Management of psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic inflammatory disease that can be progressive and may be associated with permanent joint damage and disability. Early identification of PsA will enable these patients with progressive disease to be treated early and aggressively. Due to lack of consistent diagnostic or classification criteria in the past, PsA was considered as uncommon. Overall it affects 6-10% of all psoriasis patients during the course of their disease. Both dermatologists and rheumatologists should be involved in the diagnosis and management of this disorder. Interest in PsA has greatly enhanced over the past several years due to many factors including a better understanding of disease mechanisms, improved investigational tools, better clinical trial design and perhaps most importantly, the availability of newer therapeutic agents. Mild forms of PsA can initially be treated with nonsteroidal antiinflammatory drugs (NSAID). In acute as well as oligo- to polyarticular joint involvement, disease-modifying anti-rheumatic drugs (DMARD) are indicated for PsA. The biologics particularly tumor necrosis factor alpha (TNF-alpha) antagonists are gaining increasing significance as second-line therapy. Treatment choice should also take into consideration the extent of skin involvement.