General measures

  • joint protection
  • exercise
  • weight loss
  • reduction of stress
  • physical therapy, occupational therapy. Note: there is no randomized control trial (RCT) which assesses the benefit of physical therapy in patients (Here is a 2021 review of the current evidence: LINK)

 

Classical Medication

  • NSAIDS: Non Steroidal Anti Inflammatory Drugs
  • Leflunomide
  • Sulfasalazine
  • Corticosteroids (intraarticular injections)
  • Methotrexate (MTX): improves symptoms but does not delay radiographic progression of the disease
  • Ciclosporine

 

“Biologics”

  1. –Tremfya (guselkumab) – an IL-23 inhibitor given via subcutaneous injection every 8 weeks.
  2. –Skyrizi (risankizumab) – an IL-23 inhibitor given via subcutaneous injection every 12 weeks.
  3. –Cosentyx (secukinumab) – blocks IL-17A and is administered as a subcutaneous injection every 4 weeks.
  4. –Taltz (ixekizumab) – another IL-17 blocker given as a monthly subcutaneous injection.
  5. –Stelara (ustekinumab) – an interleukin-12 and -23 inhibitor given as a subcutaneous injection or IV infusion.
  6. –Enbrel (etanercept) – another TNF-alpha blocker given as a weekly subcutaneous injection or twice weekly for severe symptoms.
  7. –Remicade (infliximab) – a TNF-alpha blocker given through IV infusion every 6 to 8 weeks.
  8. –Humira (adalimumab) – a TNF-alpha blocker administered as a subcutaneous injection every other week, or weekly if necessary.
  9. –Cimzia (certolizumab pegol) – a TNF-alpha blocker given via subcutaneous injection every 2 to 4 weeks.
  10. –Orencia (abatacept) – the only biologic stopping T cells, available as a weekly subcutaneous injection or IV infusion every 4 weeks.
  11. –Simponi (golimumab) – a TNF-alpha blocker available as a subcutaneous injection or IV infusion.

 

Comments

  • Apremilast (Otezla), although no mentioned also shows interesting results
  • Il -7 inhibitors such as ustekinumab and brodalumab (withdrawn at time of publication) respond more in a delayed way on the arthritis, although they work effectively on the skin

 

 

Psoriatic arthritis for the dermatologist. Alan Menter (United States). SY31 – Clinical Aspects of Psoriasis, Including Co-Morbidities. World Congress of Dermatology 2015 –  Vancouver, Canada

Updated July 2023