Abstract
Psoriatic arthritis is a chronic inflammatory arthritis that is part of the spondyloarthropathy group of rheumatic diseases and has associated co-morbidities. It can present with various clinical manifestations making diagnosis and treatment challenging, resulting in significant disability and reduced quality of life for patients. Whilst there have been advances in understanding the pathogenic mechanisms of the disease which have resulted in targeted therapies, there is still the need for further studies as some patients fail or are intolerant of current therapies. Better identification of early disease and knowledge of prognostic markers would enable clinicians to initiate appropriate therapy with the expectation that early aggressive treatment will minimise joint damage progression. Improved knowledge of the condition would also enable clinicians to better tailor specific treatment strategies for each of the various clinical domains in psoriatic arthritis.
Similar content being viewed by others
References
Ritchlin CT, Colbert RA, Gladman D (2017) Psoriatic arthritis. N Engl J Med 376:957–970
Mease PJ, Armstrong AW (2014) Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs 74(4):423–441
Huynh DQ, Kavanaugh A (2015) Psoriatic arthritis: current therapy and future approaches. Rheumatology (Oxford) 54(1):20–28
Kavanaugh A, Helliwell P, Ritchlin CT (2016) Psoriatic arthritis and burden of disease: patient perspectives from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Rheumatol Ther 3(1):91–102
Van de Kerkhof PCM, Reich K, Kavanaugh A et al (2015) Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based multinational assessment of psoriasis and psoriatic arthritis survey. J Eur Acad Dermatol Venereol 29(10):2002–2010
Coates LC, Helliwell P (2016) Psoriatic Arthritis. Oxford Textbook of Rheumatology 4th edition Chapter 114
Nograles KE, Brasington RD, Bowcock AM (2009) New insights into the pathogenesis and genetics of psoriatic arthritis. Nat ClinPract Rheumatol 5(2):83–91
Busse K, Liao W (2010) Which psoriasis patients develop psoriatic arthritis? Psoriasis Forum 16(4):17–25
Palazzi C et al (2005) Hepatitis C virus infection in psoriatic arthritis. Arthritis Rheum 53:223–225
FitzGerald O, Haroon M, Giles JT, Winchester R (2015) Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Res Ther 17(1):115
Haroon M, Winchester R, Giles JT et al (2016) Certain class I HLA alleles and haplotypes implicated in susceptibility play a role in determining specific features of the psoriatic arthritis phenotype. Ann Rheum Dis 75:155–162
Cretu D, Gao L, Liang K, Soosaipillai A, Diamandis EP, Chandran V (2017) Novel serum biomarkers differentiate psoriatic arthritis from psoriasis without psoriatic arthritis. Arthritis Care & Research, Accepted Author Manuscript [epub ahead of print]
Kerschbaumer A, Fenzl KH, Erlacher L, Aletaha D (2016) An overview of psoriatic arthritis—epidemiology, clinical features, pathophysiology and novel treatment targets. Wien Klin Wochenschr 128(21):791–795
McGonagle D (2009) Enthesitis: an autoinflammatory lesion linking nail and joint involvement in psoriatic disease. J Eur Acad Dermatol Venereol 23:9–13
Gisondi P, Tinazzi I, El-Dalati G et al (2008) Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case–control study. Ann Rheum Dis 67:26–30
Gill T, Asquith M, Rosenbaum JT, Colbert RA (2015) The intestinal microbiome in spondyloarthritis. Curr Opin Rheumatol 27(4):319–325
Scher JU, Ubeda C, Artacho A et al (2015) Decreased bacterial diversity characterizes an altered gut microbiota in psoriatic arthritis and resembles dysbiosis of inflammatory bowel disease. Arthritis Rheumatol (Hoboken, NJ) 67(1):128–139
Coates LC, Moverley AR, McParland L et al (2015) Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised, controlled trial. Lancet (London, England) 386(10012):2489–2498
Wilkins RA, Siddle HJ, Redmond AC, Helliwell PS (2016) Plantar forefoot pressures in psoriatic arthritis-related dactylitis: an exploratory study. Clin Rheumatol 35:2333–2338
Mease PJ, Karki C, Palmer J et al (2017) Clinical characteristics, disease activity, and patient-reported outcomes in psoriatic arthritis patients with dactylitis or enthesitis: results from the Corrona psoriatic arthritis/spondyloarthritis registry. Arthritis Care Res. Accepted Author Manuscript
Mease PJ, Van den Bosch F, Sieper J et al (2011) Performance of 3 enthesitis indices in patients with peripheral spondyloarthritis during treatment with adalimumab. J Rheumatol 38(8):1656–1660
Raychaudhuri SP, Wilken R, Sukhov AC et al (2017) Management of psoriatic arthritis: early diagnosis, monitoring of disease severity and cutting edge therapies. J Autoimmun 76:21–37
Siebert S et al (2017) Urinary proteomics can define distinct diagnostic inflammatory arthritis subgroups. Sci Rep 7:40473
Gladman DD (2016) Recent advances in understanding and managing psoriatic arthritis. F1000Research 5:2670
Poggenborg RP, Pedersen SJ, Eshed I, Sørensen IJ, Møller JM, Madsen OR, Thomsen HS, Østergaard M (2015) Head-to-toe whole-body MRI in psoriatic arthritis, axial spondyloarthritis and healthy subjects: first steps towards global inflammation and damage scores of peripheral and axial joints. Rheumatology (Oxford) 54(6):1039–1049
Haroon M, Gallagher P, FitzGerald O (2015) Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis 74(6):1045–1050. https://doi.org/10.1136/annrheumdis-2013-204858
Rudwaleit M, van der Heijde D, Landewé R et al (2011) The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 70:25–31
Taylor W, Gladman D, Helliwell P et al (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673
Congi L, Roussou E (2010) Clinical application of the CASPAR criteria for psoriatic arthritis compared to other existing criteria. Clin Exp Rheumatol 28(3):304–310
Duffin KC, Chandran V, Gladman DD, Krueger GG, Elder JT, Rahman P (2008) Genetics of psoriasis and psoriatic arthritis: update and future direction (GRAPPA 2007). J Rheumatol 35(7):1449–1453
Coates LC, Aslam T, Al Balushi F et al (2013) Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study). Br J Dermatol 168:802–807
De Marco G, Helliwell P, McGonagle D et al (2017) The GOLMePsA study protocol: an investigator-initiated, double-blind, parallel-group, randomised, controlled trial of GOLimumab and methotrexate versus methotrexate in early diagnosed psoriatic arthritis using clinical and whole body MRI outcomes. BMC Musculoskelet Disord 18:303
Coates LC, Helliwell PS (2016) Psoriasis flare with corticosteroid use in psoriatic arthritis. Br J Dermatol 174:219–221
Marchesoni A, Lubrano E, Cauli A et al (2015) Psoriatic disease: update on traditional disease-modifying antirheumatic drugs. J Rheumatol Suppl 93:61–64
Kavanaugh A, Mease PJ, Gomez-Reino JJ et al (2014) Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann Rheum Dis 73(6):1020–1026
Elyoussfi S, Thomas BJ, Ciurtin C (2016) Tailored treatment options for patients with psoriatic arthritis and psoriasis: review of established and new biologic and small molecule therapies. Rheumatol Int 36:603–612
Asahina A, Etoh T, Igarashi A et al (2016) Oral tofacitinib efficacy, safety and tolerability in Japanese patients with moderate to severe plaque psoriasis and psoriatic arthritis: a randomized, double-blind, phase 3 study. J Dermatol 43(8):869–880
Mease P, Hall S, Fitzgerald O et al OP0216 (oral presentation 2017)Efficacy and safety of tofacitinib, an oral janus kinase inhibitor, or adalimumab in patients with active psoriatic arthritis and an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (CSDMARDS): a randomised, placebo-controlled, phase 3 trial. Ann Rheum Dis Suppl 2 76:141–142
Mease PJ, Gottlieb AB, van der Heijde D et al (2017) Efficacy and safety of abatacept, a T-cell modulator, in a randomised, double-blind, placebo-controlled, phase III study in psoriatic arthritis. Ann Rheum Dis Published Online First: 04 May
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This paper is not a clinical study and contains no patient data.
Disclosures
None.
Additional information
Paper requested by Dr. Luis R Espinoza
Rights and permissions
About this article
Cite this article
Mahmood, F., Coates, L.C. & Helliwell, P.S. Current concepts and unmet needs in psoriatic arthritis. Clin Rheumatol 37, 297–305 (2018). https://doi.org/10.1007/s10067-017-3908-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-017-3908-y