Psoriatic arthritis in transition: cytokine signaling, immune dysregulation, and therapeutic innovation

Psoriatic arthritis (PsA) is an immune-mediated, chronic inflammatory condition characterized by a complicated interplay between genetic, immunologic, and environmental determinants. The literature search was conducted using electronic databases including PubMed, Scopus, Web of Science, and Cochrane Library for articles published between 2010 and 2025. Keywords such as "Psoriatic Arthritis," "biologic therapies," "targeted treatments," and "clinical trends" were used with Boolean operators. Presenting in up to 30% of those with psoriasis, PsA involves joint inflammation, enthesitis, dactylitis, and skin and nail lesions and is commonly accompanied by comorbid conditions such as cardiovascular disease, metabolic syndrome, and depression. This review critically reviews the epidemiology, pathophysiology, clinical manifestations, and diagnostic modalities of PsA, including the role of genetic markers (e.g., HLA-B27, IL-23R), innate and adaptive immune dysregulation, and the emerging role of microbiome and epigenetic factors. Diagnostic approaches such as CASPAR criteria, imaging techniques, and novel biomarkers are discussed. The article also indicates current and developing management strategies, including the use of DMARDs, biologics, JAK inhibitors, and non-pharmacological interventions like exercise, diet, and patient education. Early recognition, tailored therapy, and the importance of a multidisciplinary team are stressed to improve patient outcomes and quality of life. Advances in targeted therapies and biomarker research are paving the way for more precise and effective PsA management.