Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy.
Drugs. 2016 Apr;76(6):663-73. doi: 10.1007/s40265-016-0557-4.
Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by psoriasis, synovitis, enthesitis, spondylitis and association with other extra-articular manifestations. Chronic inflammation of involved tissues possibly leads to structural damage and to a reduction in function and quality of life. The treatment of PsA dramatically changed with the introduction of anti-tumor necrosis factor (TNF)-α drugs, which have been shown to reduce the symptoms and signs of the disease, and slow radiographic progression. However, some patients do not respond to anti-TNFα or have a loss of response. Recently, the discovery of new pathogenic mechanisms have made possible the development of new drugs that target pro-inflammatory cytokines, such as interleukin (IL)-12, IL-23 and IL-17, or interfere with cellular pathways involved in skin, joint and entheseal inflammation. New molecules, namely ustekinumab, secukinumab, and apremilast have shown efficacy and safety over the various components of the disease in randomized clinical trials. These drugs have been recently approved for the treatment of PsA and included in new treatment recommendations. Other molecules are currently being tested in phase III clinical trials and are potential new treatment options for PsA. The aim of this review is to update the new pathways involved in the development of the disease and the emerging treatments for PsA beyond TNFα inhibition.
银屑病关节炎（PsA）是一种慢性炎症性疾病，其特征为银屑病、滑膜炎、肌腱端炎、脊柱关节炎，并伴有其他关节外表现。受累组织的慢性炎症可能导致结构损伤，并降低功能和生活质量。随着抗肿瘤坏死因子（TNF）-α药物的引入，PsA 的治疗发生了巨大变化，这些药物已被证明可减轻疾病的症状和体征，并减缓影像学进展。然而，一些患者对 TNF-α拮抗剂无反应或出现应答丧失。最近，新的发病机制的发现使得靶向促炎细胞因子（如白细胞介素[IL]-12、IL-23 和 IL-17）或干扰皮肤、关节和肌腱炎症相关细胞途径的新药的开发成为可能。新型药物乌司奴单抗、司库奇尤单抗和阿普米司特在随机临床试验中显示出对疾病各个方面的疗效和安全性。这些药物最近已被批准用于治疗 PsA，并被纳入新的治疗建议中。其他药物目前正在进行 III 期临床试验，是 PsA 的潜在新治疗选择。本文旨在更新疾病发展过程中的新途径以及除 TNFα 抑制以外治疗 PsA 的新兴方法。
