From the Guidelines
Patients with psoriatic arthritis should see a rheumatologist as their primary specialist, who manages the joint inflammation and systemic aspects of the disease, and a dermatologist who addresses the skin manifestations, as recommended by the most recent guidelines 1. The treatment plan for psoriatic arthritis typically follows a stepwise approach, with the primary goal of maximizing health-related quality of life through control of symptoms, prevention of structural damage, normalization of function, and social participation, as stated in the 2023 update of the EULAR recommendations 1. Some key points to consider in the treatment plan include:
- First-line treatments: non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for pain and inflammation
- For persistent disease: conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate
- For insufficient response to DMARDs: biologics like TNF inhibitors, IL-17 inhibitors, or IL-23 inhibitors may be prescribed
- For skin symptoms: topical treatments including corticosteroids, vitamin D analogs, or combination products
- Physical therapy is also important to maintain joint function and muscle strength The choice of treatment should take into account safety considerations regarding individual modes of action to optimize the benefit–risk profile, as recommended by the EULAR guidelines 1. It is essential to consider each musculoskeletal manifestation and non-musculoskeletal manifestations, such as skin, eye, and gastrointestinal tract, as well as comorbidities like obesity, metabolic syndrome, cardiovascular disease, or depression, when managing patients with psoriatic arthritis 1.
From the FDA Drug Label
- 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.
The patient with psoriatic arthritis should see a rheumatologist.
- The treatment plan may include Enbrel (etanercept), which can be used with or without methotrexate.
- The recommended dosage for adult patients with PsA is 50 mg weekly administered by subcutaneous injection 2.
From the Research
Specialists Involved in Psoriatic Arthritis Care
- Rheumatologists: play a crucial role in the management of psoriatic arthritis, particularly in evaluating and treating joint symptoms 3, 4, 5, 6
- Dermatologists: essential in managing skin symptoms and identifying signs of psoriatic arthritis, with a recommended collaboration with rheumatologists for comprehensive care 3, 4, 5, 6
Treatment Plan for Psoriatic Arthritis
- Non-prescription non-steroidal anti-inflammatory drugs (NSAIDs) for initial management of joint symptoms 3
- Disease-modifying antirheumatic drugs (DMARDs) for patients with disabling joint symptoms or no improvement on NSAIDs 3, 7
- Biologic agents, such as anti-TNF inhibitors, may be used in combination with DMARDs for improved disease control 7
- Multidisciplinary care models, involving both rheumatologists and dermatologists, can provide comprehensive and efficient care for patients with psoriatic arthritis 4, 5, 6
Multidisciplinary Care Models
- A shared-care model between rheumatology and dermatology can improve patient outcomes and satisfaction 4, 6
- Collaboration between specialists allows for a more complete understanding of the disease burden and a more comprehensive treatment approach 5
- Interdisciplinary models can enhance cross-specialty partnerships, provide opportunities for education and training, and center care on patient goals and understanding 6