Novel Treatment Concepts in Psoriatic Arthritis

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Key points

  • Early diagnosis and implementation of highly effective therapies provides the possibility of achieving better outcome in PsA.

  • Tight control with frequent adjustments to medications and a treat-to-target approach to maintain low disease activity has shown clinical benefit.

  • 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.

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.

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  • Disclosure Statement: The authors have nothing to disclose.

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