Psoriatic Arthritis and its Novel Therapeutics

Psoriatic arthritis (PsA) is a chronic systemic disease with inflammatory arthritis which occurs in patients who are currently or have been affected by psoriasis. PsA may result in significant functional impairment and reduced quality of life. Evidence now exists documenting the central role of TNF-α in both PsA and psoriasis. Genetic, environmental, and immunologic factors play an interrelated role which provides us with a better insight in disease pathogenesis and options for treatment. Although the cause of PsA is unknown, research has shown the transformations occurring in the skin, synovium, enthesium, and bone in PsA. Both features of this disease similar to, and distinct from, other forms of SpA were revealed. Psoriatic arthritis develops into a disorder of peripheral joints, spine and entheses associated with psoriasis. Over the past two decades it has become clear that PsA is more aggressive than previously thought. About 20% of the patients develop a destructive form of arthritis. The presence of radiologic changes early in the course of psoriatic arthritis suggests an aggressive form of disease. The treatment of psoriatic arthritis is directed at controlling the inflammatory process and preventing damage to joints. Treatment of PsA should be individualized, balancing risk associated with active disease and likelihood of progression in peripheral joints, spine, enthesis, skin and the impact on physical function and quality of life (QoL). There is now great interest for clinicians with regard to PsA with the novel treatments and therapeutic strategies. Based on greater understanding of immunology and on the pathogenesis of the disease along with progress in biopharmaceutical development, a completely new concept of the treatment of PsA has emerged. Much data focus on anti-TNF-alpha. Results of 3 Phase III randomized controlled trials with infliximab, etanercept, and adalimumab have been published. All three agents and more recently a fully humanized antibody against TNFα – Golimumab - were approved for use in PsA by the United States Food and Drug Administration (FDA). The introduction of biologic therapies has changed the management of psoriatic arthritis and more and more trials are done to find better and safer treatments. Keywords: Psoriatic arthritis, TNT-alpha, biologics, etanercept, infliximab, adalimumab