Advances in the management of psoriatic arthritis

An article in Current Opinion in Rheumatology focuses on recent advances (since January 2002) in the management of psoriatic arthritis (PA). The review identifies a range of recently approved treatments or those pending approval, which it considers safe and effective in improving patients quality of life and preventing long-term disease progression.Dr Philip Mease, from Seattle Rheumatology Associates, describes PA as a chronic spondyloarthropathy, with a reported occurrence, based on most recent estimates, "close to 30%" in patients with active psoriasis. The clinical manifestations include joint inflammation, enthesitis, dactylitis, and psoriatic skin lesions. Common clinical features, which distinguish psoriatic arthritis from rheumatoid arthritis, include asymmetry of joint involvement, initial oligoarticular involvement, enthesial inflammation, iritis, and infrequent elevation of rheumatoid factor. According to Dr Mease, unmanaged psoriatic arthritis may result in progressive radiologic erosion, severe physical limitations, and disability.The review continues by evaluating recent data for therapies targeted to inhibit tumor necrosis factor a (TNF) such as etantercept and infliximab and considers the immunopathogenic role of TNF and the potential risks of these therapies. Furthermore, Dr Mease discusses other highly specific immunosuppressants aimed at treating psoriatic arthritis such as leflunomide. The author cites recent data supporting the efficacy and tolerability of this agent. Other new strategies that are touched on include antigens which bind to memory-effector T cells and a ligand for PPAR(gamma) causing down-regulation of pro-inflammatory cytokines.Reflecting on his review, Dr Mease comments that therapeutic advancements in spondyloarthropathies have benefited from the development of disease-modifying antirheumatic drugs (DMARDs), and from an emerging understanding that a similar immunopathologic etiology underlies both psoriatic arthritis and rheumatoid arthritis. "A new crop of biologics and pharmaceuticals with increased molecular specificity compared with traditional immunosuppressant DMARDS have been shown to be highly effective in inhibiting the symptoms and progression of psoriatic arthritis with less severe side effects" the author writes.Dr Mease adds that "the development of several new cell and cytokine-specific immunomodulatory medications in the coming years should further extend the ability to treat the disease effectively and improve patient health outcomes and quality of life".Reference...