| | Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: Overview and guidelines of care for treatment with an emphasis on the biologicsPsoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this second of 5 sections of the guidelines of care for psoriasis, we give an overview of psoriatic arthritis including its cardinal clinical features, pathogenesis, prognosis, classification, assessment tools used to evaluate psoriatic arthritis, and the approach to treatment. Although patients with mild to moderate psoriatic arthritis may be treated with nonsteroidal anti-inflammatory drugs and/or intra-articular steroid injections, the use of disease-modifying antirheumatic drugs, particularly methotrexate, along with the biologic agents, are considered the standard of care in patients with more significant psoriatic arthritis. We will discuss the use of disease-modifying antirheumatic drugs and the biologic therapies in the treatment of patients with moderate to severe psoriatic arthritis. Abbreviations used: AAD, American Academy of Dermatology, ACR, American College of Rheumatology, AS, ankylosing spondylitis, DAS, Disease Activity Score, DIP, distal interphalangeal, DMARD, disease-modifying antirheumatic drug, FDA, Food and Drug Administration, HAQ, Health Assessment Questionnaire, IL, interleukin, NSAID, nonsteroidal anti-inflammatory drug, PsA, psoriatic arthritis, PsARC, Psoriatic Arthritis Response Criteria, QOL, quality of life, RA, rheumatoid arthritis, TNF, tumor necrosis factor a Department of Dermatology, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts b Murdough Family Center For Psoriasis, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio c Division of Dermatology, Evanston Northwestern Healthcare and Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois d Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina e Department of Dermatology, Mount Sinai School of Medicine, New York, New York f Department of Dermatology, University of California–San Francisco, San Francisco, California g Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania h University of Alabama at Birmingham, Birmingham, Alabama i Department of Dermatology, Saint Louis University, Saint Louis, Missouri j Anacor Pharmaceuticals Inc, Palo Alto, California k American Academy of Dermatology, Schaumburg, Illinois l Baylor University Medical Center, Dallas, Texas  Reprint requests: Reva Bhushan, PhD, 930 E Woodfield Rd, Schaumburg, IL 60173.
Conflicts of interest: The authors' conflict of interest/disclosure statements appear at the end of the article. PII: S0190-9622(08)00274-0 doi:10.1016/j.jaad.2008.02.040 © 2008 American Academy of Dermatology, Inc. Published by Elsevier Inc All rights reserved. | |
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