Recent advances in the management of psoriatic arthritis: practical considerations

Psoriatic arthritis (PsA) is an inflammatory arthritis characterized by inflammation of peripheral and / or axial joints, with or without other tissue manifestations, including skin psoriasis, dactylitis, enthesitis, uveitis, and inflammatory bowel disease. There has been an exponential increase in PsA treatment options over the last 2 decades, and while guidelines have attempted to keep up with the deluge of emerging data, there are several areas in which guidance remains sparse. This is, in part, due to a lack of robust strategy trials, head-to-head studies, and real-world observational data. In addition, trials seldom address key questions, such as the complex need to balance the treatment of joint disease with the other competing tissue manifestations of PsA, as well as other relevant medical comorbidities and patient lifestyle and personal preferences, all of which may change several times over the course of an individual’s lifetime. This article provides a concise summary of the current state of guidelines for the management of PsA, and an in-depth discussion of some of the areas where guidelines and evidence are still lacking. These areas of unmet clinical need in the treatment of PsA should be a priority for further PsA research in the coming years. Only by working with patients and addressing these gaps in our knowledge can we strive for a future where all PsA patients are able to receive treatment that is the best for them, and tailored to their specific needs at any particular time point in their disease trajectory.