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3156104 tn?1357284795

IFN Alfa 2b induced psoriasis

Completed 4 doses of Peg Ifn alfa 2b with RIBAVIRIN unfortunately autoimmune disease appears PSORIASIS along my joint areas like on my hands and feet please suggest what to do i dont want to stop therapy what shall i do if it worsens i am 31 years old infected with "C" genotype 3
10 Responses
766573 tn?1365170066
Greeting and welcome. I am sorry this is happening. I do not have firsthand experience or knowledge about PA however I have some time on my hands so I just Googled some of the key words in your post. I hope the things I found this elsewhere help until someone else posts. Meanwhile perhaps  you can post more details so others can offer insight:

Psoriasis can most definitely cause joint pain or arthritis, commonly referred to as psoriatic arthritis. Most commonly, this occurs after 10 years or more of suffering with skin and/or nail psoriasis; however, there are instances where the arthritis precedes the skin condition. If you have both joint and skin involvement, or just joint involvement, then in some cases we'd consider traditional systemic (oral) therapy such as methotrexate, or more commonly these days the self-injected or infused biologic agents such as adalimumab, etanercept, ustekinumab or infliximab.

Speak to your dermatologist about all your treatment options
________________________-

There are some older articles about psoriatic arthritis being triggered such as the one in the first link, "IFN-alpha-induced psoriatic arthritis (and HCV-related liver cirrhosis)" but there are also articles on this condition being managed during treatment.

http://www.ncbi.nlm.nih.gov/pubmed/18432326

~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I do know a key to being able to treat the whole time is managing side effects. Have you had a 4 week VL draw yet?

Here is an article"
"Successful clearance of hepatitis C virus with pegylated interferon α-2a and ribavirin in an etanercept-treated patient with psoriatic arthritis" The person had Gt 3 as well (looks like they used  etanercept)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264933/

These are just links that show in some particular circumstances the condition was managed during treatment.

Either way it would be great if there were a way I hope you can see a Derm or a Hepa who has background in all this.


This is tiny (and not free)
http://ard.bmj.com/content/70/7/1343.extract
1815939 tn?1377995399
"unfortunately autoimmune disease appears PSORIASIS along my joint areas like on my hands and feet please "
------------------------------
If I understand correctly, you have psoriasis on the skin around your joints. You do not have joint pain. Is that correct?

If you have dermatological psoriasis (skin psoriasis), then I would recommend seeing a Dermatologist for treatment. He/she will probably give you prescriptions for topical steroid creams or ointments. Possibly an oral antihistamine prescription will help too.

I treated from September 26, 2011 through August 25, 2012, 48 weeks total. I developed psoriasis late in treatment, about week 40 or 42. It first appeared around my eyes, on the eyelids and just below the eyes. Then it appeared on my face and scalp and ears. Eventually it became generalized. My face and scalp were pretty bad. I saw Dermatologist and was prescribed Clobetesol solution for the scalp and Hydrocortizone Valerate for the face and other areas. I was also prescribed Hydroxyzine 25 to 50 mg every 6 hours (which I was already taking for another type of rash I had during most of my treatment).  

After treatment it took a long time for the face and scalp to clear up totally, a few months. It is clear now. However, I still have spots of psoriasis on the rest of my body, not many and not bad, but they are there. I use the Hydrocortizone Valerate on those spots. They come and go and they do appear on my fingers and hands and wrists as well as on my arms, back, and chest. There are a few spots on my legs. However, these spots are minor compared to the spots I previously had.

I have read literature that says that this is common, to develop psoriasis lesions during treatment but that they usually go away after treatment, although it may take time.

I would suggest seeing a dermatologist about the psoriasis and for treatment. He/she may also want to order some autoimmune tests to be done. Mine did. My ANA was positive but the other tests were negative (5 tests). I am now seeing a Rheumatologist and she just run many, many autoimmune tests, just to be sure I have no autoimmune diseases lurking.

If you also have psoriatic arthritis, then I would suggest seeing a Rheumatologist.

Best of luck.
1815939 tn?1377995399
PS: You may have read these articles, but if not, I found them interesting:

http://www.jmedicalcasereports.com/content/1/1/86

http://pmj.bmj.com/content/76/896/365.full

http://www.ncbi.nlm.nih.gov/pubmed/22671985

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0002737

4113881 tn?1415853876
Hello and welcome. I am 35 with genotype 3 as well. I started treatment September 2012 and developed Psoriasis 6 weeks into it on my wrists, hips, naval area, throat, scalp, and under my finger nails. 6 weeks after that came the joint pain in my fingers, wrist, and left knee. I saw a Rheumatologist who diagnosed me with Psoraitic Arthritis.

I finished 28 weeks of treatment on April 7th and was a mess. Psoriasis everywhere and severe joint pain. My Rheumatologist wanted to start me on Humira or Enbril right away....but I waited.

I am now 3 months 3 weeks post treatment. My psoriasis has completely cleared except for 1 of my fingernails but I'm confident it will get better too. The joint pain in my wrists and fingers are gone but Im still dealing with left knee pain. (But it is 75% better than when I was on treatment) Im confident it will eventually get better to. I go to the gym and ride the bike for 20 minutes low impact and its helped.

More importantly, the Hep C genotype 3a is GONE!

My advice is to keep going with your treatment You may or may not develop the joint pain. Dont worry about that now. Worry about clearing the virus. I see your from India. Genotype 3 is prevalent in your country. I dont know how familiar you are with being a Genotype 3 but Id recommend you doing some research so you know. A good place to start is this thread link Im posting below.

http://www.medhelp.org/posts/Hepatitis-C/-Genotype-3-HCV-The-Next-Hurdle-in-Hepatitis-C-Therapy/show/1983049

Many people experience what you are experiencing and it gets better after treatment is over. Hang in there.

Always,

ABN
446474 tn?1446351282
Psoriasis  is a well known side effect of interferon. See treating label below. If you have had psoriasis or other autoimmune conditions previously your doctor should plan for the event of this happening. I was directed to see a dermatologist before starting treatment and they had a plan of treatment based on how servere my psoriasis got during treatment.

Package Insert
PEG-IntronTM (Peginterferon alfa-2b)
Powder for Injection, Schering Corporation

Autoimmune disorders

Development or exacerbation of autoimmune disorders (e.g. thyroiditis, thrombocytopenia, rheumatoid arthritis, interstitial nephritis, systemic lupus erythematosus, psoriasis) have been observed in patients receiving PEG-Intron. PEG-Intron should be used with caution in patients with autoimmune disorders.

Psoriasis typically occurs on areas of skin around joints such as ankles, knees, elbows etc. But can appear anywhere. It usually will reoccur in the same locations to different degree over time.

You must see a dermatologist to get treatment. The sooner the better as psoriasis can get worse over time and is harder to treat. There are new topical creams and ointments that may work for you. Not all treatments work for everyone you must try different ones until you find one that works for you. What the treatment does is slow the time the the lower layers skin take to push up to the surface of the skin. The skin renewing process happens so fast that the skin is not developed enough so it is has that silver scale like appearance and can bleed.

See a dermatologist and they will help you manage the psoriasis so you can continue treatment.

Another option if you have difficulty getting through this treatment is there will be new treatment available in early 2014 for genotype 3 patients without interferon so you this won't be an issue patients will have to worry about. I am not sure why your doctor didn't give you the option especially if he/she know you have autoimmune issues and since you are so young your hepatitis C doesn't need to be treated (the chances of you having advanced liver disease are very low) now with better treatments (less treating duration and less side effects) in the next for years.

Good luck!
Hector
Avatar universal
Good luck Taj82, lets hope you are able to get through this time with current treatment. I hear about these new meds that will be here in 2014 but I guess people are not reading the results for genotype 3. For now SOC has a better chance of curing type 3...... Best to you.
1815939 tn?1377995399
I also hope you can get through this current treatment with Interferon and Ribavirin. This current treatment, Interferon and Ribavirin, which you are on, has a 69% cure rate in people with Genotype 3. That is a much higher rate of cure than the 56% and 62% cure rate with the newer drugs.

Also, even if they were better, which they are not, I am not sure when they will become available in India.

In addition, as you probably know, Genotype 3 is associated with Steatosis and it also progresses faster to Cirrhosis than the other Genotypes. So treating early is probably the prudent thing to do.

From Clinical Care Options:

"A substantial departure from the other HCV genotypes, genotype 3 presents a unique diagnostic and treatment challenge with treatment success rates substantially lower than those of other HCV genotypes. The FUSION trial of sofosbuvir plus ribavirin for 12 or 16 weeks in treatment-experienced patients reported that 94% of HCV genotype 2–infected patients treated for 16 weeks achieved SVR12 vs only 62% of those infected with genotype 3. Similarly, treatment-naive patients in the FISSION trial of sofosbuvir plus ribavirin for 12 weeks experienced SVR12 rates of 97% if they were infected with HCV genotype 2, but only 56% if infected with HCV genotype 3. Currently, EASL treatment guidelines report SVR rates of 69% for genotype 3-infected, treatment naive patients treated for 24 weeks with peginterferon plus ribavirin (Management Guidelines).[EASL 2011]

Steatosis is commonly associated with genotype 3 infection, and may challenge the latest noninvasive hepatic imaging devices rendering their results less reliable for this viral strain making it more difficult to accurately assess fibrosis severity. Intrahepatic fat may be, at least in part, responsible for the persistently low rates of SVR associated with genotype 3. It is unclear whether intrahepatic fat sequestration by the replicating virus reduces access to direct acting anti-viral agents thereby reducing the efficacy of these drugs and further work to examine the mechanisms underlying treatment failure with this genotype is urgently required. "

Full article in this thread (as mentioned also by Acting Brand New):

http://www.medhelp.org/posts/Hepatitis-C/-Genotype-3-HCV-The-Next-Hurdle-in-Hepatitis-C-Therapy/show/1983049
3156104 tn?1357284795
Thanx to all

by and large i got an idea that therapy should not be stopped even if psoriasis worsens bit hope it will not go more bad.....i had a dermatologist consultation today he advised me Colobetesol topical approach let me see whether will it work! i never have psoriasis historical background.........
And yes i completed my 4 doses and i have given blood sample for RVR status...................will update you all after colobetesol usage

Regards    
4113881 tn?1415853876
We look forward to hearing your 4 week lab draw results...hoping for an RVR!

I just wanted to add to what Pooh said about in terms of being a Genotype 3 and its faster progression. Its my opinion from being a Genotype 3 and having read studies about the genotype that if you can tolerate the current SOC you should treat now. As you've read above...the new meds are less efficient for a genotype 3 and if you were to wait and then develop fibrosis, you would become that much harder to treat.(with SOC)

Role of Hepatitis C Virus Genotype 3 in Liver Fibrosis Progression

"The progression of liver fibrosis in chronic hepatitis C has long been considered to be independent from viral genotypes. However, recent studies suggest an association between Hepatitis C virus (HCV) genotype 3 and accelerated liver disease progression. "...................
............."In conclusion, viral genotype 3 was associated with faster fibrosis progression in single-biopsy studies. This observation may have important consequences on the clinical management of genotype 3-infected patients."

http://www.medscape.com/viewarticle/752097

766573 tn?1365170066
Great I hope you do not have to stop treatment.
I also hope you post your four week labs,
Colobetesol topical is a heavy duty med so be sure to follow directions exactly,. I had a little skin thinning from it due to using it a tad longer than I ought.
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