A dermatologist perspective in the pharmacological treatment of patients with psoriasis and psoriatic arthritis

ABSTRACT

Introduction

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis in 20-30% of patients. PsA presents as a heterogeneous disease involving different domains and burdened by an important impact on function and quality of life.

Areas covered

Dermatologists play an important role in the early detection of PsA because in most patients PsA develop after cutaneous psoriasis. The ideal goal of treating patients with PsA is to optimize the controls of symptoms, improve quality of life, and prevent structural damage and disability. The choice of treatment in patients with PsA should take into account also the skin signs and symptoms. Treatment options include NSAIDs, synthetic DMARDSs, anti-TNF-α agents, anti-IL-12/IL-23 agents, anti-IL-17 agents, PDE4 inhibitors, JAK inhibitors, and co-stimulatory blockers. A narrative review based on electronic searches on PubMed® database was performed. Original articles assessing either the role of the dermatologist in the management of PsA and the available treatments for PsA were included.

Expert opinion

Among different treatments, some drugs show more efficacy in joint signs and symptoms, and poor response on the skin and vice versa. The perspective of the dermatologist in a multidisciplinary setting may provide a helpful tool in the management of patients with PsA.

KEYWORDS:

• Psoriatic arthritis
• psoriasis
• pharmacological treatment
• biologics
• small molecules

Article highlights

• Dermatologists play an important role in different phases of PsA management.

• The integrated dermatologic and rheumatologic management of PsA patients allows a prompt establishment of the diagnosis and the best therapeutic and follow-up approach with a consistent amelioration of quality of life.

• The domain of the disease with the highest level of activity drives the treatment choices.

• Treatment choices are moving from conventional systemic treatments to biological agents and cases in which DMARDs may be preferred over biological agents nowadays are limited.

• Still open aspects are whether the early intervention with systemic treatments in patients with PsO could prevent the development of PsA and the possible effects of biologics on comorbidities such as cardiovascular diseases and metabolic disorders.

Declaration of interest

P. Gisondi has received consultation fees from AbbVie, Abiogen, Bayer, Celgene, Eli-Lilly, Janssen, Leo Pharma, Merck, MSD, Novartis, Otsuka, Pfizer, Pierre Fabre. G. Girolomoni has received consultation fees from AbbVie, Abiogen, Allmirall, Amgen, Biogen, Boehringer Ingelheim, Celgene, Eli-Lilly, Leo Pharma, Merck, Novartis, Pfizer, Pierre Fabre, Regeneron, Sandoz, Sanofi, and Sun Pharma. 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.

Additional information

Funding

This paper was not funded.