The treatment options for psoriatic arthritis (PsA) encompass a range of pharmacological therapies, including non-steroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biologic DMARDs (bDMARDs), and targeted synthetic DMARDs (tsDMARDs). The choice of treatment is guided by the patient's specific disease manifestations, comorbidities, and treatment response.
NSAIDs
- NSAIDs are recommended as first-line pharmacotherapy for relieving musculoskeletal signs and symptoms in patients with PsA
- They are particularly useful in patients experiencing pain and stiffness, and treatment can be continued if symptoms are well-controlled
Conventional DMARDs
- Methotrexate is recommended for patients with peripheral arthritis but not for axial involvement
- Sulfasalazine is considered for patients with peripheral arthritis
- Conventional synthetic DMARDs are not recommended for patients with purely axial disease
Biologic DMARDs
- For patients with predominantly axial disease, TNF inhibitors, IL-17 inhibitors, or JAK inhibitors are recommended if disease activity remains high despite conventional treatments
- In case of failure of anti-TNF therapy due to inefficacy or adverse events, an alternative anti-TNF agent may be considered
- For patients with peripheral arthritis, TNF inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, IL-23 inhibitors, or CTLA-4 immunoglobulin are recommended
- In patients with mild disease and an inadequate response to at least one conventional synthetic DMARD, a PDE4 inhibitor may be considered
Targeted synthetic DMARDs
- JAK inhibitors or PDE4 inhibitors are recommended for patients with active psoriatic enthesitis or dactylitis with inadequate response or intolerance to conventional synthetic DMARDs
Goals of treatment
- The treatment aims to achieve remission or low disease activity by regular disease activity assessment and appropriate adjustment of therapy
- Treatment should be individualized according to the current signs and symptoms of the disease and the patient's characteristics, including comorbidities and psychosocial factors
Assessment of treatment response
- The initial efficacy response should be assessed following 3–6 months of anti-TNF therapy and reassessed every 6 months thereafter
In conclusion, the treatment of PsA is multifaceted and should be tailored to the individual patient's disease manifestations and response to therapy. Regular assessment of disease activity and treatment response is crucial to achieving optimal outcomes.