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  • Review Article
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Advances in the management of psoriatic arthritis

Nature Reviews Rheumatology volume 10, pages 531–542 (2014)Cite this article

Subjects

Key Points

  • The management of psoriatic arthritis (PsA) is advancing, owing to progress in treatment strategies and outcome assessment

  • Early referral, diagnosis and initiation of treatment for PsA are crucial for the optimization of management strategies

  • As for treatment of rheumatoid arthritis, PsA should be treated-to-the-target of remission or to the alternative target of low disease activity

  • Validated tools to measure the cutaneous and musculoskeletal manifestations of psoriatic disease now exist, and EULAR and GRAPPA recommend useful therapeutic algorithms to account for the main clinical presentation of the disease

  • The five approved TNF inhibitors are effective at reducing the signs and symptoms of PsA, and can slow the progression of joint damage

  • The IL-12 and IL-23 inhibitor ustekinumab, which has been licensed, offers an alternative treatment option for patients with PsA

Abstract

Psoriatic arthritis (PsA), which affects musculoskeletal structures, skin and nails, is a heterogeneous chronic inflammatory disease with a wide clinical spectrum and variable course. Patients with PsA are more likely than healthy individuals to have metabolic syndrome or cardiovascular disease. To include these comorbidities, 'psoriatic disease' has been suggested as an umbrella term. The management of PsA has changed tremendously over the past decade owing to early diagnosis and improvement in treatment strategies, including, early referral from dermatologists and primary-care physicians to rheumatologists, early initiation of therapy, treating to the target of remission or low disease activity, and advances in pharmacological therapy. Outcome assessment is also improving, because of validated instruments for clinical disease manifestations. The commercialization of TNF blockers, including adalimumab, etanercept, golimumab and infliximab, is representative of a revolution in the treatment of PsA. A new anti-TNF agent, certolizumab pegol, and a fully human monoclonal antibody against IL-12 and IL-23, ustekinumab, are approved for the treatment of active PsA. The efficacy of ustekinumab suggests that inhibiting the type 17 T helper pathway might be an alternative to blocking TNF. PsA management must now use improved measures to predict patient outcomes and define remission, and develop better-targeted therapies.

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Figure 1: PsA manifestations and corresponding treatment.
Figure 2: Advances in PsA management.
Figure 3: EULAR recommendations for the management of PsA.

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Authors and Affiliations

  1. Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Via Potito Petrone Snc, Potenza, 85100, Italy

    Ignazio Olivieri, Salvatore D'Angelo & Angela Padula

  2. Rheumatology Department of Lucania, Madonna delle Grazie Hospital of Matera, Contrada Cattedra Ambulante Snc, Matera, 75100, Italy

    Carlo Palazzi

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  1. Ignazio Olivieri
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  2. Salvatore D'Angelo
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  3. Carlo Palazzi
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  4. Angela Padula
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All authors researched data for the article, substantially contributed to discussion of the content, and wrote, reviewed and edited the manuscript.

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Correspondence to Ignazio Olivieri.

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All authors declare that they have received honoraria from Abbvie, Bristol–Myers Squibb, MSD, Pfizer, Roche, and UCB to attend scientific meetings. The authors have received no payment in preparation of this manuscript.

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Olivieri, I., D'Angelo, S., Palazzi, C. et al. Advances in the management of psoriatic arthritis. Nat Rev Rheumatol 10, 531–542 (2014). https://doi.org/10.1038/nrrheum.2014.106

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