Psoriatic arthritis (PsA) is a complicated condition that can present very differently in different people. Currently, there is no cure for this condition.
PsA occurs in about 30% of people with psoriasis. However, one study suggests that up to two-thirds of individuals with PsA have not received a diagnosis from a rheumatologist.
Because PsA is so complex, treatment can be difficult. The same study suggests that up to 60% of people with PsA do not respond well to traditional treatments.
As our understanding of the condition grows, more and more treatment options are becoming available. However, it remains unclear if a cure will be available in the future.
Learn more below about the changing landscape of PsA treatment from experts in the field.
“[PsA] is caused by an imbalance in the body’s immune system, which causes inflammation in the joints and skin,” explained Dr. Joseph F. Merola, director of the Center for Skin and Related Musculoskeletal Diseases at the Brigham and Women’s Hospital in Boston, MA, and Dr. Lourdes Perez-Chada, a dermatologist and PsA research fellow at the Brigham and Women’s Hospital.
“This abnormal immune response is likely [regulated] by genetic factors. For example, many people with PsA have a family history of either psoriasis or PsA, and several genetic markers have been associated with PsA,” they added.
There are other factors involved, as well.
“We know a fair amount of the genetics, but the genetic contribution [of PsA] is quite incomplete and not very useful in the clinic,” said Dr. Arthur Kavanaugh, a professor of medicine at the University of California, San Diego.
“As most people who develop PsA have skin psoriasis long before they develop PsA, there are clearly other factors involved,” Dr. Kavanaugh noted.
“Environmental factors, our gastrointestinal microbiome, and physical trauma may also play a role in triggering or perpetuating PsA in people with an inherited tendency,” Drs. Merola and Perez-Chada suggested.
“There has been tremendous progress, with many new therapies available recently,” said Dr. Kavanaugh.
“It is as good a time as any in the past to have psoriatic disease,” Drs. Merola and Perez-Chada stated. “Treatments for psoriatic skin disease have come a particularly long way, with newer agents able to get a majority of [people] clear or almost clear with regard to skin disease.”
“Treatments for PsA have also come a long way, although we have a harder time pushing the envelope on [more complicated aspects of PsA], such as low disease activity or remission.”
“The management of PsA is mainly challenged by the multifaceted nature of the disease. PsA may present with different clinical features […] that sometimes respond differently to different treatments,” they noted.
Drs. Merola and Perez-Chada also explained that treatment may be complicated by the presence of other health concerns, which may affect the availability of safe treatment options and make it harder to determine whether or not treatment is working.
“To optimize treatment in PsA, most treatment guidelines suggest following a treat-to-target approach. In this approach, [doctors] monitor disease activity through the measurement of well-defined, clinically relevant targets and adjust therapy accordingly,” said Drs. Merola and Perez-Chada.
However, they added that there is still work to be done for this kind of treatment approach. Challenges include:
- the lack of a clear definition of PsA disease remission
- limited data to guide the selection of one treatment over another
- the presence of joint damage from PsA, which may not respond well to treatment
This “trial-and-error” approach to treatment may also require more visits to the clinic, higher treatment costs, and more frequent side effects.
Experts tend to agree that markers that can guide treatment at an individual level would represent a much-needed advancement for PsA treatment. This strategy is known as precision medicine.
“The ultimate goal would be a marker of some sort so that we know what specific treatment is best for each individual,” Dr. Kavanaugh explained.
“Predicting which treatment will [work well] for an individual [person] or disease manifestation is one of the key unmet needs in psoriatic disease management,” Drs. Merola and Perez-Chada added.
“While several studies have identified genetic, [blood], and cellular factors that might be associated with treatment response in psoriatic disease, more research is needed to confirm [if these markers work well enough].”
The experts were hopeful that a cure may someday be available, but they emphasized that there is still a lot that we need to understand before we can reach that point.
“Ideally, a cure is the ultimate goal; hopefully we can get there,” Dr. Kavanaugh said. “But PsA, like many autoimmune diseases, is incredibly complicated.”
Drs. Merola and Perez-Chada agreed. “A cure for PsA remains aspirational at present. However, the remarkable advances in genomics, informatics, immunology, molecular biology, and treatments are certainly paving the way toward finding a cure.”
“[People with PsA] can get involved in research endeavors related to a cure and remission through multiple organizations dedicated to psoriatic research,” suggested Drs. Merola and Perez-Chada.
These organizations include the:
- National Psoriasis Foundation
- American College of Rheumatology
- Group for Research and Assessment of Psoriasis and Psoriatic Arthritis
- Psoriasis & Psoriatic Arthritis Clinics Multicenter Advancement Network
- International Dermatology Outcome Measures initiative
People with PsA can also participate directly in ongoing clinical research studies and registries. These are available through the organizations above.
Treatment options for PsA have come a long way in recent years. There is still a lot of work to do to fully understand PsA, but experts seem optimistic about the future of treatment.
Research that focuses on understanding what PsA looks like in different individuals will help push the field toward a precision medicine-based approached to treatment, which may be the first step toward finding a cure.