Managing psoriatic arthritis in different clinical scenarios

ABSTRACT

Introduction

Psoriatic arthritis (PsA) is a chronic, immune-mediated disease characterized by synovio-entheseal inflammation. It is estimated to affect around 30% of patients with psoriasis and significantly reduces patients’ physical function and quality of life. There is a growing number of treatment options for PsA, but due to the heterogeneous clinical features of the disease and prevalence of comorbidities, managing PsA can be challenging.

Areas covered

In this article, we review current understanding of the disease and available pharmacological options. Based on published treatment guidelines, emerging evidence and clinical experience, we provide our expert opinion on treatment strategies, taking into consideration the predominant disease domain and the presence of comorbidities, which can impact treatment decisions and clinical outcomes.

Expert opinion

Biological and targeted synthetic disease-modifying agents are dramatically improving the lives of patients with PsA. Biosimilar TNF inhibitors offer a particularly versatile and cost-effective option, whilst newer biologics and targeted synthetic molecules that can be used to treat most domains of psoriatic disease are an attractive alternative to TNF inhibitors. Despite a lack of consensus on treatment sequencing and tapering, it is important that PsA patients, especially those with comorbidities, are looked after by a multidisciplinary team to optimize their care.

KEYWORDS:

• Arthritis
• biological therapy
• biosimilar
• comorbidity
• DMARD
• inflammation
• psoriasis
• remission

Article highlights

• The number of therapeutic options for PsA has increased dramatically in the past decade but due to the heterogeneity of the disease and prevalence of comorbidities, the selection and sequence of treatment is often unclear.

• Focusing on the latest RCTs, observational studies and the authors’ experience of treating a diverse range of PsA patients in clinical practice, this article provides the perspective of a group of experts on how to manage the disease taking predominant disease domains and comorbidities into account.

• PsA is usually treated with csDMARDs in combination with TNF inhibitors. The approval of new biologic DMARDs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) that inhibit other key molecules involved in the development of PsA provide an opportunity to improve patient outcomes by tailoring treatment according to predominant disease domain and/or comorbidities.

• Further understanding PsA pathogenesis and establishing validated biomarkers for diagnosis, response to treatment and remission, as well as adequately controlling common comorbidities, will help to further improve the care of patients with PsA.

Declaration of interest

R Queiro has received honoraria as part of advisory committees, researcher, lecturer, trainer, and project manager from Abbvie, Amgen, Galapagos, Ely-Lilly, Janssen, MSD, Novartis, Pfizer, UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

R Queiro is responsible for the conceptualization and design of the review, critically reviewing and revising all drafts of the review, and approving the final version of the manuscript. M Loredo, I Braña, E Pardo, S Alonso and M Alperi, critically reviewed and revised all drafts of the manuscript and approved the final version.

Acknowledgments

We would like to thank Monica Hoyos Flight of Springer Healthcare Communications who wrote the outline and first draft of the manuscript.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Additional information

Funding

The medical writing assistance was funded by UCB. The authors received no honoraria related to the development of this publication.