What are the treatment options for Psoriatic Arthritis (PsA)?

From the Guidelines

Psoriatic arthritis treatment should prioritize a treat-to-target strategy, using a combination of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologics, including TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors, to achieve remission or low disease activity and improve quality of life. When considering treatment options, the most recent and highest quality study, 1, provides conditional recommendations based on low-quality evidence, suggesting that a treat-to-target strategy is preferred over not following a treat-to-target strategy. The treatment approach should be individualized based on disease severity, affected joints, skin involvement, and comorbidities, with regular monitoring for medication side effects and disease progression. Some key considerations include:

• Using NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), as first-line treatment to reduce pain and inflammation
• Adding DMARDs, such as methotrexate (starting at 7.5-15mg once weekly), for patients with persistent symptoms
• Considering biologics, including TNF inhibitors (adalimumab, etanercept, infliximab), IL-17 inhibitors (secukinumab, ixekizumab), or IL-23 inhibitors (ustekinumab, guselkumab), for more severe cases or when DMARDs are ineffective
• Incorporating physical therapy to maintain joint function and range of motion
• Regularly assessing treatment effectiveness and adjusting the treatment plan as needed to achieve remission or low disease activity, preventing joint damage and disability while improving quality of life, as supported by 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.

Table 1 Recommended Dosage for Adult Patients with RA, AS, PsA and PsO Patient PopulationRecommended Dosage Adult RA, AS, and PsA50 mg weekly

Psoriatic Arthritis Treatment: Etanercept (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). The recommended dosage for adult patients with PsA is 50 mg weekly. Enbrel can be used with or without methotrexate 2.

From the Research

Psoriatic Arthritis Treatment Options

• Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for symptomatic relief 3, 4, 5, 6
• Conventional synthetic disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate, leflunomide, and sulfasalazine are used to control the disease process 3, 4, 5, 6
• Biologic and targeted DMARDs, including anti-tumor necrosis factor (TNFα), anti-interleukin-17 (IL-17), anti-IL-12/23, and anti-IL-23 agents, as well as Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) antagonists, are also used to treat psoriatic arthritis 3, 6, 7
• Non-medicinal interventions such as education, lifestyle changes, physiotherapy, and occupational therapy are also important in the management of psoriatic arthritis 3

Treatment Strategies

• The treatment of psoriatic arthritis typically involves a combination of NSAIDs, DMARDs, and biologic agents 4, 5, 6
• The choice of treatment depends on the severity of the disease, the presence of comorbidities, and the patient's clinical profile 3, 7
• Biomarkers predictive of response to therapy are needed to allow for a more personalized approach to treatment 3

Evidence for Treatment Efficacy

• There is evidence to support the efficacy of NSAIDs, synthetic DMARDs, and biologic agents in the treatment of psoriatic arthritis 4, 5, 6
• Anti-TNF agents have been shown to be effective in reducing the signs and symptoms of psoriatic arthritis and slowing radiographic progression 6
• Newer agents such as ustekinumab, secukinumab, and apremilast have also been shown to be effective in the treatment of psoriatic arthritis 7