Light Therapy Benefits for Arthritis and Psoriasis

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Psoriatic arthritis (http://www.everydayhealth.com/psoriatic-arthritis/psoriatic-arthritis-information.aspx) often takes a multi-therapy approach to treat. One component may be light therapy, or phototherapy, which offers an effective and low-risk option for treating mild to moderate psoriasis.
Psoriasis (http://www.everydayhealth.com/skin-health/psoriasis/understanding/index.aspx) is particularly responsive to a narrow frequency of ultraviolet light, and this so-called “narrow band” light therapy has gradually supplanted older broadband treatment options for psoriasis.

Although phototherapy is not approved by the U. S. Food and Drug Administration for the treatment of psoriatic arthritis (http://www.everydayhealth.com/psoriatic-arthritis/psoriatic-arthritis-treatment.aspx), limited evidence suggests that joints affected by the disease will respond to treatment targeted to the skin: “You do get a systemic modulation of the immune system. It’s interesting that when you treat the skin, the joints respond,” says Jami Miller, MD, assistant professor at Vanderbilt University in Nashville, Tenn., and supervisor of the Vanderbilt Phototherapy Center.

Just how much the joints respond varies, and it’s important to understand that your medical team (http://www.everydayhealth.com/psoriatic-arthritis/psoriat...) may suggest other treatment for your psoriatic arthritis. “The arthritis needs drugs to control because it can be a very destructive type of arthritis if it’s not treated aggressively,” says Yusuf Yazici, MD, a rheumatologist at the New York University Hospital for Joint Diseases in New York City.

Types of UV Light Treatment for Psoriasis

Your doctor may suggest one or more of the following UV phototherapy or combination therapy approaches:

Ultraviolet A (UVA). One of the most common options is short bursts of UVA, typically starting at 30 seconds in length and building in duration as a patient adapts to the exposure. A conventional treatment schedule calls for three sessions per week for 4 to 50 sessions, until the psoriasis has cleared. “We typically go for 20 sessions at first,” says Dr. Miller. “If we don’t see anything at all after 20 sessions, we rethink the treatment.”
Ultraviolet B (UVB) with alefacept. Recently, researchers have had success in teaming UVB with the drug Amevive (alefacept), a biologic agent that appears to have fewer side effects than other systemic anti-psoriatic agents.
PUVA (psoralen and UVA). For advanced cases of psoriasis, a physician might suggest augmenting UVA treatment with an oral medication called psoralen. Taken shortly before light treatment, psoralen seems to boost the therapeutic effect of light on the immune system. “PUVA is spectacularly effective,” says Miller. Because PUVA can be so powerful, the treatment is rarely used in children.

Cautions About UV Light Therapy

There are many factors to consider if you're thinking of undergoing light therapy:

Darker complexions may not respond as well. While phototherapy for psoriasis can be used regardless of your complexion type, light-skinned people typically respond to treatment more quickly than those with darker skin, Miller says.
Scheduling can be difficult. The scheduling of phototherapy proves daunting to many prospective patients, Miller says. The biggest deterrent is the hassle of traveling to a treatment site several times a week for a regimen that can extend for months. Another complication is that patients who augment UVA treatment with psoralen must wear protective sunglasses when outdoors for 24 hours afterward to protect their eyes against natutally occurring UVA in sunlight.
Light therapy is not as widely available as it used to be. Psoriasis phototherapy is generally less available than it was 10 or 20 years ago, because there are more treatments for psoriasis now and insurance coverage for phototherapy has become less available, Miller says. And it can be expensive: The cost of a single phototherapy session can reach $100, particularly if the treatment is provided in combination with psoralen or another systemic drug.
PUVA carries some cancer risk. UVB is very low-energy, and long-term use does not seem to increase a person’s risk of skin cancer. But long-term use of PUVA does appear to increase the risk of both basal and squamous cell carcinoma. “The break seems to be at 250 sessions in a lifetime, so we do try to limit it,” Miller says.

Insurance Issues With Light Therapy

Recently, a National Psoriasis Foundation (NPF) report (http://www.psoriasis.org/reducecopays/) shed some light on problems patients were having in getting insurance coverage for light therapy. Lack of insurance coverage, or cost, was one of the top three reasons patients discontinued phototherapy, according to about 90 percent of the 200 physicians responding to the NPF survey.

That’s not surprising given the typical pattern of phototherapy insurance coverage, says Sheila Rittenburg, senior director of advocacy and external affairs for the NPF. Insured patients usually are asked for a co-pay of $30 to $50 per phototherapy session, and a course of therapy usually involves three sessions a week for up to 30 weeks. Maintenance phototherapy after that may entail one visit per week.

Because of the costs and the time commitment involved, undertaking light therapy is a decision that requires a lot of thought. To help you determine whether this therapy makes sense for you, talk over the possible advantages with your medical team.

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