What is Psoriatic Arthritis (PsA)?

From the Guidelines

Psio likely refers to Psoriatic Arthritis (PsA), a condition that requires multidisciplinary treatment, and the primary goal of treating patients with PsA is to maximize long-term health-related quality of life, through control of symptoms, prevention of structural damage, normalization of function, and social participation, as recommended by the European League Against Rheumatism 1. Given the potential severity of PsA and its impact on quality of life, it's crucial to approach its management with a comprehensive strategy. The condition may affect up to 42% of patients with psoriasis, although the most common estimates suggest approximately 25% to 30% of patients with psoriasis will develop PsA, usually 5 to 12 years after the onset of their skin disease 1.

Key Considerations for PsA Management

• Treatment should aim at the best care and must be based on a shared decision between the patient and the rheumatologist, emphasizing the importance of patient involvement in the management plan 1.
• Rheumatologists are the specialists who should primarily care for the musculoskeletal manifestations of patients with PsA, with collaboration from dermatologists in cases of significant skin involvement 1.
• The primary goal of treatment is to maximize long-term health-related quality of life, focusing on symptom control, prevention of structural damage, normalization of function, and social participation, with abrogation of inflammation being a key component 1.

Recommendations for Treatment

• Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to relieve musculoskeletal signs and symptoms, as recommended by the European League Against Rheumatism with a level of evidence 1b and grade of recommendation A 1.
• Disease-modifying drugs, such as methotrexate, sulfasalazine, leflunomide, should be considered at an early stage for patients with active disease, particularly those with many swollen joints, structural damage, high ESR/CRP, and/or clinically relevant extra-articular manifestations 1.
• Tumor necrosis factor inhibitors should be commenced in patients with active arthritis and an inadequate response to at least one synthetic disease-modifying antirheumatic drug, such as methotrexate, with a level of evidence 1b and grade of recommendation B 1.

Conclusion on Best Approach

Given the complexity and potential severity of PsA, a multidisciplinary approach that prioritizes patient involvement, aims for maximal health-related quality of life, and considers the use of NSAIDs, disease-modifying drugs, and biologic agents like tumor necrosis factor inhibitors as necessary, is recommended, based on the most recent and highest quality evidence available 1.

From the Research

Psio Treatment Options

• The effectiveness of antipsychotic drugs in treating psychosis has been studied in various research papers 2, 3, 4, 5, 6.
• Studies have compared the effectiveness of different antipsychotic drugs, including olanzapine, quetiapine, risperidone, ziprasidone, and haloperidol, in patients with psychosis 2, 3, 4, 5, 6.
• The results of these studies suggest that quetiapine may be a good starting drug candidate for patients admitted to hospital for symptoms of psychosis 2.
• Olanzapine, risperidone, and aripiprazole have been found to have advantages for the first-line treatment of first episode of psychosis in terms of effectiveness 4.
• The studies also found that olanzapine, quetiapine, and risperidone demonstrated comparable effectiveness in early-psychosis patients, as indicated by similar rates of all-cause treatment discontinuation 5.

Comparison of Antipsychotic Drugs

• A study found that quetiapine was superior to risperidone and olanzapine in reducing the PANSS total score and the positive subscore 2.
• Another study found that olanzapine, risperidone, and quetiapine were as effective as haloperidol and better tolerated in the treatment of psychotic agitation 3.
• A 3-year follow-up study found that treatment discontinuation rates were significantly different among treatment groups, with olanzapine, risperidone, and aripiprazole having lower discontinuation rates than haloperidol and quetiapine 4.
• A 52-week study found that olanzapine, quetiapine, and risperidone had similar rates of all-cause treatment discontinuation in early-psychosis patients 5.
• A 1-year study found that olanzapine might lead to longer treatment continuation in treatment-naive first-episode psychosis patients than haloperidol and ziprasidone 6.

Tolerability and Side Effects

• The studies found that the antipsychotic drugs had different side effect profiles, with olanzapine associated with a higher increase in hip circumference, and risperidone associated with more galactorrhoea 2.
• Quetiapine was found to have a lower risk of extrapyramidal symptoms compared to haloperidol 3.
• The studies also found that olanzapine, quetiapine, and risperidone had similar rates of adverse events, including drowsiness, weight gain, and insomnia 5.