Are you trying to discover the latest advancements in Psoriatic Arthritis treatments? Are you eager to unravel what’s new and promising in this field? Well, you’ve landed in the right place! In this comprehensive guide, I’ll delve into the most recent breakthroughs in the management and treatment of Psoriatic Arthritis (PsA). Drawing from the 2021 Guidelines and various research studies, I will provide an updated overview of the PsA treatment landscape.
But remember, individual treatment plans should always be customized to your specific needs. So, let’s get started!
What is Psoriatic Arthritis?
PsA is a unique form of arthritis that affects approximately 25-30% of people living with the skin condition known as psoriasis. Approximately a decade after the onset of skin disease, patients with psoriasis may develop a joint disease that can affect not only the joints but also the tendons. If you’re curious to learn more about PsA, check out our other posts where I discuss the 7 most common signs of Psoriatic Arthritis or watch the video posted on my Youtube channel.
Goals of Psoriatic Arthritis Treatment
The treatment strategy for PsA aims for minimal or very minimal disease activity. This means
- reducing the number of tender and swollen joints
- minimizing skin lesions
- managing pain to minimal levels.
But just like any pair of shoes need to be the perfect fit, PsA treatment must be tailored to each patient’s needs and disease severity.
Exploring the Arsenal of Treatments
Let’s now explore the various types of treatments, each with its strengths and potential drawbacks, and how they can be effective for synovitis, enthesitis, or dactylitis.
Methotrexate, a disease-modifying anti-rheumatic drug (DMARD), has been around for a while. Primarily used for rheumatoid arthritis, it’s also beneficial in managing psoriasis and psoriatic arthritis. However, like any medication, it comes with potential side effects like nausea, stomach pain, diarrhea, and hair loss. It is inexpensive, and that is why many insurance companies request us, the physicians, to start therapy before trying something more expensive. It may work in about 40-60% of patients.
TNF inhibitors, such as Adalimumab (Humira) and Etanercept (Enbrel), are also important in PsA treatment. They work by blocking TNF alpha, a protein that can cause inflammation in our body. These inhibitors are recommended when the patient does not respond well to Methotrexate. Interestingly some studies show that when methotrexate is added to adalimumab or etanercept, the response is better rather than as monotherapy.
Other classes of inhibitors, including IL-12/23 inhibitors like Ustekinumab (Stelara) are commonly used to treat skin disease, but they can have a beneficial effect on the joints.
IL-17 is a cytokine or a molecule produced by many immune system cells, known to create inflammation. It seems that in people with Psoriasis and PsA, IL-17 cytokine plays an important role in the pathogenesis of the disease. So, inhibiting this molecule, with this relatively new class of medications that we call IL-17 inhibitors, was a very promising therapy. And it does work!
This is a fascinating class of medication that has been proven to do wonders for skin psoriasis, but it is efficacious for the joints as well.
A newer drug in this class of medication is called bimekizumab. This drug has both IL-17A and IL-17 F effects, which means that can inhibit different types of molecules and receptors that can induce inflammation.
What is good about this new medication, bimekizumab, is that it has similar effects to other IL-17 inhibitors on the skin and joints but had better results with a complete resolution for dactylitis (sausage digits) and enthesitis (inflammation of the tendons); however, this medication is still not approved in the US.
IL-23 Inhibitors and T Cell Modulator
IL23 inhibitors, like Guselkumab (Tremfya) and Risankizumab (Skyrizi), and T cell modulators, such as Abatacept, are relatively new to the treatment landscape of psoriasis and PsA. These drugs have been shown to improve fatigue, skin, and arthritis symptoms, with very low rates of serious infections.
Targeted Synthetic DMARDs
Targeted synthetic DMARDs like Jak inhibitors, TIK2 or tyrosine kinase 2 inhibitors, and the PDE4 inhibitor (Apremilast) have effectively managed PsA symptoms.
JAK inhibitors: These drugs can decrease the levels of multiple cytokines, which are involved in inflammation. Tofacitinib has shown improvement in skin and PsA symptoms, while Upatacitinib has demonstrated better results for skin, enthesitis, and dactylitis and has also been shown to inhibit radiographic progression. However, it’s important to note that JAK inhibitors should be avoided in patients with increased cardiovascular events due to their increased risk for thrombosis.
They may also increase the risk of herpes zoster infections and possibly malignancy.
That is why the guidelines recommend using JAK inhibitors after TNF inhibitors.
TIK2 inhibitors: Deucravacitinib, which inhibits the tyrosine kinase-2 pathway and decreases Interferon-gamma and IL12/23, is currently in a phase 2 trial. Preliminary results show improvement in PsA function, skin, and arthritis.
Also, its safety profile is promising, with no reported cases of herpes zoster, thrombosis, opportunistic infections, or malignancies. Unlike JAK inhibitors, Deucravacitinib doesn’t have to be preceded by TNF alpha inhibitors.
Apremilast (Otezla) is not considered a biologic medication but rather a targeted synthetic DMARD and can benefit both the skin and arthritis. However, the use may be limited by gastrointestinal side effects like nausea, diarrhea, and abdominal pain, and it has to be avoided if you suffer from depression or you have a history of depression.
When Standard Treatments Don’t Work: The Need for a Personalized Approach
While these conventional treatments can be effective, it’s important to note that each person’s experience with PsA differs. Factors such as the severity of the disease, the presence of coexisting conditions, patient preferences, and response to previous treatments all play a role in deciding the best treatment course. When standard treatments do not provide the desired results, a more personalized approach is necessary.
The Role of Biosimilars
Biosimilars are also part of the future of PsA treatment. These are biological, medical products highly similar to other already approved biological medicine. As patents expire for biologic drugs, biosimilars can potentially provide more affordable and accessible treatment options for PsA.
The Future: Immunomodulatory Nanomedicines
Looking toward the future, one promising area of research in PsA treatment is the development of immunomodulatory nanomedicines. These could potentially deliver drugs directly to inflamed tissues, improving their effectiveness and reducing side effects.
The Importance of Lifestyle Modifications
While medication is important in managing PsA, lifestyle modifications also play a crucial role. Maintaining a healthy weight, regular exercise, good sleep, and stress management can all contribute to better disease management. It’s also recommended that patients with PsA quit smoking and limit alcohol, as both can interfere with treatments and worsen disease symptoms.
While managing PsA can be challenging, the future of its treatment is promising. Living with Psoriatic Arthritis (PsA) is a daily struggle. It requires constant monitoring and management, but you don’t have to do this alone.
Here at Rheumatologist OnCall, we’re dedicated to helping you navigate the complexities of PsA and we always offer a personalized approach. We offer you access to a top rheumatologist, from the comfort of your own home, removing barriers to quality care. If you’re tired of searching for answers or need a second opinion about your treatment plan, schedule a virtual visit with us today. You’ll get an in-depth, personalized consultation where we’ll discuss your symptoms, treatment options, and help tailor a management plan that suits you best.
Don’t let PsA control your life. Start your journey towards better health and a better future!