ABSTRACT
Psoriatic arthritis (PsA) is the second most common inflammatory arthropathy that presents to early arthritis clinics, after rheumatoid arthritis. PsA involves 30% of patients with psoriasis and can characteristically affect the axial skeleton, peripheral joints, nails, enthesis, and tendon sheaths as well as the gut and joints. The degree of involvement in each domain can vary over time in individual patients and can differ substantially between PsA patients, which presents a challenge to the treating rheumatologist. There have been various advancements in the pathogenesis in areas of genetics and molecular biology implicating both adaptive and innate immunity. Dysbiosis of the gut microbiome has also been implicated as one of the triggers for PsA. The management of PsA has improved tremendously over the past decade owing to early diagnosis, better screening tools, early referrals from dermatologists and primary care physicians, and a treat to target approach. The increased availability of therapeutic options beyond conventional disease-modifying antirheumatic drugs (DMARDs) in the form of various biological and targeted synthetic DMARDs has prompted clinicians to use the full clinical picture of the patient to make a treatment decision. In this review we summarize the epidemiology, pathogenesis, clinical features, diagnosis, and latest management of PsA.
