Miyagawa Ippei, Tanaka Yoshiya
The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahata-nishi, Kitakyushu 807-8555, Japan.
Ther Adv Musculoskelet Dis. 2025 Jan 5;17:1759720X241311462. doi: 10.1177/1759720X241311462. eCollection 2025.
Psoriatic arthritis (PsA) presents various clinical manifestations, including skin lesions, peripheral arthritis, axial involvement, enthesitis, nail involvement, dactylitis, and uveitis. In addition, it causes a high incidence of lifestyle-related diseases and an increase in cerebrovascular and cardiovascular events. As the pathology of PsA has been clarified, molecular-targeted drugs targeting tumor necrosis factor-α, interleukin (IL)-17A, IL-17A/F, IL-17 receptor, IL-12/23(p40), IL-23p19, Cytotoxic T-lymphocyte Antigen-4 (CTLA-4), Janus kinase, and phosphodiesterase-4 have been developed and are widely used in clinical practice. PsA is clinically and molecularly heterogeneous, and it is necessary to improve various clinical symptoms with limited treatment options simultaneously; therefore, rheumatologists sometimes encounter difficult situations in clinical practice. Hence, the development of precision medicine may improve treatment outcomes. Recently, the strategic use of molecular-targeted drugs based on the stratification of patients with PsA by peripheral blood lymphocyte phenotyping and serum cytokine concentrations has been reported to possibly lead to a higher therapeutic response. A randomized controlled trial was initiated to verify the efficacy of this treatment strategy. However, to make precision medicine in PsA feasible, shifting from conventional clinical trials to clinical trials based on biomarker profiles and accumulating further data are necessary.
银屑病关节炎（PsA）具有多种临床表现，包括皮肤病变、外周关节炎、中轴受累、附着点炎、指甲受累、指（趾）炎和葡萄膜炎。此外，它还导致与生活方式相关疾病的高发病率以及脑血管和心血管事件的增加。随着PsA病理机制的阐明，针对肿瘤坏死因子-α、白细胞介素（IL）-17A、IL-17A/F、IL-17受体、IL-12/23（p40）、IL-23p19、细胞毒性T淋巴细胞抗原4（CTLA-4）、Janus激酶和磷酸二酯酶-4的分子靶向药物已被研发出来并广泛应用于临床实践。PsA在临床和分子层面具有异质性，需要在治疗选择有限的情况下同时改善各种临床症状；因此，风湿病学家在临床实践中有时会遇到困难情况。因此，精准医学的发展可能会改善治疗效果。最近，有报道称，根据外周血淋巴细胞表型和血清细胞因子浓度对PsA患者进行分层，战略性地使用分子靶向药物可能会带来更高的治疗反应。一项随机对照试验已启动，以验证这种治疗策略的疗效。然而，要使PsA的精准医学可行，从传统临床试验转向基于生物标志物谱的临床试验并积累更多数据是必要的。
