Difficult to treat psoriatic arthritis — how should we manage?

Psoriatic arthritis (PsA) is a chronic, multi-domain immune–mediated inflammatory arthritis with a high disease burden. PsA patients have significant co-morbidities like obesity, depression, fibromyalgia which can impact disease activity assessment. The management of PsA has undergone a paradigm shi...

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Bibliographic Details
Published in:Clinical rheumatology 2023-09, Vol.42 (9), p.2251-2265
Main Authors: Kumthekar, Anand, Ashrafi, Maedeh, Deodhar, Atul
Format: Article
Language:English
Subjects:
Cardiovascular disease
Clinical medicine
Differential diagnosis
Fibromyalgia
Immunosuppressive agents
Inflammation
Inflammatory diseases
Medicine
Medicine & Public Health
Morbidity
Patients
Psoriasis
Psoriatic arthritis
Remission (Medicine)
Review Article
Rheumatology
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Summary:Psoriatic arthritis (PsA) is a chronic, multi-domain immune–mediated inflammatory arthritis with a high disease burden. PsA patients have significant co-morbidities like obesity, depression, fibromyalgia which can impact disease activity assessment. The management of PsA has undergone a paradigm shift over the last decade due to the availability of multiple biologic and targeted synthetic disease modifying anti-rheumatic drugs. Despite the availability of multiple therapeutic agents, it is not uncommon to find patients not responding adequately and continuing to have active disease and/or high disease burden. In our review, we propose what is “difficult to treat PsA”, discuss differential diagnosis, commonly overlooked factors, co-morbidities that affect treatment responses, and suggest a stepwise algorithm to manage these patients.
ISSN:0770-3198
1434-9949
DOI:10.1007/s10067-023-06605-9