Division of Rheumatology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, NY, USA.
Department of Medicine, Jacobi Medical Center / Albert Einstein College of Medicine, New York, NY, USA.
Clin Rheumatol. 2023 Sep;42(9):2251-2265. doi: 10.1007/s10067-023-06605-9. Epub 2023 Apr 25.
Psoriatic arthritis (PsA) is a chronic, multi-domain immune-mediated inflammatory arthritis with a high disease burden. PsA patients have significant co-morbidities like obesity, depression, fibromyalgia which can impact disease activity assessment. The management of PsA has undergone a paradigm shift over the last decade due to the availability of multiple biologic and targeted synthetic disease modifying anti-rheumatic drugs. Despite the availability of multiple therapeutic agents, it is not uncommon to find patients not responding adequately and continuing to have active disease and/or high disease burden. In our review, we propose what is "difficult to treat PsA", discuss differential diagnosis, commonly overlooked factors, co-morbidities that affect treatment responses, and suggest a stepwise algorithm to manage these patients.
银屑病关节炎（PsA）是一种慢性、多领域的免疫介导的炎症性关节炎，疾病负担高。PsA 患者存在肥胖症、抑郁症、纤维肌痛症等多种合并症，这可能会影响疾病活动度评估。由于多种生物制剂和靶向合成疾病修正抗风湿药物的出现，过去十年中，PsA 的治疗模式发生了转变。尽管有多种治疗药物，但并不罕见的是，发现患者治疗反应不佳，持续存在疾病活动和/或高疾病负担。在我们的综述中，我们提出了“难治性 PsA”的概念，讨论了鉴别诊断、常见被忽视的因素、影响治疗反应的合并症，并提出了管理这些患者的分步算法。
