Denver Arthritis Center offers referred infusion care for new patients | Learn More
Living with plaque psoriasis means dealing with more than just the visible red, scaly patches on your skin. You might feel self-conscious about wearing short sleeves or going to the beach, constantly worry about flaking skin on your clothes or furniture, and experience itching and discomfort that disrupts your sleep and daily activities. The thick, raised plaques covered with silvery scales can crack and bleed, making even simple movements painful.
For many people, psoriasis affects their emotional well-being as much as their physical health, leading to anxiety, depression, and social isolation. While topical creams and ointments work for some patients with mild psoriasis, moderate to severe plaque psoriasis often requires more advanced treatment to control symptoms and prevent the condition from affecting your joints and overall health.
Denver Arthritis Clinic specializes in treating moderate to severe plaque psoriasis with advanced biologic infusion therapies [Infusion Therapy] that target the underlying immune system dysfunction causing your symptoms. Our board-certified rheumatologists and dermatology partners work together to provide comprehensive care that goes beyond treating the visible skin symptoms.
We offer cutting-edge infusion therapies, including Cosentyx and Remicade, at our comfortable outpatient infusion centers in Lowry [Lowry location page] and Lone Tree [Lone Tree location page]. These biologic medications work by targeting specific proteins involved in the inflammatory process, providing significant improvement for many patients who haven't found adequate relief with topical treatments or oral medications.
Don't let plaque psoriasis control your life. Schedule an appointment with Denver Arthritis Clinic to meet with a specialist who can evaluate your psoriasis severity and determine if infusion therapy is right for you.
Plaque psoriasis is a chronic autoimmune condition that causes your skin cells to multiply much faster than normal. Instead of shedding gradually over weeks as healthy skin does, psoriatic skin cells rise to the surface in just a few days, creating thick, red patches covered with silvery-white scales called plaques. These plaques can appear anywhere on your body, but most commonly develop on the elbows, knees, scalp, lower back, and trunk. The condition follows a pattern of flare-ups, when symptoms worsen, and periods of remission, when symptoms improve or disappear. Understanding what causes psoriasis and how biologic therapies work can help you make informed decisions about your treatment.
Plaque psoriasis is caused by an overactive immune system that triggers excessive inflammation and rapid skin cell production. In healthy skin, the immune system sends T-cells to fight infections and heal wounds. In psoriasis, these T-cells mistakenly attack healthy skin cells, triggering an inflammatory cascade. This inflammation causes blood vessels in the skin to dilate (creating redness), stimulates rapid skin cell production (creating thick plaques), and causes the characteristic scaling as cells build up on the surface.
While the exact cause of this immune system dysfunction isn't fully understood, genetics play a significant role. About 40% of people with psoriasis have a family member with the condition, suggesting a hereditary component. However, having the genetic predisposition doesn't guarantee you'll develop psoriasis; environmental triggers often activate the condition in people who are genetically susceptible.
Common triggers that can cause psoriasis to develop or worsen include infections, particularly strep throat which often precedes the first psoriasis outbreak in children and young adults, skin injuries like cuts, scrapes, bug bites, or severe sunburn (a phenomenon called the Koebner response), stress which can trigger flares or make existing symptoms worse, cold and dry weather that can dry out skin and trigger symptoms, smoking and heavy alcohol consumption which increase psoriasis risk and severity, and certain medications including lithium, antimalarials, some blood pressure medications, and NSAIDs.
The severity of plaque psoriasis is determined by how much of your body surface is affected and how significantly it impacts your quality of life. Mild psoriasis affects less than 3% of your body, moderate psoriasis affects 3-10% of your body, and severe psoriasis affects more than 10% of your body or involves sensitive areas like the face, hands, feet, or genitals, regardless of the total area affected.
However, body surface area alone doesn't tell the whole story. Psoriasis affecting the palms, soles, face, scalp, or genital area can be considered severe even if it covers a small area because of the significant impact on daily function and quality of life. Similarly, psoriasis that doesn't respond adequately to topical treatments, causes severe itching or pain, significantly affects your emotional well-being, or is associated with psoriatic arthritis (joint inflammation) may warrant more aggressive treatment.
The appearance of plaque psoriasis can vary, but typical characteristics include well-defined, raised red patches covered with silvery-white scales, dry skin that may crack and bleed, itching, burning, or soreness in the affected areas, thickened or pitted nails, and plaques that may join together to cover large areas. During flares, symptoms intensify, and new plaques may appear. During remission, plaques may fade significantly or disappear completely, though they often return when triggered.
Biologic medications represent a major advancement in psoriasis treatment. Unlike topical treatments that only affect the skin surface or traditional oral medications that broadly suppress the immune system, biologics are engineered proteins that target specific parts of the immune system involved in psoriasis. This targeted approach often provides better results with fewer side effects than older systemic treatments.
Cosentyx (secukinumab) works by blocking interleukin-17A (IL-17A), a protein that plays a key role in the inflammatory process of psoriasis. IL-17A promotes the rapid skin cell growth and inflammation that characterize psoriasis. By blocking this protein, Cosentyx reduces inflammation and slows the excessive skin cell production, leading to clearer skin for many patients. Cosentyx is FDA-approved for moderate to severe plaque psoriasis in adults and children aged 6 and older.
Cosentyx is typically given as an infusion for the initial loading doses, followed by self-injections at home for maintenance therapy. The initial treatment involves infusions at weeks 0, 1, 2, 3, and 4, followed by monthly injections. Many patients see significant improvement within the first few weeks, with continued improvement over the following months. In clinical trials, about 80% of patients achieved at least a 75% reduction in psoriasis severity, and many achieved completely clear or nearly clear skin.
Remicade (infliximab) is another powerful biologic option for moderate to severe plaque psoriasis. It works by blocking tumor necrosis factor-alpha (TNF-alpha), a different inflammatory protein involved in psoriasis. TNF-alpha promotes inflammation throughout the body, so blocking it can improve both skin symptoms and joint symptoms if you have psoriatic arthritis. Remicade is particularly useful for patients with both psoriasis and psoriatic arthritis.
Remicade infusions are given at weeks 0, 2, and 6 for initial treatment, then every 8 weeks for maintenance. Each infusion takes about 2-3 hours. Many patients notice improvement in their skin within the first few infusions, with maximum benefit typically seen by 10-12 weeks. Clinical studies show that about 75-80% of patients achieve significant improvement in their psoriasis with Remicade treatment.
When you receive infusion therapy [Infusion Therapy] at Denver Arthritis Clinic, you'll be treated in our comfortable outpatient infusion center designed specifically for biologic infusions. Before your first infusion, your doctor will review your medical history, perform necessary screening tests (including tuberculosis testing, as biologics can reactivate latent TB), and ensure you're a good candidate for the medication.
On the day of your infusion, you'll be seated in one of our oversized recliners. Our experienced nursing staff will start an IV line and administer any pre-medications needed to reduce the risk of infusion reactions. During the infusion, which takes 1-3 hours depending on the medication, you can relax, use our Wi-Fi, watch television, or simply rest. You'll be monitored throughout the infusion and for a period afterward to ensure you tolerate the treatment well.
Most patients tolerate biologic infusions well. Possible side effects include infusion reactions like mild itching, flushing, or headache during the infusion, increased risk of infections due to immune system suppression, upper respiratory infections like colds or sinus infections, and injection site reactions when you transition to home injections. Serious side effects are uncommon but can include severe infections, reactivation of tuberculosis or hepatitis B, heart failure worsening, or new or worsening neurological problems. Your rheumatologist will monitor you carefully for any complications.
The decision to move to infusion therapy typically depends on the severity of your psoriasis, how well you've responded to other treatments, and how much the condition affects your quality of life. Topical treatments, including steroid creams, vitamin D analogs, and moisturizers, work well for many people with mild psoriasis affecting small areas of the body. If you're controlling your symptoms adequately with these treatments and psoriasis isn't significantly impacting your life, you may not need more aggressive therapy.
However, infusion therapy should be considered if topical treatments don't adequately control your symptoms despite consistent use, psoriasis affects more than 10% of your body surface area, psoriasis affects sensitive areas like your face, hands, feet, or genitals and significantly impacts your daily function, your psoriasis is causing severe physical or emotional distress, you've developed psoriatic arthritis (joint inflammation associated with psoriasis), or you've tried oral medications like methotrexate or acitretin without adequate response or with intolerable side effects.
Your dermatologist or rheumatologist will assess your psoriasis using standard severity scales, review your treatment history, and discuss your goals and concerns. Together, you'll determine whether biologic infusion therapy is appropriate for your situation. Many patients who have struggled with inadequate control of topical treatments experience dramatic improvement with biologics, significantly enhancing their quality of life.
Yes, psoriasis is now recognized as a systemic inflammatory condition that can affect multiple aspects of your health beyond the visible skin symptoms. The most significant complication is psoriatic arthritis, which develops in about 30% of people with psoriasis. Psoriatic arthritis causes painful, swollen joints, stiffness (especially in the morning), and can lead to permanent joint damage if not treated promptly. Some people develop joint symptoms before skin symptoms, while others develop arthritis years after their psoriasis appears.
People with psoriasis also have higher rates of other health conditions related to chronic inflammation. Cardiovascular disease is more common in psoriasis patients, with increased risk of heart attacks, strokes, and high blood pressure. The risk is highest in people with severe psoriasis. Metabolic syndrome, a cluster of conditions including obesity, high blood sugar, high blood pressure, and abnormal cholesterol levels, occurs more frequently in psoriasis patients. Inflammatory bowel disease, depression and anxiety, and liver disease (particularly non-alcoholic fatty liver disease) are also more common.
This is why comprehensive care for psoriasis involves more than just treating skin symptoms. At Denver Arthritis Clinic, we screen for psoriatic arthritis and other complications, work with your other doctors to manage cardiovascular and metabolic risk factors, and address the emotional and psychological impact of living with a chronic condition. Biologic therapies like Cosentyx and Remicade can help prevent or slow the progression of psoriatic arthritis while improving skin symptoms.
Psoriasis is a chronic condition, and biologic therapies control symptoms rather than cure the disease. For most patients, discontinuing treatment leads to the return of symptoms within weeks to months. The timeline varies, but studies show that the majority of patients experience relapse within three to six months of stopping biologics. Because of this, most patients continue biologic therapy long-term to maintain clear or nearly clear skin.
However, some patients may be able to reduce their treatment frequency once they achieve good control. For example, after maintaining clear skin for an extended period, some patients can space out their infusions or injections beyond the standard schedule while still maintaining good control. This approach, sometimes called "treatment optimization," is individualized based on your response and should only be done under close medical supervision.
There are situations where stopping or pausing treatment might be necessary, such as before surgery to reduce infection risk, during serious infections, if you become pregnant (though some biologics may be safe during pregnancy—discuss with your doctor), or if you develop side effects that outweigh the benefits. Your rheumatologist will help you navigate these situations and develop a plan to manage your psoriasis if treatment interruption is necessary.
The decision about long-term treatment should weigh the benefits of maintaining clear skin and preventing joint damage against the inconvenience and cost of ongoing therapy. For many patients, the dramatic improvement in quality of life from biologic treatment makes long-term therapy worthwhile.
Both Cosentyx and Remicade are highly effective biologic therapies for moderate to severe plaque psoriasis, but they work through different mechanisms and have some distinct characteristics. Cosentyx blocks IL-17A, while Remicade blocks TNF-alpha. Both approaches effectively reduce the inflammation driving psoriasis, but they target different parts of the inflammatory cascade.
In terms of effectiveness, clinical studies show similar overall response rates, with 75-80% of patients achieving significant improvement with either medication. Some studies suggest Cosentyx may produce slightly faster clearing of skin lesions, while Remicade has been available longer and has more long-term safety data. Individual response varies, so some patients respond better to one medication than the other.
The administration schedules differ. Cosentyx uses an initial loading phase with weekly infusions for the first month, then transitions to monthly self-injections that you give at home. Remicade is given as infusions every 8 weeks indefinitely, meaning you'll continue coming to the infusion center for ongoing treatment. Some patients prefer the convenience of home injections, while others prefer the monitoring and support of coming to the infusion center.
If you also have psoriatic arthritis, this may influence the choice. Remicade is FDA-approved for psoriatic arthritis and has extensive evidence for treating both skin and joint symptoms. Cosentyx is also approved for psoriatic arthritis and is very effective for joint symptoms. Your medical history matters too; certain conditions may make one medication preferable over the other. For instance, if you have inflammatory bowel disease, Remicade might be preferred as it's also used to treat that condition, while Cosentyx has been associated with worsening IBD in some cases.
Your rheumatologist will consider all these factors (your specific symptoms, other health conditions, lifestyle preferences, and insurance [Insurance] coverage) to recommend the best option for you. If the first biologic you try doesn't work as well as hoped or causes problematic side effects, switching to a different biologic is always an option.