Rheumatology & ISPA Translational Immunology Division, Central University Hospital of Asturias, Oviedo, Spain.
Department of Medicine, Oviedo University School of Medicine, Oviedo, Spain.
Expert Rev Clin Immunol. 2023 Jul-Dec;19(12):1469-1484. doi: 10.1080/1744666X.2023.2249235. Epub 2023 Aug 21.
Psoriatic arthritis (PsA) is a chronic, immune-mediated disease characterized by synovio-entheseal inflammation. It is estimated to affect around 30% of patients with psoriasis and significantly reduces patients' physical function and quality of life. There is a growing number of treatment options for PsA, but due to the heterogeneous clinical features of the disease and prevalence of comorbidities, managing PsA can be challenging.
In this article, we review current understanding of the disease and available pharmacological options. Based on published treatment guidelines, emerging evidence and clinical experience, we provide our expert opinion on treatment strategies, taking into consideration the predominant disease domain and the presence of comorbidities, which can impact treatment decisions and clinical outcomes.
Biological and targeted synthetic disease-modifying agents are dramatically improving the lives of patients with PsA. Biosimilar TNF inhibitors offer a particularly versatile and cost-effective option, whilst newer biologics and targeted synthetic molecules that can be used to treat most domains of psoriatic disease are an attractive alternative to TNF inhibitors. Despite a lack of consensus on treatment sequencing and tapering, it is important that PsA patients, especially those with comorbidities, are looked after by a multidisciplinary team to optimize their care.
银屑病关节炎（PsA）是一种慢性、免疫介导的疾病，其特征为滑膜-肌腱附着处炎症。据估计，约 30%的银屑病患者会受到影响，这显著降低了患者的身体功能和生活质量。目前有越来越多的治疗银屑病关节炎的选择，但由于疾病的临床特征具有异质性且常合并共存疾病，因此管理银屑病关节炎具有挑战性。
本文综述了目前对该病的认识以及现有的药物治疗选择。基于已发表的治疗指南、新出现的证据和临床经验，我们结合主要疾病领域和共存疾病的存在情况，针对治疗策略提出了我们的专家意见，这些情况可能会影响治疗决策和临床结局。
生物制剂和靶向合成的疾病修饰药物极大地改善了银屑病关节炎患者的生活。TNF 抑制剂的生物类似药提供了一种特别灵活且具有成本效益的选择，而新型生物制剂和靶向合成分子可用于治疗银屑病的大多数疾病领域，是 TNF 抑制剂的一种有吸引力的替代选择。尽管在治疗排序和逐渐减少剂量方面尚未达成共识，但重要的是，应通过多学科团队来照顾银屑病关节炎患者，尤其是那些合并共存疾病的患者，以优化他们的治疗。
