From the Guidelines
Psoriatic arthritis should be treated with a combination of medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologic medications, with the goal of maximizing long-term health-related quality of life and preventing structural damage. The treatment of psoriatic arthritis (PsA) typically involves a combination of medications to manage both skin and joint symptoms. First-line treatments include NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation, as recommended by the European League Against Rheumatism (EULAR) 1. For more severe cases, DMARDs such as methotrexate (starting at 7.5-15mg once weekly) are often prescribed, as suggested by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 1. Biologic medications like tumor necrosis factor (TNF) inhibitors (adalimumab, etanercept, infliximab) or interleukin inhibitors (secukinumab, ustekinumab) may be necessary for patients who don't respond adequately to conventional DMARDs, as recommended by the American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of PsA 1.
Some key points to consider in the treatment of PsA include:
- The primary goal of treatment 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 stated by EULAR 1.
- Treatment should be individualized, taking into account the patient's disease activity, comorbidities, and safety issues, as recommended by GRAPPA 1.
- Regular monitoring is essential to adjust treatment and prevent progressive joint damage, as suggested by the American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of PsA 1.
- Physical therapy is also important to maintain joint function and range of motion, as recommended by EULAR 1.
Overall, the treatment of PsA requires a comprehensive approach, taking into account the patient's overall health and well-being, and aiming to maximize long-term health-related quality of life. The most recent and highest quality study, the GRAPPA treatment recommendations for PsA, provides up-to-date guidance on the optimal treatment of patients with PsA, based on the best scientific evidence 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.
Etanercept (SQ) is indicated for the treatment of psoriatic arthritis (PsA) in adult patients. The medication can be used with or without methotrexate to reduce signs and symptoms, inhibit the progression of structural damage, and improve physical function in patients with PsA 2.
From the Research
Overview of Psoriatic Arthritis
- Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by arthritis and psoriasis, with variable extra-articular manifestations 3.
- The disease can lead to joint erosions, damage, and functional limitation, especially in patients with axial skeleton involvement 3.
Treatment Strategies
- Treatment of PsA typically starts with non-steroidal anti-inflammatory drugs (NSAIDs) and may progress to disease-modifying anti-rheumatic agents (DMARDs) for inflammation suppression 3, 4.
- Commonly used DMARDs include methotrexate, sulfasalazine, leflunomide, and ciclosporin, although their efficacy in inhibiting joint erosions is not well established 3.
- The effectiveness of DMARDs in treating enthesitis and dactylitis is also controversial 3.
Efficacy of Therapies
- Evidence supports the marginal efficacy of sulfasalazine and gold in treating peripheral psoriatic arthropathy, while methotrexate and ciclosporin are effective for skin disease 4.
- Anti-tumour necrosis factor (anti-TNF) agents, such as adalimumab, etanercept, golimumab, and infliximab, have shown efficacy in treating PsA signs and symptoms, as well as reducing radiographic progression 5.
- Newer agents, including ustekinumab, secukinumab, and apremilast, have also been introduced, offering additional treatment options 6, 7.
Management Recommendations
- Expert groups, such as 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 6.
- These recommendations cover pharmacological treatments, including NSAIDs, glucocorticoids, conventional synthetic disease-modifying drugs, and tumour necrosis factor inhibitors, as well as newer agents with other mechanisms of action 6.