title: Advances in the management of psoriatic arthritis.
abstract: Psoriatic arthritis (PsA), which affects musculoskeletal structures, skin and nails, is a heterogeneous chronic inflammatory disease with a wide clinical spectrum and variable course. Patients with PsA are more likely than healthy individuals to have metabolic syndrome or cardiovascular disease. To include these comorbidities, 'psoriatic disease' has been suggested as an umbrella term. The management of PsA has changed tremendously over the past decade owing to early diagnosis and improvement in treatment strategies, including, early referral from dermatologists and primary-care physicians to rheumatologists, early initiation of therapy, treating to the target of remission or low disease activity, and advances in pharmacological therapy. Outcome assessment is also improving, because of validated instruments for clinical disease manifestations. The commercialization of TNF blockers, including adalimumab, etanercept, golimumab and infliximab, is representative of a revolution in the treatment of PsA. A new anti-TNF agent, certolizumab pegol, and a fully human monoclonal antibody against IL-12 and IL-23, ustekinumab, are approved for the treatment of active PsA. The efficacy of ustekinumab suggests that inhibiting the type 17 T helper pathway might be an alternative to blocking TNF. PsA management must now use improved measures to predict patient outcomes and define remission, and develop better-targeted therapies.
authors.affiliation: Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Via Potito Petrone Snc, Potenza 85100, Italy.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.affiliation: Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Via Potito Petrone Snc, Potenza 85100, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Angelo
authors.affiliation: Rheumatology Department of Lucania, Madonna delle Grazie Hospital of Matera, Contrada Cattedra Ambulante Snc, Matera 75100, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Palazzi
authors.affiliation: Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Via Potito Petrone Snc, Potenza 85100, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Padula
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D006801:Humans; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha