 50 and above; however, nowadays individuals are developing its symptoms as early as at the age of 35. Given that arthritis can be a painful condition, it can only be considered chronic if the level of pain continues to escalate, makes it difficult to perform regular everyday activities, and tends to last longer than six months.

For those suffering from chronic arthritis condition, we are going to recommend some sure shot ways to managing it.

Taking inflammation medication

When it comes to arthritis, no pain relief strategy is as important as controlling inflammation. The number one choice to relieve inflammation is to use disease modifying drugs known as DMARDs. The gap during acute flares can be bridged using steroids, and if flares continue any way, the doctor may suggest a triple drug therapy. Newer drugs may be expensive but they are more effective. More information on these medications can be obtained at the Arthritis UK website.

Pain Management Medications

After inflammation, the next concern of most patients is to manage acute pain that follows in this condition. To treat this, non-steroidal inflammatory medications are used. Opioids are known as powerful pain relievers mostly used to treat chronic pain. Note that these medications are cautiously prescribed by doctors, as it is rather easy to build up tolerance against these medications that often leads to abuse. It is advised that you contact your GP about pain management medications. Some online clinics will also prescribe pain management medications on a short course until you can see your GP. The Online Clinic provides this service but they do require that you provide details for your GP so that he or she can be kept informed.

Weight management

One effective way of managing chronic arthritis pain is managing ones weight. By maintaining a healthy weight, you reduce the amount of stress you put your joints through. In a study conducted in 2013, it was found that being overweight requires stronger and more frequent dosage of medicines to control pain and relieve symptoms.

Consulting a Massage Therapist

A complementary treatment to manage arthritis pain also lies in the hand of a massage therapist. In the same study mentioned above, it was also found that light and medium massages a couple of times a week helped patients in curbing the symptoms of Arthritis. After a month of regular massages, the pain patients felt was reduced considerably.

Staying Active and Exercising

Given that one doesn’t feel like staying active when suffering from arthritis, but maintaining a light routine of exercise can prove to have pain relieving effects on patients. Depending on the severity of your condition, your doctor will suggest different types of exercises, which include walking, cycling and swimming. In fact, doctors recommend that water aerobics are perhaps the best way exercise as it doesn’t stress any particular joint because water tends to buoy your body.

Orthoses may prove to be helpful

Orthoses are essentially mechanical aids that protect and help support your joints. Examples of orthoses are padded insoles, bracers or splints that help keep joints properly aligned. Patients can even find specially made gloves for chronic pain in their fingers and hands. In order to know which orthoses suits you best, consult a physical therapist to determine that.

If you suffer from chronic arthritis pain, before you go on trying different techniques to see what helps with the pain, consult your doctor first as they will be able to advise you as to which ways will be the most effective for your condition.

People that suffer from psoriasis do everything in their power to keep the condition in check. They avoid their known triggers and take appropriate medicine as well as avoid psychological stress to minimize the flare-ups.
Treatments other than the medication itself are equally important to containing psoriasis. This is because stress and psoriasis are linked rather intricately. Given that this is basically a genetic disease, environmental triggers like stressful events often triggers it, said an excerpt from American Academy of Dermatology. Psoriasis in itself is a stressful condition, and taking stress apart from that can trigger chronic flare ups. This is why management of stress is a key component for treating Psoriasis.
Immune system, stress, and Psoriasis
Psoriasis is a type skin inflammation conditions. While researchers and doctors don’t completely understand what causes it, but it generally occurs when your immune system turns against the body. This causes skin cells to grow rather rapidly and abnormally. Since stress has a significant impact on our immune system, doctors have suspected this link with stress for a long time, and recent research proves this theory.
Psoriasis is extremely sensitive to stress. It tends to flare up rather easily when those suffering are stressed out, and the symptoms begin to improve when relaxed. Most people that have psoriasis have one thing in common; their very first outbreak is around the time they were going through a difficult period in their lives.
Stress Related to Psoriasis
This condition itself can be a difficult problem, sometimes stressful depending on which part of the body it has decided to flare up. This makes the treatment for this condition rather tricky. Due to its unappealing symptoms, for much Psoriasis is a stigmatizing condition. People suffering from this condition avoid wearing warmer clothes in the winter and prefer sweating in their full sleeves shirts to hide their skin. Being worried and feeling self-conscious of these physical symptoms increase emotional stress that cause flare ups even more.
Stress Management in Psoriasis
In order to keep Psoriasis in check, doctors recommend stress management as an effective way to counter it. For starters, regular exercise is perhaps the best way to relieve stress along with offering you innumerable health benefits. Most patients prefer exercise as a stress reliever as most find it an enjoyable activity. Other stress relievers include pilates, yoga and meditation.
Those suffering from psoriasis should also identify their behaviors and triggers that relate with stress. Drugs and alcohol that people use to reduce their stress actually make the psoriasis symptoms worse. A lot can be said about managing addictive behaviors such as these. Your stress escaping rituals like smoking and alcohol further aggravate the condition adding to its severity.
Identifying these sources of stress can significantly aid you in keeping the symptoms in check, but you don’t have to fight this battle alone. Building and strengthening a support system can be paramount to coping with a condition as chronic as this. Counseling may yield promising results as well if stress reducing techniques aren’t enough for you.

External medication in the form of topical treatment that is applied to skin,is usually the first option when it comes to treating psoriasis.

Many topicals can be purchased over the counter whilst others are available by prescription only.