Trends I See in Psoriatic Arthritis Treatment

By Elizabeth Ortiz, MD, as told to Janie McQueen

Understanding of Psoriatic Arthritis Has Improved

I’ve seen a big increase in our understanding of psoriatic arthritis just in my time in practice. This has resulted in more specific treatments but also our ability to make a more rapid diagnosis.

There are no specific blood tests for psoriatic arthritis. Making a diagnosis relies heavily on the doctor’s experience and level of suspicion. As we have learned more about what to look for and how the symptoms may vary among men, women, and people of color, collectively our experience and level of suspicion have been raised. This results in patients reaching an appropriate 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

There are always a number of clinical trials being done to evaluate the effectiveness of targeting new inflammatory proteins along the complicated inflammatory cascade that’s activated in psoriatic arthritis. For me, what is most exciting is the work being done to help us identify which patient will respond best to which therapy.

Right now, medication choices are made based largely on physician experience. The art of choosing the right biologic is just that, an art. Rheumatologists have long needed more science to back their decision-making in choosing the right biologic for the right patient. We are now much closer to having that. 

New Treatments for Psoriatic Arthritis Are Game Changers

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

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

Another treatment option is using Janus kinase (JAK) inhibitors. They’re not biologics. They come in a pill form and can prevent your immune system from making certain enzymes that lead to psoriatic arthritis. Your rheumatologist may even prescribe these before trying a biologic. 

Gathering Your Toolbox for Psoriatic Arthritis 

Psoriatic arthritis can be frustrating, as joint and skin flares can be disconnected. Just when you think one is controlled, the other will flare. I work with patients in building a robust toolbox they can turn to when faced with a diverse set of flare symptoms. Medications are certainly a big part of that toolbox, but diet changes, improved sleep, mindfulness, and movement are also effective tools that can be utilized. 

What Caregivers Should Know About Psoriatic Arthritis 

I make sure to remind caregivers to remember that even when their loved one may “look OK,” inflammatory conditions, such as psoriatic arthritis, are still there and can be impacting the person in ways that aren’t obvious. Fatigue, brain fog, and generalized muscle pain can persist, even if the skin and joints seem OK.