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14-04-2018 | Psoriatic arthritis | Article

Treatment of Enthesitis, Dactylitis and Nail Lesions in Psoriatic Arthritis

Journal:
Current Treatment Options in Rheumatology

Authors: MBBS, H, DipInt, Med, FCP Ajesh B. Maharaj, MBChB (Natal), FCP (SA), PhD F. Paruk

Publisher: Springer International Publishing

Abstract

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with the skin disease, psoriasis. It is a highly heterogeneous disorder, not only in the musculoskeletal phenotype but also in its cutaneous manifestations. Enthesitis, dactylitis, and nail changes are the hallmark of the disease, and experts in the field believe that the initiating process of PsA is a deep Koebner phenomenon which triggers enthesitis and the subsequent disease process and progression. We aim to discuss the most recent advances in the treatment of enthesitis, dactylitis, and nail changes in psoriatic arthritis.
Various treatment regimens have been used to control the above manifestations of PsA, including conventional synthetic disease-modifying agents (csDMARDs), biologic disease-modifying agents (bDMARDs), and newer therapies which include interleukin (IL)-12/23 antagonist (ustekinumab), IL-17 antagonists (secukinumab and ixekizumab), as well as small molecules including the Janus kinase (JAK) inhibitors and phosphodiesterase-4 inhibitor (apremilast). The csDMARDs include methotrexate, sulphasalazine, leflunomide, as well as cyclosporine.
These modalities of treatment are further discussed in this review. Rapid escalation of therapy in patients who have an inadequate response to conventional therapy results in better outcomes. Future research includes specific antibodies against the p19 subunit of IL-23.

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