Psoriatic arthritis and COVID-19 pandemic: Consequences in medical treatment?

The COVID-19 pandemic has a strong negative impact on human society worldwide. Patients with immune-mediated disease may be prone to an increased risk of infection and/or more severe course. We review the available data for patients with psoriatic arthritis (PSA) and systemic treatments. Current treatment options are summarized. Based upon the experience with COVID-19, the following problems are addressed: (a) Can systemic treatment reduce comorbidities of PsA that are also comorbidities for COVID-19? Does systemic medical treatment pose an increased risk of infection with SARS-CoV-2? Does systemic drug therapy have an impact on the risk of pulmonary fibrosis-a factor with strong negative impact on COVID-19 outcome? Small molecules, inhibitors of tumor necrosis factor alfa, interleukin, and JAK inhibitors are considered. The data are inhomogeneous for the multiple drugs used in PsA. Although the risk for severe upper airway tract infections during clinical controlled trials was mostly in the range of placebo, these data have been obtained before the COVID-19 pandemic and should be interpreted with caution. Some biologics demonstrated an antifibrotic activity in vitro and in animal disease models. None of the biologics is indicated during an active infection with fever. In nonsymptomatic PsA patients, systemic drug therapy can be continued.