Psoriatic Arthritis

Biologic compounds are being used more frequently to treat a multitude of systemic inflammatory conditions. This article discusses the increased risk of opportunistic infections of tuberculosis, herpes zoster, Legionella pneumophila, and Listeria monocytogenes.

Early diagnosis of psoriatic arthritis (PsA) is essential for preventing disease progression and joint destruction. We will review the presentation and temporal relationship of psoriasis and PsA, the diagnosis, classification, and management and the role of the dermatologist.

This article discusses the main objectives of psoriatic arthritis treatment and management. Expectations, as well as specific symptoms like joint stiffness are discussed.

Methotrexate, originally an anti-cancer drug, has been used to treat psoriasis and psoriatic arthritis effectively. This article discusses methotrexate, including side-effects drug interactions, and tests, as well as efficacy in the context of treating psoriatic arthritis.

Sulfasalazine is the only drug that was developed specifically for arthritis and combines a sulfa drug with acetylsalicylic acid. This article discusses the use of sulfasalazine for treating psoriatic arthritis.

Leflunomide was initially developed for use in the treatment of cancer and has been used successfully in rheumatoid arthritis. This article discusses the use of leflunomide for the treatment of psoriatic arthritis.

Cyclosporin A, originally used as a drug used to fight organ rejection - is used to treat psoriatic arthritis. Its mechanism of action, mode of administration, and side effects are discussed.

Azathioprine is used as an immunosuppressive agent used to control transplant rejection. It is also being used to treat psoriatic arthritis. This article reviews the case for its use for this purpose.

This article provides an important overview of the mechanisms and objectives in using immunobiologics to control psoriatic arthritis.

This article discusses other treatments for psoriatic arthritis that are often used in complement to other treatment modalities like methotrexate. Surgery, physiotherapy, gold, and anti-malarial treatments are all discussed.

To date, the US FDA has approved three tumor necrosis factor (TNF)-a inhibitors for use in dermatology. The distinct and targeted mechanism of action of the TNF inhibitors allows dermatologists to customize therapy to match the individual needs and characteristics of patients who are candidates for systemic therapy.

Advancements in topical antipsoriatic therapies have provided safer and more effective treatment options, especially when used in combination. Consequently, much research is underway to investigate novel treatment combinations for psoriasis in the hope that it will provide further enhancements in efficacy.

Etanercept (Enbrel®, Amgen and Wyeth), a tumor necrosis factor (TNF) antagonist, was approved in January 2002, for the treatment of psoriatic arthritis (PsA). Etanercept was evaluated for the treatment of PsA and psoriasis in a preliminary study of 60 patients and in a confirmatory phase III study of 205 patients.

With growing public reluctance to use systemic medications we can expect topical treatments for psoriasis and other skin conditions to become increasingly important in the future. These drugs are useful not only to control this disease, but also to limit the irritation caused by medications such as tazarotene and anthralin.