Management of psoriatic arthritis (PsA)

Published on October 28, 2021   28 min

A selection of talks on Clinical Practice

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Hello, my name's Laura Coates, an associate professor from the University of Oxford, and I'll be speaking today about the treatment of psoriatic arthritis.
When we think about the treatment of psoriatic arthritis, this slide shows the overarching principles for treatment, from the GRAPPA recommendations (the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis). Here we see goals of therapy, guidance on the way that we assess patients, assessment of co-morbidities, individualising treatment choices, and incorporating prompt and regular review, which underpin how we treat people with psoriatic arthritis. We need to control inflammation, minimise complications from the disease and from the treatment, and aim to reduce disease impact, and maximise quality of life for patients.
Now we're going to talk more about the three principles shown on the bottom of the previous slide, the first one being the assessment of co-morbidities. We know that co-morbidities are particularly important for patients with psoriasis, and psoriatic arthritis. They have a high rate of depression and anxiety, a high rate of cardiovascular complications - including obesity, diabetes, and the metabolic syndrome - and it's often associated with liver disease and gout, which may impact and complicate the assessment of disease, and the use of some of our common medications.
The GRAPPA treatment recommendations list clear advice on the treatments that can be used in co-morbidities, as shown here in this table. Across the top, you can see the different medications used in psoriatic arthritis, and down the left-hand side, key co-morbidities and related conditions that we see. It's clear that, depending on the co-morbidities, this may push you towards or away from a particular treatment. For example, a number of the anti-TNF treatments also have a license for ulcerative colitis and Crohn's disease, so may be particularly helpful in patients who have these conditions as well; whereas some medications have a caution around use in patients with diabetes or liver disease, and it may be better to choose an alternative therapy. This brings me on to individualising treatment.