From the Guidelines
Psoriatic arthritis (PsA) should be treated with a combination approach, starting with nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs), and progressing to biologic agents if necessary, as recommended by the 2018 American College of Rheumatology/National Psoriasis Foundation guideline 1. The diagnosis of PsA involves a comprehensive evaluation of the patient's medical history, physical examination, and laboratory tests, including rheumatoid factor and imaging studies.
Key Considerations
- The treatment of PsA should be individualized, taking into account the patient's disease severity, comorbidities, and personal preferences.
- The goal of treatment is to achieve minimal disease activity or remission, and to improve the patient's quality of life.
- Regular monitoring of disease activity and medication side effects is crucial to adjust treatment as needed.
Treatment Options
- First-line medications: NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation.
- DMARDs: methotrexate (starting at 7.5-15mg once weekly) for more severe cases.
- Biologic agents: TNF inhibitors (adalimumab, etanercept) or IL-17 inhibitors (secukinumab) for patients who don't respond adequately to DMARDs.
Non-Pharmacologic Interventions
- Physical therapy to maintain joint function and range of motion.
- Regular exercise, weight management, and avoiding smoking to help manage symptoms.
Disease Management
- Early diagnosis and treatment are crucial to prevent joint damage and disability.
- Patients should be monitored regularly for disease activity and medication side effects, with treatment adjusted as needed based on response, as recommended by the European League Against Rheumatism 1.
From the FDA Drug Label
Enbrel is indicated for reducing signs and symptoms, inhibiting the progression of structural damage of active arthritis, and improving physical function in adult patients with psoriatic arthritis (PsA). Enbrel can be used with or without methotrexate. Enbrel is a prescription medicine called a Tumor Necrosis Factor (TNF) blocker. Enbrel is used to treat: ... psoriatic arthritis (PsA) in adults. Enbrel can be used alone or with methotrexate.
The diagnosis of Psoriatic Arthritis (PsA) is not explicitly stated in the provided drug labels. The treatment for PsA is Enbrel, which can be used with or without methotrexate to reduce signs and symptoms, inhibit the progression of structural damage, and improve physical function in adult patients with PsA 2.
From the Research
Diagnosis of Psoriatic Arthritis (PsA)
- PsA is a chronic inflammatory disease characterized by arthritis and psoriasis, with variable extra-articular manifestations 3
- The disease can involve the axial skeleton, leading to functional limitation and deformity in about 20-40% of patients 3
Treatment of PsA
- Initial treatment often involves non-steroidal anti-inflammatory drugs (NSAIDs) for symptom relief 4, 5
- Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, leflunomide, and ciclosporin may be used for patients with recalcitrant peripheral joint disease 3, 6
- Tumor necrosis factor alpha (TNF-alpha) antagonists, such as etanercept, infliximab, and adalimumab, represent a major advance in the treatment of PsA 4, 5, 7
- Biological therapies, including targeted therapies and anti-cytokine therapies, are suitable options for patients with extensive disease 7
- Treatment should be individualized based on the degree and type of joint pain and inflammation, as well as the presence of extra-articular manifestations 4
Treatment Options for Specific Manifestations of PsA
- Peripheral joint disease: NSAIDs, DMARDs, and TNF-alpha antagonists may be effective 3, 4, 5
- Axial skeleton involvement: treatment options are limited, but TNF-alpha antagonists may be effective 3
- Enthesitis and dactylitis: the effectiveness of DMARDs and TNF-alpha antagonists is controversial 3
- Skin and nail involvement: topical agents, phototherapy, and systemic therapies such as methotrexate may be effective 7