Psoriatic arthritis treatment: biological response modifiers
- 1Seattle Rheumatology Associates, Swedish Medical Center Rheumatology Research Division, Clinical Professor, University of Washington School of Medicine, Seattle, WA, USA
- 2Department of Medicine III, Friedrich-Alexander University Erlangen-Nuernberg, Germany
- Correspondence to:
Dr P J Mease
Seattle Rheumatology Associates, 1101 Madison St, 10th floor, Seattle, WA 98104, USA;
In recent years there has been a surge of interest in the treatment of chronic inflammatory disorders as a result of the development and application of targeted biological therapies. The elucidation of the overlapping cellular and cytokine immunopathology of such diverse conditions as rheumatoid arthritis (RA), Crohn’s disease, and psoriasis points to specific targets for bioengineered proteins or small molecules.
Similar to clinical trials in RA, trials in psoriatic arthritis (PsA) have shown excellent clinical results with the tumour necrosis factor (TNF) blockers, etanercept, infliximab, and adalimumab in a variety of domains including the joints, quality of life, function, and slowing of disease progress as evidenced radiologically. In addition, these agents have shown benefit in domains more unique to PsA, such as the skin lesions of psoriasis, enthesitis, and dactylitis, pointing out the similar pathogenesis of the disease in the skin, the tendons, and the synovial membrane. This therapy has been generally safe and well tolerated in clinical trials of PsA.
Other logical candidates for targeted therapy in development include other anti-TNF agents, costimulatory blockade agents that affect T cell function, blockers of other cytokines such as interleukin (IL)-1, 6, 12, 15, or 18, and B cell modulatory medicines. Also, it will be useful to learn more about the effects of combining traditional disease modifying drugs and the newer biologicals.
- ACR, American College of Rheumatology
- DMARD, disease modifying antirheumatic drug
- HAQ, Health Assessment Questionnaire
- MTX, methotrexate
- PsA, psoriatic arthritis
- PsARC, PsA response criteria
- PASI, Psoriasis Area and Severity Index
- RA, rheumatoid arthritis
- TNF, tumour necrosis factor