Psoriatic Arthritis: Clinical Pearls

Arthur Kavanaugh, MD

Do you manage patients with psoriatic arthritis (PsA)? Dr Kavanaugh, a Rheumatologist at the University of California San Diego, highlights some important information in the area of PsA….

• There is increasing evidence that early diagnosis and treatment of PsA results in improved outcomes.
• There exists a large gap and unmet need in PsA, with many patients not being evaluated by doctors or receiving appropriate therapy.
• Because skin manifestations usually precede joint involvement, often by years, Dermatologists play a key role in PsA diagnosis. However, this can present challenges.
• New guidelines for PsA treatment are under development, and may provide some assistance to clinicians.
• TNF inhibitors have allowed improved outcomes in PsA, and there continues to be great interest in optimizing therapy with these agents.
• There is great interest in new targets and agents for the treatment of PsA. Recently revealed data with IL-17 inhibition show promise for treatment of all the various domains of PsA, including peripheral arthritis, skin and nail disease, enthesitis and dactylitis, and axial/spinal arthritis.
• The IL-12/23 inhibitor ustekinumab was approved last year in PsA and has been shown to be effective across domains of disease.
• The PDE4 inhibitor apremilast received FDA approval for PsA 3/21/14 and for psoriasis 9/23/14. Its use is increasing in the clinic, for diverse PsA patients. Safety is a particularly attractive feature of this drug.
• Additional agents are in development for PsA.
• Optimal management of PsA depends on the levels of activity and severity across the various domains of disease.