Trends I See in the Treatment of Psoriatic Arthritis

By Elizabeth Ortiz, MD, told to Janie McQueen

Understanding of psoriatic arthritis has improved

I have seen a huge increase in our understanding of psoriatic arthritis in my time in practice alone. This has resulted in more specific treatments, but also in our ability to make a faster diagnosis.

There are no specific blood tests for psoriatic arthritis. Making a diagnosis depends largely on the experience and level of suspicion of the doctor. As we have learned more about what to look for and how symptoms can vary among men, women, and people of color, collectively our experience and level of suspicion have increased. This results in patients reaching a proper diagnosis sooner.

We still have a long way to go, as far too many people are dealing with psoriatic arthritis for longer than they should. But we are definitely making progress.

Personalized therapies for psoriatic arthritis

Several clinical trials are always being conducted to assess the effectiveness of targeting new inflammatory proteins along the complicated inflammatory cascade that is activated in psoriatic arthritis. What’s most exciting to me is the work that’s being done to help us identify which patient will respond best to which therapy.

Right now, drug choices are largely based on the doctor’s experience. The art of choosing the right biologic is just that, an art. Rheumatologists have long needed more science to support their decision making in choosing the right biologic for the right patient. Now we are much closer to having that.

New treatments for psoriatic arthritis are game changers

There is no question that biologic therapies have revolutionized the way we treat people with inflammatory arthritis. Understanding how various inflammatory conditions differ, at the cellular level, has further refined our ability to target certain inflammatory proteins in each condition. This allows us to be more specific in our treatment strategies.

Psoriatic arthritis, in particular, has benefited from this. We are no longer limited to using biologics developed for rheumatoid arthritis in psoriatic arthritis. Where we’re moving to now is learning how to identify markers within the individual that will help inform which drug is best suited for them.

Another treatment option is the use of Janus kinase (JAK) inhibitors. They are not biological. They come in pill form and can prevent your immune system from making certain enzymes that lead to psoriatic arthritis. Your rheumatologist may even prescribe them before trying a biologic.

Assembling Your Psoriatic Arthritis Toolbox

Psoriatic arthritis can be frustrating, as joint and skin flare-ups can be triggered. Just when you think one is controlled, the other will break out. I work with patients building a robust toolbox that they can draw on when dealing with a diverse set of exacerbation symptoms. Medications are certainly a big part of that toolbox, but dietary changes, improved sleep, mindfulness, and movement are also effective tools that can be used.

What caregivers need to know about psoriatic arthritis

I make sure to remind caregivers to remember that even when their loved one may “look good,” inflammatory conditions, such as psoriatic arthritis, are still present and can affect the person in ways that are not obvious. Fatigue, brain fog, and widespread muscle pain may persist, even if the skin and joints appear fine.