Update on the treatment of peripheral arthritis in psoriatic arthritis

Psoriatic arthritis is a chronic, disabling disease for which therapies have been borrowed from rheumatoid arthritis and spondylitis. Traditional disease-modifying antirheumatic drugs (DMARDs) remain the first choice for the treatment of peripheral arthritis despite scarce evidence of their efficacy or ability to halt radiographic progression. Tumor necrosis factor antagonists have the greatest level of evidence for symptom control and radiographic progression. They are currently used after the failure of DMARDs to effectively treat peripheral arthritis, enthesitis, and dactylitis, and are the first choice when axial disease predominates. Despite the use of these treatments, 30% to 40% of patients will still have active disease. Among new drugs, evidence of efficacy has already been published with regard to anti-IL12/23 monoclonal antibody (ustekimumab) and golimumab. Results are forthcoming from trials with certolizumab pegol, abatacept, and rituximab. As knowledge of the pathogenesis of psoriatic arthritis evolves and differences among other arthritis conditions become evident, therapies targeting these distinct features are needed.