WWW.6-DOMAINS.COM IS NOT INTENDED FOR US, UK OR IRELAND AUDIENCES

Treating psoriatic arthritis: Advances in our understanding

Professor Pascal Richette, Dr Frank Behrens and Professor Oliver FitzGerald share their perspective on the importance of tailoring your treatment approach to consider all six domains of psoriatic arthritis and individual patient needs.

Play button

Advances in the understanding of psoriatic arthritis pathophysiology, comorbidities and assessment measures, in addition to the development of new targeted therapies, have led to the updating of treatment recommendations, such as the GRAPPA recommendations (see Additional Resources).68

New targeted drug treatments have demonstrated different results in psoriatic arthritis and rheumatoid arthritis patients, suggesting the diseases have distinct underlying mechanisms and require different treatment approaches.69

Updated recommendations advise that treatment selection for psoriatic arthritis should take into account the different active disease domains and the presence of comorbidities. Therapies in psoriatic arthritis should target as many active disease domains as possible.

Historically, conventional disease-modifying antirheumatic drugs (cDMARDs) have been used to treat psoriatic arthritis based on efficacy in treating joint disease in rheumatoid arthritis, and for cutaneous psoriasis.70 However, there are conflicting data on the benefits of cDMARDs in treating some domains of psoriatic arthritis, such as enthesitis.21,71

GRAPPA recommendations

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) advocate a tailored treatment approach for patients with psoriatic arthritis based on domain involvement, to optimise patient benefit.68 The recommendations suggest targeting as many active disease domains as possible and considering a patient’s prior treatment history and comorbidities.68

The therapeutic recommendations differ between disease domains. For example, cDMARDs are not recommended for the treatment of patients with enthesitis.68

Taking patient preference into consideration: The MAPP Study

The objective of the Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) study was to investigate physicians’ perspectives on the effect of psoriasis and psoriatic arthritis on patients’ daily lives, and of patients’ satisfaction with treatments and medical care.72,73

The study findings suggested a mismatch between patient perceptions and treatment goals, with concerns among participating physicians and patients about the use of conventional treatments to treat psoriasis or psoriatic arthritis. Tolerability issues were the most common patient concerns regarding the use of cDMARDs (78%)72 and the most common reason for rheumatologists not initiating cDMARDs therapy (30%).72

Long-term safety, patient contraindications, side effects, patient lifestyle modifications and loss or reduction of efficacy with the use of cDMARD therapy were also areas of concern for physicians and patients.72,73

The MAPP survey revealed that 57% of the psoriasis and psoriatic arthritis patients who had been prescribed a cDMARD discontinued treatment. This was most often due to safety and tolerability issues (45%), and/or lack of efficacy (30%).73

Further research has identified concerns around pre-screening and ongoing monitoring requirements, as well as multiple cautions associated with the use of cDMARDs, for example in patients with fatty liver disease, a comorbidity associated with psoriatic arthritis. Research concludes that alternative treatment options are important to help patients for whom cDMARDs therapy is ineffective or unsuitable.74

References

1. Kavanaugh A, et al. Rheumatol Ther 2016;3:91–102
2. Kyriakou A, et al. Sci World J 2014; Article ID 508178;
3. Lee E, et al. J Exp Med 2004;199:125–30;
4. Lowes M, et al. J Invest Dermatol 2008;128:1207–11
5. Yao Y, et al. PLoS One 2008;3:e2737
6. Taylan A, et al. Rheumatol Int 2012;32:2511
7. Limon-Camacho L, et al. J Rheumatol 2012;39:830–5.
8. Van Kuijk A and Tak P. Curr Rheumatol Rep 2011;13:353–9
9. Ritchlin C, et al. J Rheumatol 1998;25:1544–52
10. Menon B, et al. Arthritis Rheumatol 2014;66:1272–81
11. Celis R, et al. Arthritis Res Ther 2012;14:R93
12. Spadaro A, et al. Ann Rheum Dis 2002;6:174–6
13. Molteni S and Reali E. Psoriasis: Targets and Therapy 2012;2:55–66
14. Siegel E, et al. Curr Opin Rheumatol 2015;27:111–7
15. Lories R, et al. Nat Med 2012;18:1018–9
16. Ebihara S, et al. Autoimmunity 2015;29:1–8
17. Ruutu M, et al. Arthritis Rheum 2012;64;2211–22
18. Sherlock J, et al. Nat Med 2012;18:1069–77
19. Yamamoto M, et al. J Invest Dermatol 2015;135:445–53
20. Reinhardt A, et al. Arthritis Rheumatol 2016;68:2476–86
21. Coates LC, et al. Lancet 2015;386:2489–98.
22. Mease PJ, et al. Drugs 2014;74:423–41.
23. Schafer P. Biochem Pharmacol 2012;83:1583–90.
24. Van Kuijk A and Tak P. Curr Rheumatol Rep 2011;13:353–9
25. Ritchlin C, et al. J Rheumatol 1998;25:1544–52

26. Menon B, et al. Arthritis Rheumatol 2014;66:1272–81
27. Celis R, et al. Arthritis Res Ther 2012;14:R93
28. Spadaro A, et al. Ann Rheum Dis 2002;6:174–6
29. Molteni S and Reali E. Psoriasis: Targets and Therapy 2012;2:55–66
30. Siegel E, et al. Curr Opin Rheumatol 2015;27:111–7
31. Lories R, et al. Nat Med 2012;18:1018–9
32. Ebihara S, et al. Autoimmunity 2015;29:1–8
33. Ruutu M, et al. Arthritis Rheum 2012;64;2211–22
34. Sherlock J, et al. Nat Med 2012;18:1069–77
35. Yamamoto M, et al. J Invest Dermatol 2015;135:445–53.
36. Reinhardt A, et al. Arthritis Rheumatol 2016;68:2476–86
37. Taylan A, et al. Rheumatol Int 2012;32:2511
38. Limon-Camacho L,et al. J Rheumatol 2012;39:830–5.
39. Lee E, et al. J Exp Med 2004;199:125–30
40. Lowes M, et al. J Invest Dermatol 2008;128:1207–11
41. Yao Y, et al. PLoS One 2008;3:e2737
42. Kyriakou A, et al. Sci World J 2014;Article ID 508178.
43. Gottlieb A, et al. J Am Acad Dermatol 2008;58:851–64.
44. Scutellari P, et al. Eur J Radiol 1998;27(suppl 1):S31–38.
45. Coates LC, et al. Arthritis Rheumatol 2016;68:1060–71.
46. Moll JMH and Wright V. Semin Arthritis Rheum 1973;3:55–78.
47. Helliwell PS. Clin Rheum 2015;33:S44-47
48. McGonagle D, et al. Lancet 1998;352:1137–40.
49. McGonagle D & McDermott MF. PLoS Med 2006;3:e29.

50. Schett G, et al. Nat Rev Rheumatol 2017;13:731–41.
51. Ritchlin CT, et al. N Engl J Med 2017;376:957–70
52. Ravindran J, et al. Arthritis Care Res 2010;62:86–91.
53. Gladman DD, et al. Arthritis Rheum 2007;56:476–88.
54. Kavanaugh A, et al. Arthritis Rheum 2012;64:2504–17.
55. Kavanaugh A, et al. Ann Rheum Dis 2014;73:1020–6
56. van der Heijde D, et al. Arthritis Rheum 2016;68:1914–21
57. Strand V & Sharp JT. Arthritis Rheum 2003;48:21–34.
58. van der Heijde, et al. Ann Rheum Dis 2005; 64(Suppl II):ii61–4.
59. Husted JA, et al. Arthritis Care Res (Hoboken) 2011;63:1729–35
60. Husted JA, et al. J Rheumatol 2013;40:1349–56.
61. Edson-Heredia E, et al. J Eur Acad Dermatol Venereol 2015;29:955–63.
62. Ogdie A, et al. J Rheumatol 2014;41:2315–22.
63. Ogdie A, et al. J Invest Dermatol 2017 [Epub]
64. Coates LC et al. Arthritis Rheum. 2013;65:1504–9.
65. Nossent JC and Gran JT. Scand J Rheumatol 2009;38:251–5
66. Lindqvist URC et al. J Rheum 2008;35:668–73.
67. Huscher D, et al. ACR 2015: Abstract 679.
68. Coates LC, et al. Arthritis Rheumatol 2016;68:1060–71.
69. Veale DJ & Fearon U. RMD Open 2015;1:e000025.
70. Wilsdon TD, et al. Cochrane Database Syst Rev 2017, Art. No.: CD012722.
71. Kingsley GH, et al. Rheumatology 2012;51:1368–77.
72. van de Kerkhof PCM, et al. J Eur Acad Dermatol Venereol 2015;29:2002–10.
73. Lebwohl MD, et al. J Am Acad Derm 2014;70:871–81.
74. van Mens LJJ, et al. Arthritis Res Ther 2017;19:226.

celgene

© Celgene Corporation 2018. All rights reserved
Six Domains Programme was developed by Celgene

logo white

We use cookies to improve the website and your navigation experience based on our Terms of Use and Privacy Policy. To accept cookies continue to browse the site or click the button. For information on how we use cookies and how to disable them, please visit our Cookies Policy.

OK