From the Guidelines
Psoriatic arthritis treatment typically involves a combination of medications to manage both joint inflammation and skin symptoms, with the primary goal of maximizing long-term health-related quality of life through control of symptoms, prevention of structural damage, and normalization of function and social participation 1.
Treatment Options
The treatment options for PsA include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to reduce pain and inflammation
- Conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate (starting at 7.5-15mg once weekly) for patients with more severe disease
- Biologics like TNF inhibitors (adalimumab, etanercept, infliximab) or IL-17 inhibitors (secukinumab, ixekizumab) for patients who do not respond to DMARDs
- JAK inhibitors like tofacitinib for patients with predominantly peripheral arthritis
Adjunctive Therapies
In addition to medication, the following adjunctive therapies are recommended:
- Physical therapy to maintain joint mobility and muscle strength
- Weight management to reduce stress on affected joints
- Regular monitoring of disease activity and medication side effects to adjust treatment as needed
Treatment Approach
The treatment approach for PsA should be individualized, taking into account the patient's disease severity, comorbidities, and preferences 1. A treat-to-target approach, aiming for minimal disease activity or remission, is recommended 1. The choice of treatment should be based on the patient's specific needs and circumstances, with consideration of the potential benefits and risks of each treatment option 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.2 Psoriatic Arthritis COSENTYX is indicated for the treatment of active psoriatic arthritis (PsA) in patients 2 years of age and older.
- 3 Psoriatic Arthritis 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.
- Treatment options for Psoriatic Arthritis (PsA):
- Secukinumab (SQ) is indicated for the treatment of active psoriatic arthritis (PsA) in patients 2 years of age and older 2.
- Etanercept (SQ) 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), and can be used with or without methotrexate 3 3.
From the Research
Treatment Options for Psoriatic Arthritis (PsA)
- Non-steroidal anti-inflammatory drugs (NSAIDs) are used as initial treatment for PsA 4, 5, 6, 7
- Disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, sulfasalazine, leflunomide, and ciclosporin are used for the suppression of inflammation in patients with recalcitrant peripheral joint disease 4, 5
- Biologic agents, including tumor necrosis factor (TNF) inhibitors, ustekinumab, secukinumab, and apremilast, are used for patients who have an inadequate response to traditional DMARDs or NSAIDs 7, 8
- Glucocorticoids and antimalarials may also be used in the treatment of PsA 5
Specific Treatment Agents
- Methotrexate is effective for treating skin disease, but evidence for improvement of arthropathy is empirical at best 5
- Sulfasalazine and gold have marginal efficacy in the treatment of peripheral psoriatic arthropathy 5
- Ciclosporin is effective for treating skin disease, but its efficacy in treating arthropathy is not well established 4, 5
- Secukinumab has a higher likelihood of achieving ACR20 response compared to apremilast, ustekinumab, and certolizumab 8
- Older TNF inhibitors (etanercept, infliximab, adalimumab, and golimumab) have a statistically significantly higher chance of achieving ACR20 response compared to apremilast, ustekinumab, and certolizumab 8
Management Recommendations
- The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and the European League against Rheumatism (EULAR) have developed management recommendations for PsA, which include pharmacological treatments such as NSAIDs, glucocorticoids, conventional synthetic DMARDs, and biologic agents 7