Disease Modification in Psoriatic Arthritis
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Purpose of review
To provide clinicians evidence-based strategies to diagnose and treat psoriatic arthritis (PsA) patients based on involvement of the key domains peripheral arthritis, psoriasis and nails, axial involvement, dactylitis, and enthesitis, with the goal of improving outcomes for PsA patients by lessening joint pain and swelling and the degree of inflammation in the other key domains. It is also imperative to limit or eliminate progressive X-ray damage.
Evidence from phase III randomized trials demonstrate that agents that inhibit tumor necrosis factor (TNF), interleukin (IL)-17, and IL12/23 relieve joint inflammation and decrease or completely inhibit radiographic progression. Agents that block TNF and IL-17 are also effective for axial disease. Additional agents effective for psoriatic arthritis but without documentation of effect on progressive damage include apremilast, abatacept, and tofacitinib. Most agents have demonstrated efficacy for treatment of enthesitis and dactylitis.
A number of therapies that effectively treat the key domains of psoriatic arthritis are now available. Comprehensive assessment of patients to determine the extent and degree of domain involvement is essential to properly individualize treatment, improve outcomes, and limit progressive joint damage.
KeywordsPsoriatic arthritis Domains Disease modification Biologic agents
Compliance with ethical standards
Conflict of interest
Dr. Ritchlin reports grants and personal fees from Abbvie, grants and personal fees from Amgen, grants and personal fees from UCB, personal fees from Novartis, personal fees from Pfizer, personal fees from Lilly, and personal fees from Janssen, during the conduct of the study. Dr. Lieberman declares no conflict of interest.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest have been highlighted as: • Of importance •• Of major importance
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