Al-Mossawi Hussein, Taams Leonie S, Goodyear Carl S, Kirkham Bruce W, McInnes Iain B, Siebert Stefan, Coates Laura C
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Centre for Inflammation Biology and Cancer Immunology, Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK.
Lancet Rheumatol. 2019 Sep;1(1):e66-e73. doi: 10.1016/S2665-9913(19)30008-6. Epub 2019 Aug 28.
Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis associated with psoriasis. Patients manifest variable presentations with potential involvement of peripheral joints, spine, tendons, skin, and nails. There has been a rapid expansion in targeted treatment options for patients with PsA, but typically less than half of those who receive therapy achieve optimal treatment targets. Many patients respond to second-line or third-line biological therapies, but little evidence exists to guide the choice of therapeutics for each individual. At present, choice of therapy is driven by active clinical disease domains, clinician familiarity with existing treatments, and cost. Here, we review recent data that highlight the potential for personalised, or precision, medicine in PsA and other forms of inflammatory arthritis, noting that this research is still at a preliminary stage. In the future, a combination of detailed immunophenotyping and sophisticated statistical analyses should help to facilitate a personalised medicine approach in PsA, following examples from other clinical areas, such as oncology. This change in approach to the treatment of PsA has the potential to maximise outcomes for patients and to provide optimal therapies without delay.
银屑病关节炎（PsA）是一种与银屑病相关的异质性炎性关节炎。患者表现出多种不同症状，外周关节、脊柱、肌腱、皮肤和指甲都可能受累。针对PsA患者的靶向治疗选择迅速增加，但接受治疗的患者中通常只有不到一半能达到最佳治疗目标。许多患者对二线或三线生物疗法有反应，但几乎没有证据可指导为每个患者选择治疗方法。目前，治疗方法的选择取决于活跃的临床疾病领域、临床医生对现有治疗方法的熟悉程度以及成本。在此，我们回顾近期数据，这些数据凸显了个性化或精准医学在PsA及其他形式炎性关节炎中的潜力，同时指出该研究仍处于初步阶段。未来，借鉴肿瘤学等其他临床领域的经验，详细的免疫表型分析与复杂的统计分析相结合，应有助于推动PsA的个性化医疗方法。这种治疗PsA方法的转变有可能使患者的治疗效果最大化，并及时提供最佳治疗方案。
