ABSTRACT
Psoriatic arthritis (PsA) is a multifaceted disorder that usually affects a number of specific anatomical areas, such as the patient’s peripheral and axial joints, entheses, skin, and nails. In fact, the right kind management of PsA emphasizes diagnosis at an early stage, close monitoring of disease progression, and making full use of available breakthrough therapies. To reach the above goal, there are quite a number of PsA-specific aids at our disposal to screen, diagnose, and determine the progress of the patients. This review enumerates the currently determined PsA screening aids, which include the Toronto Psoriatic Arthritis Screening Questionnaire (TOPAS), the Psoriasis Epidemiology Screening Tool (PEST), the Psoriatic Arthritis Screening and Evaluation (PASE), and the Psoriasis and Arthritis Screening Questionnaire (PASQ). In addition to the above, we also reassess the Classification Criteria for Psoriatic Arthritis (CASPAR) and available PsA disease severity measures, such as the Disease Activity Index for Psoriatic Arthritis (DAPSA), the Psoriatic Arthritis Joint Activity Index (PsAJAI), and the Composite Psoriatic Disease Activity Index (CPDAI).
A number of new modalities of treatment are available for PsA. In the past, patients with PsA were usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and other available disease-modifying antirheumatic drugs (DMARDs). But unfortunately, such medications have not shown any convincing proof in delaying or reducing the radiographic progression of joint disease. On the contrary, anti–tumor necrosis factor (TNF) agents, such as etanercept, infliximab, adalimumab, golimumab, and certolizumab, have demonstrated efficacy in this matter. Upcoming PsA therapy comprises an oral phosphodiesterase 4 inhibitor, apremilast; a Janus kinase (JAK) inhibitor, tofacitinib; and many more newer biologics that target the interleukin (IL)-23/IL-17 pathway, which includes secukinumab, brodalumab, ixekizumab, and ustekinumab. In this chapter, we discuss in detail the exact mode of action of these drugs, their outcome in clinical trials, and the guidelines for administration. At the end, therapeutic recommendations from the European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) are addressed in detail.
