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Early diagnosis and implementation of highly effective therapies provides the possibility of achieving better outcome in PsA.
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Tight control with frequent adjustments to medications and a treat-to-target approach to maintain low disease activity has shown clinical benefit.
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Refractory patients pose a challenge, but strategies to overcome treatment failure exist (eg, switching TNF inhibitors or implementing alternative therapies). Evidence for these strategies is accumulating in clinical trials.
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Novel Treatment Concepts in Psoriatic Arthritis
Section snippets
Key points
Early intervention
The importance of early intervention and initiation of therapy in PsA has become increasingly recognized (discussed elsewhere in this issue). This insight resulted mainly from the growing recognition that PsA is a more severe disease than previously thought, and the introduction of medications capable of altering the disease course in PsA. This section discusses early detection and diagnosis, early treatment, and highly effective therapy.
Disease-specific considerations
Once likened to a mild form of seronegative RA, PsA is now recognized as a distinct clinical entity with unique features. One of the most striking differences is the significant heterogeneity that occurs in PsA. In addition to affecting multiple clinical domains, several associated extra-articular manifestations and comorbidities must also be taken into account when selecting therapy (Fig. 3). The term “psoriatic disease” was coined to encompass the diverse clinical spectrum, which occurs in
Modifications to the treatment paradigm
Newer and more effective therapies have changed the landscape for treating PsA. Once thought unattainable, remission and low disease activity are now considered realistic goals of therapy. This section discusses targeted therapy, treatment options in refractory disease, and treatment options in controlled disease.
Summary
Therapeutic options for patients with PsA have increased substantially over the last decade. Nevertheless, the high variability and potential severity of clinical manifestations and comorbidities along with the combination of domain involvement in a single patient confronts the clinician with a range of challenges. Further studies are needed to provide evidence that the aforementioned strategies are effective, not only in peripheral arthritis and skin disease, but also in other domains of PsA.
References (67)
- et al.
Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicenter, double-blind, placebo-controlled PSUMMIT 1 trial
Lancet
(2013) - et al.
Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomized controlled trial
Lancet
(2004) - et al.
Can we reduce the dosage of biologics in spondyloarthritis?
Autoimmun Rev
(2013) - et al.
Psoriatic arthritis: current therapy and future approaches
Rheumatology (Oxford)
(2015) - et al.
Psoriatic arthritis: epidemiology, clinical features, course, and outcome
Ann Rheum Dis
(2005) - et al.
The diagnosis and treatment of early psoriatic arthritis
Nat Rev Rheumatol
(2009) - et al.
Dermatology screening tools: project update from the GRAPPA 2012 annual meeting
J Rheumatol
(2013) - et al.
The early psoriatic arthritis screening questionnaire: a simple and fast method for the identification of arthritis in patients with psoriasis
Rheumatology
(2012) - et al.
Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study)
Br J Dermatol
(2013) - et al.
High prevalence of psoriatic arthritis patients with severe psoriasis with suboptimal performance of screening questionnaires
Ann Rheum Dis
(2013)
Development and testing of new candidate psoriatic arthritis screening questionnaires combining optimal questions from existing tools
Arthritis Care Res
Classification criteria for psoriatic arthritis: development of new criteria from a larger international study
Arthritis Rheum
Sensitivity of the classification of psoriatic arthritis criteria in early psoriatic arthritis
Arthritis Rheum
Sensitivity and specificity of the classification criteria of psoriatic arthritis criteria in early psoriatic arthritis
Arthritis Rheum
CASPAR criteria are sensitive in early psoriatic arthritis (PsA) and are accurate when applied to patients attending a family practice clinic
Ann Rheum Dis
Anti-citrullinated peptide antibodies may occur in patients with psoriatic arthritis
Ann Rheum Dis
Anti-CCP antibodies in rheumatoid arthritis and psoriatic arthritis
Clin Rheumatol
Defining remission in psoriatic arthritis
Clin Exp Rheumatol
Can we identify psoriatic arthritis early?
Curr Rheumatol Rep
Progression of peripheral joint disease in psoriatic arthritis
Rheumatology (Oxford)
Longitudinal study of clinical and radiological progression in psoriatic arthritis
J Rheumatol
Comparison of disability and quality of life in rheumatoid and psoriatic arthritis
Rheumatology (Oxford)
A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience
Rheumatology
Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis
Ann Rheum Dis
Treating to target in psoriatic arthritis
Curr Opin Rheumatol
Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis
Rheumatology
Advances in the management of psoriatic arthritis
Nat Rev Rheumatol
Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease?
Ann Rheum Dis
Management of psoriatic arthritis: the therapeutic interface between rheumatology and dermatology
Curr Rheumatol Rep
Anti-tumor necrosis factor (TNF) drugs for the treatment of psoriatic arthritis: an indirect comparison meta-analysis
Biologics
Treatment recommendations for psoriatic arthritis
Ann Rheum Dis
European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacologic therapies
Ann Rheum Dis
Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor
Ann Rheum Dis
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Correlation of serum protein biomarkers with disease activity in psoriatic arthritis
2020, Expert Review of Clinical ImmunologyDiagnosis and classification criteria in psoriatic arthritis
2019, Revista Argentina de ReumatologiaDisease activity states of the DAPSA, a psoriatic arthritis specific instrument, are valid against functional status and structural progression
2017, Annals of the Rheumatic Diseases
Disclosure Statement: The authors have nothing to disclose.