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How early should psoriatic arthritis be treated with a TNF-blocker?
Leonard Harty1, Douglas James Veale
1Dublin Academic Medical Centre, Department of Rheumatology, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.
Current Opinion in Rheumatology
|June 4, 2010
Summary
Early diagnosis and treatment of psoriatic arthritis (PsA) are crucial. Specialist assessment guides therapy, with combination disease-modifying antirheumatic drugs (DMARDs) and biologics potentially achieving high remission rates in PsA patients.
Area of Science:
- Rheumatology
- Immunology
- Dermatology
Background:
- Psoriatic arthritis (PsA) is a common inflammatory arthropathy affecting joints, skin, and potentially other systems like the spine, eyes, and digits.
- Early joint erosions occur in up to 50% of PsA patients within two years, highlighting the disease's potential severity.
- Skin manifestations may precede or accompany joint inflammation in PsA.
Purpose of the Study:
- To review current understanding and treatment approaches for psoriatic arthritis (PsA).
- To emphasize the importance of early intervention and specialist assessment in managing PsA.
- To discuss therapeutic options ranging from mild anti-inflammatories to advanced systemic and biologic therapies.
Main Methods:
- Review of current literature on psoriatic arthritis (PsA) management.
- Analysis of therapeutic efficacy based on disease presentation (mild, widespread, or extra-articular).
- Evaluation of treatment outcomes, including remission rates with combination therapies.
Main Results:
- Mild anti-inflammatories are effective only for very localized PsA.
- Systemic disease-modifying antirheumatic drugs (DMARDs) like methotrexate are indicated for widespread joint involvement.
- Biologic therapy shows high efficacy for extra-articular or spinal disease unresponsive to DMARDs.
Conclusions:
- Treatment decisions for PsA should be made in specialist rheumatology centers after thorough assessment.
- Combination therapy with DMARDs and biologics can achieve remission rates up to 60% in PsA patients.
- PsA is not a benign condition and requires timely, appropriate management to prevent joint damage.
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