Biologic Treatment and Psoriatic Arthritis
A Review for the Dermatologist
Abstract
In busy dermatology practices, assessing for psoriatic arthritis (PsA) on top of discussing the diagnosis and management options for psoriasis (PsO) can be a challenge. Interestingly, data suggests that dermatologists are poor in evaluating for PsA in their PsO patients. In a study evaluating the prevalence of PsA in dermatology clinics, nearly one third of patients with plaque-type psoriasis were found to have PsA. Moreover, about 40% of those were newly diagnosed with PsA and had not been given a diagnosis of PsA before. This suggests that dermatologists are possibly missing cases of PsA. Dermatologists are uniquely positioned to diagnose PsA early and prevent worsening of the patient’s rheumatologic disease. PsO typically appears 7–12 years before PsA and 64.5% of patients had PsO diagnosed prior to a diagnosis of PsA. By comparison only 19.4% of patients were diagnosed with PsA before a PsO diagnosis. Even a 6-month delay in symptom onset to the first visit with a rheumatologist was associated with worsening peripheral joint erosion and worse long-term physical function.
References
Mease PJ, et al. Comparative performance of psoriatic arthritis screening tools in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2014;71:649–655.
Mease, P. J. & Armstrong, A. W. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs 74, 423–441 (2014).
Elmets, C. A. et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. Journal of the American Academy of Dermatology 80, 1073–1113 (2019).
Scarpa, R. et al. Psoriatic arthritis in psoriatic patients. Br. J. Rheumatol. 23, 246–250 (1984).
Haroon, M., Gallagher, P. & FitzGerald, O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann. Rheum. Dis. 74, 1045–1050 (2015).
Wilson, F. C. et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 61, 233–239 (2009).
Cretu, D. et al. Differentiating Psoriatic Arthritis From Psoriasis Without Psoriatic Arthritis Using Novel Serum Biomarkers. Arthritis Care Res (Hoboken) 70, 454–461 (2018).
Saad, A. A., Symmons, D. P. M., Noyce, P. R. & Ashcroft, D. M. Risks and benefits of tumor necrosis factor-alpha inhibitors in the management of psoriatic arthritis: systematic review and metaanalysis of randomized controlled trials. J. Rheumatol. 35, 883–890 (2008).
Mease, P. J. et al. Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet 356, 385–390 (2000).
Mease, P. J. et al. Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum. 50, 2264–2272 (2004).
Mease, P. J. et al. Continued inhibition of radiographic progression in patients with psoriatic arthritis following 2 years of treatment with etanercept. J. Rheumatol. 33, 712–721 (2006).
Van Den Bosch, F. et al. Randomized double-blind comparison of chimeric monoclonal antibody to tumor necrosis factor alpha (infliximab) versus placebo in active spondylarthropathy. Arthritis Rheum. 46, 755–765 (2002).
Antoni, C. E. et al. Two-year efficacy and safety of infliximab treatment in patients with active psoriatic arthritis: findings of the Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT). J. Rheumatol. 35, 869–876 (2008).
Antoni, C. et al. Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trial. Ann. Rheum. Dis. 64, 1150–1157 (2005).
Kavanaugh, A. et al. The Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT): results of radiographic analyses after 1 year. Ann. Rheum. Dis. 65, 1038–1043 (2006).
Mease, P. J. et al. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 52, 3279–3289 (2005).
Gladman, D. D. et al. Adalimumab for long-term treatment of psoriatic arthritis: forty-eight week data from the adalimumab effectiveness in psoriatic arthritis trial. Arthritis Rheum. 56, 476–488 (2007).
Gladman, D. D. et al. Risk factors for radiographic progression in psoriatic arthritis: subanalysis of the randomized controlled trial ADEPT. Arthritis Res. Ther. 12, R113–9 (2010).
Genovese, M. C. et al. Safety and efficacy of adalimumab in treatment of patients with psoriatic arthritis who had failed disease modifying antirheumatic drug therapy. J. Rheumatol. 34, 1040–1050 (2007).
Van den Bosch, F. et al. Effectiveness of adalimumab in treating patients with active psoriatic arthritis and predictors of good clinical responses for arthritis, skin and nail lesions. Ann. Rheum. Dis. 69, 394–399 (2010).
Mease, P. J. et al. Impact of adalimumab on symptoms of psoriatic arthritis in patients with moderate to severe psoriasis: a pooled analysis of randomized clinical trials. Dermatology (Basel) 220, 1–7 (2010).
Kavanaugh, A. et al. Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: Twenty-four-week efficacy and safety results of a randomized, placebo-controlled study. Arthritis Rheum. 60, 976–986 (2009).
Kavanaugh, A. et al. Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial. Arthritis Rheum. 64, 2504–2517 (2012).
Mease, P. J. et al. Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a Phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Ann. Rheum. Dis. 73, 48–55 (2014).
van der Heijde, D. et al. Effect of different imputation approaches on the evaluation of radiographic progression in patients with psoriatic arthritis: results of the RAPID-PsA 24-week phase III double-blind randomised placebo-controlled study of certolizumab pegol. Ann. Rheum. Dis. 73, 233–237 (2014).
Heiberg, M. S. et al. The comparative effectiveness of anti-TNF therapy and methotrexate in patients with psoriatic arthritis: 6 month results from a longitudinal, observational, multicentre study. Ann. Rheum. Dis. 66, 1038–1042 (2007).
McInnes, I. B. et al. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 382, 780–789 (2013).
Ritchlin, C. et al. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial. Ann. Rheum. Dis. 73, 990–999 (2014).
Kavanaugh, A. et al. Ustekinumab, an anti-IL-12/23 p40 monoclonal antibody, inhibits radiographic progression in patients with active psoriatic arthritis: results of an integrated analysis of radiographic data from the phase 3, multicentre, randomised, double-blind, placebo-controlled PSUMMIT-1 and PSUMMIT-2 trials. Ann. Rheum. Dis. 73, 1000–1006 (2014).
McInnes, I. B. et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 386, 1137–1146 (2015).
Mease, P. J. et al. Secukinumab Provides Sustained Improvements in the Signs and Symptoms of Psoriatic Arthritis: Final 5-year Results from the Phase 3 FUTURE 1 Study. ACR Open Rheumatol 2, 18–25 (2020).
Mease, P. J. Inhibition of interleukin-17, interleukin-23 and the TH17 cell pathway in the treatment of psoriatic arthritis and psoriasis. Curr Opin Rheumatol 27, 127–133 (2015).
Kavanaugh, A. et al. Secukinumab for Long-Term Treatment of Psoriatic Arthritis: A Two-Year Followup From a Phase III, Randomized, Double-Blind Placebo-Controlled Study. Arthritis Care Res (Hoboken) 69, 347–355 (2017).
Mease, P. J. et al. Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann. Rheum. Dis. 76, 79–87 (2017).
Mease, P. J. et al. Brodalumab, an anti-IL17RA monoclonal antibody, in psoriatic arthritis. N. Engl. J. Med. 370, 2295–2306 (2014).
Sondag, M., Verhoeven, F., Guillot, X., Prati, C. & Wendling, D. Efficacy of new treatments for dactylitis of psoriatic arthritis: update of literature review. Clin. Rheumatol. 38, 591–596 (2019).
Deodhar, A. et al. Efficacy and safety of guselkumab in patients with active psoriatic arthritis: a randomised, double-blind, placebo-controlled, phase 2 study. Lancet 391, 2213–2224 (2018).
