Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Nat Rev Dis Primers. 2021 Aug 12;7(1):59. doi: 10.1038/s41572-021-00293-y.
Psoriatic arthritis (PsA) is a complex inflammatory disease with heterogeneous clinical features, which complicates psoriasis in 30% of patients. There are no diagnostic criteria or tests available. Diagnosis is most commonly made by identifying inflammatory musculoskeletal features in joints, entheses or the spine in the presence of skin and/or nail psoriasis and in the usual absence of rheumatoid factor and anti-cyclic citrullinated peptide. The evolution of psoriasis to PsA may occur in stages, although the mechanisms are unclear. In many patients, there may be little or no relationship between severity of musculoskeletal inflammation and severity of skin or nail psoriasis. The reason for this disease heterogeneity may be explained by differences in genotype, especially in the HLA region. New targeted therapies for PsA have been approved with additional therapies in development. These developments have substantially improved both short-term and long-term outcomes including a reduction in musculoskeletal and skin manifestations and in radiographic damage. With efforts underway aimed at improving our understanding of the molecular basis for the heterogeneity of PsA, a personalized approach to treating PsA may become possible.
银屑病关节炎（PsA）是一种具有异质性临床特征的复杂炎症性疾病，可使 30%的银屑病患者病情复杂化。目前尚无诊断标准或检测方法。诊断通常是通过在存在皮肤和/或指甲银屑病的情况下，在关节、附着点或脊柱处发现炎症性肌肉骨骼特征来确定，通常不存在类风湿因子和抗环瓜氨酸肽。银屑病向 PsA 的发展可能是分阶段发生的，尽管其机制尚不清楚。在许多患者中，肌肉骨骼炎症的严重程度与皮肤或指甲银屑病的严重程度之间可能没有关系或关系很小。这种疾病异质性的原因可能是由于基因型的差异，尤其是在 HLA 区域。目前已有针对 PsA 的新型靶向治疗药物获得批准，还有其他治疗方法正在开发中。这些进展极大地改善了短期和长期预后，包括减轻肌肉骨骼和皮肤表现以及放射学损伤。目前正在努力提高我们对 PsA 异质性分子基础的理解，这可能使针对 PsA 的个体化治疗成为可能。
