Targeted therapies for psoriatic arthritis: an update for the dermatologist.

Dermatologists are on the front line to identify psoriatic arthritis (PsA) in their patients with psoriasis. PsA is a prevalent and underdiagnosed disease with potential long-term complications and sequelae for patients. Targeted biologics have transformed the landscape of psoriasis and PsA therapy. These medications variably treat clinical manifestations of psoriatic disease: skin psoriasis, peripheral and axial arthritis, enthesitis, and nail disease. With many new medications either on the market or currently being evaluated by the Food and Drug Administration, the purpose of this article is to review PsA for the dermatologist, to identify the current therapies that are available, and to help select which patients may benefit from these medications. Overall, it is important to decide therapy for patients based on the active domains of their disease, their comorbidities, and the safety profiles of these medications, as well as patient preference for route of administration, frequency, and tolerability.

Elman SA ，Weinblatt M ，Merola JF 《seminars in cutaneous medicine and surgery》

Psoriatic arthritis for the dermatologist.

Tintle SJ ，Gottlieb AB 《-》

New targets in psoriatic arthritis.

PsA is an immune-mediated chronic inflammatory disease that affects both skin and joints; it is a heterogeneous disease characterized by synovitis, enthesitis, dactylitis and spondylitis. The impact on patients and the burden of disease are substantial. For assessment of the disease, patient-reported outcomes are increasingly important. Conventional therapy consists of NSAIDs, local and systemic CSs, and synthetic and biological DMARDs. While MTX, LEF, SSZ and CYC are the synthetic drugs mainly used, TNF-α blocking agents have represented the majority of biologics used in the last decade (infliximab, etanercept, adalimumab, certolizumab and golimumab). Treat-to-target strategies have been used successfully in PsA. This review concentrates on new developments, mainly covering biologic agents with an IL-17 inhibitor (secukinumab) and an anti-IL-23 agent (ustekinumab), but also synthetic drugs, including a novel phosphodiesterase-4 inhibitor (apremilast) and a Janus kinase inhibitor (tofacitinib) that blocks mainly Jak3 and Jak1 and, to a lesser extent, Jak2. The efficacy of some of these new agents may be even better for the skin than for the joints.

Braun J 《-》

The Psoriasis Treatment Pipeline: An Overview and Update.

Significant research advances in our understanding of psoriatic disease have led to the development of several highly selective, effective, and safe topical and systemic treatments. These treatments have led to unprecedented levels of disease clearance and control for most patients with psoriasis with cutaneous disease. However, there remains a need for improved treatments for those patients with recalcitrant disease, psoriatic arthritis, or nonplaque disease variants. Recently approved therapies and investigational products in ongoing clinical development programs that target IL-17A/F, IL-23, TYK2, PDE4, AhR or IL-36 cytokine signaling are improving the clinician's ability to care for a broader range of patients affected by psoriasis.

Hawkes JE ，Al-Saedy M ，Bouché N ，Al-Saedy S ，Drew DT ，Song EJ ... -  《-》

Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis.

To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.

Singh JA ，Guyatt G ，Ogdie A ，Gladman DD ，Deal C ，Deodhar A ，Dubreuil M ，Dunham J ，Husni ME ，Kenny S ，Kwan-Morley J ，Lin J ，Marchetta P ，Mease PJ ，Merola JF ，Miner J ，Ritchlin CT ，Siaton B ，Smith BJ ，Van Voorhees AS ，Jonsson AH ，Shah AA ，Sullivan N ，Turgunbaev M ，Coates LC ，Gottlieb A ，Magrey M ，Nowell WB ，Orbai AM ，Reddy SM ，Scher JU ，Siegel E ，Siegel M ，Walsh JA ，Turner AS ，Reston J ... -  《-》