Updated therapies for the management of Psoriatic Arthritis

• Published in: Clinical immunology (Orlando, Fla.) Vol. 220; p. 108536
• Main Authors: Toussi, Atrin, Maverakis, Natalia, Le, Stephanie T., Sarkar, Soumajyoti, Raychaudhuri, Smriti K., Raychaudhuri, Siba P.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2020
• Subjects: IL-12/23; IL-17; IL-23; Psoriasis; Psoriatic arthritis; TNF inhibitor; Psoriasis; IL-23; TNF inhibitor; IL-12/23; IL-17; Psoriatic arthritis
• ISSN: 1521-6616; 1521-7035
• DOI: 10.1016/j.clim.2020.108536

Psoriatic arthritis (PsA) is a large volume of our clinical practice and its management can be challenging. Traditional DMARDs have been used over last six decades and observational studies have substantiated an effective use of many of these drugs. However, in last two decades use of anti-TNF agents has brought a new dimension in treatment of PsA and in many other autoimmune diseases. Regulatory role of the Th17 cells and its cytokines in the pathogenesis of PsA has successfully paved the foundations of anti-IL antibody based therapies in PsA. Newer therapies targeting the IL-23/IL-17 cytokines and its signaling proteins are now in development and bringing new promises for management of PsA. Herein, we provide an overview of the landscape of drug therapies, including IL-17, IL-12/23, IL-23 inhibitors, and janus kinase (JAK) inhibitors, as well as those in development, such as RORγt inhibitors, anti-NGF agents, mTOR inhibitors and T cell ion-channel blockers. •Psoriatic arthritis (PsA) is associated with heterogeneous musculoskeletal involvement and dermatological manifestations.•csDMARDs have only a modest benefit in PsA•Biologics such as anti-tumor necrosis factor (TNF) agents are highly effective for all clinical domains involved in PsA.•Promising new therapies in trials for PsA are anti-IL-23 and its several signaling proteins•mTOR, NGF, RORgt and potassium ion channel inhibitors are in development stage for novel therapies of PsA•PsA patients need a “Total Care Program”, that is treatment of all comorbidities; and exemplary care of the skin and joint.