University of Toronto, Psoriatic Arthritis Program, University Health Network, Toronto Western Hospital, Toronto, ON, Canada.
Gladman-Krembil Psoriatic Disease Program, Toronto Western Hospital, Toronto, ON, Canada.
BMJ. 2024 Nov 21;387:e081860. doi: 10.1136/bmj-2024-081860.
Psoriatic arthritis is an inflammatory arthritis that affects around 30% of patients with psoriasis. The disease spectrum includes peripheral arthritis, enthesitis, tenosynovitis, dactylitis, axial involvement, and skin and nail psoriasis in most patients. In addition to the cutaneous and musculoskeletal manifestations, several comorbidities can complicate the disease course, including cardiovascular disease, diabetes mellitus, metabolic syndrome, gout, anxiety, and depression. The management of patients with psoriatic arthritis begins with a careful assessment of the skin and joints and screening for comorbidities. This review describes the assessment tools and outcome measures used in the evaluation of patients with psoriatic arthritis. It summarizes the approach to therapy, including non-medicinal interventions such as education, lifestyle changes, physiotherapy, and occupational therapy. It discusses the evidence on pharmacologic treatments, including drugs used for symptomatic relief such as non-steroidal anti-inflammatory drugs, and those used to control the disease process; this last group comprises conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), including methotrexate, leflunomide, and sulfasalazine, and biologic and targeted DMARDs, including anti-tumor necrosis factor (TNFα), anti-interleukin-17 (IL-17), anti-IL-12/23, and anti-IL-23 agents, as well as Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) antagonists. Although these drugs are usually tailored to the clinical profile of the patient, biomarkers predictive of response to therapy are needed so that a more personalized approach can be followed.
银屑病关节炎是一种炎症性关节炎，影响约 30%的银屑病患者。该疾病谱包括大多数患者的外周关节炎、肌腱端炎、腱鞘炎、指（趾）炎、轴性疾病以及皮肤和指甲银屑病。除了皮肤和肌肉骨骼表现外，几种合并症可使疾病过程复杂化，包括心血管疾病、糖尿病、代谢综合征、痛风、焦虑和抑郁。银屑病关节炎患者的管理始于对皮肤和关节的仔细评估以及合并症的筛查。本综述描述了用于评估银屑病关节炎患者的评估工具和结局指标。它总结了治疗方法，包括非药物干预措施，如教育、生活方式改变、物理治疗和职业治疗。它讨论了药物治疗的证据，包括用于缓解症状的药物，如非甾体抗炎药，以及用于控制疾病过程的药物；后一组包括传统的合成疾病修饰抗风湿药物（DMARDs），包括甲氨蝶呤、来氟米特和柳氮磺胺吡啶，以及生物制剂和靶向 DMARDs，包括抗肿瘤坏死因子（TNFα）、抗白细胞介素-17（IL-17）、抗白细胞介素-12/23 和抗白细胞介素-23 药物，以及 Janus 激酶（JAK）抑制剂和磷酸二酯酶 4（PDE4）拮抗剂。尽管这些药物通常根据患者的临床特征进行调整，但需要预测治疗反应的生物标志物，以便采用更个性化的方法。
