D'Angelo Salvatore, Tramontano Giuseppina, Gilio Michele, Leccese Pietro, Olivieri Ignazio
Rheumatology Institute of Lucania (IRel) - Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera.
Rheumatology Institute of Lucania (IRel) - Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera; Basilicata Ricerca Biomedica (BRB) Foundation, Potenza, Italy.
Open Access Rheumatol. 2017 Mar 2;9:21-28. doi: 10.2147/OARRR.S56073. eCollection 2017.
Psoriatic arthritis (PsA) is a heterogeneous chronic inflammatory disease with a broad clinical spectrum and variable course. It can involve musculoskeletal structures as well as skin, nails, eyes, and gut. The management of PsA has changed tremendously in the last decade, thanks to an earlier diagnosis, an advancement in pharmacological therapies, and a wider application of a multidisciplinary approach. The commercialization of tumor necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab) as well as interleukin (IL)-12/23 (ustekinumab) and IL-17 (secukinumab) inhibitors is representative of a revolution in the treatment of PsA. No evidence-based strategies are currently available for guiding the rheumatologist to prescribe biological drugs. Several international and national recommendation sets are currently available with the aim to help rheumatologists in everyday clinical practice management of PsA patients treated with biological therapy. Since no specific biological agent has been demonstrated to be more effective than others, the drug choice should be made according to the available safety data, the presence of extra-articular manifestations, the patient's preferences (e.g., administration route), and the drug price. However, future studies directly comparing different biological drugs and assessing the efficacy of treatment strategies specific for PsA are urgently needed.
银屑病关节炎（PsA）是一种异质性慢性炎症性疾病，临床谱广泛，病程多变。它可累及肌肉骨骼结构以及皮肤、指甲、眼睛和肠道。在过去十年中，由于早期诊断、药物治疗的进展以及多学科方法的更广泛应用，PsA的管理发生了巨大变化。肿瘤坏死因子抑制剂（阿达木单抗、赛妥珠单抗、依那西普、戈利木单抗和英夫利昔单抗）以及白细胞介素（IL）-12/23（乌司奴单抗）和IL-17（司库奇尤单抗）抑制剂的商业化是PsA治疗革命的代表。目前尚无基于证据的策略来指导风湿病学家开具生物药物。目前有几个国际和国家推荐集，旨在帮助风湿病学家在日常临床实践中管理接受生物治疗的PsA患者。由于没有特定的生物制剂被证明比其他制剂更有效，药物选择应根据现有的安全性数据、关节外表现的存在、患者的偏好（如给药途径）和药物价格来做出。然而，迫切需要直接比较不同生物药物并评估针对PsA的治疗策略疗效的未来研究。
