Psoriatic arthritis - update on pathophysiology, assessment, and management

Psoriatic arthritis (PsA) is classified as a spondyloarthropathy and characterized by synovitis, enthesitis, dactylitis, and spondylitis, usually manifesting in a person with skin and nail psoriasis. Our understanding about the PsA disease state, its genetics, pathophysiology, and comorbidities, as well as our ability to assess and treat the disease, has advanced as a result of significant collaborative efforts by rheumatologists and dermatologists. This work has been primarily in the development of classification criteria, outcome measures to assess the various clinical domains, and treatment trials with agents also used for diseases such as rheumatoid arthritis (RA) and psoriasis. Biologic agents, especially the anti-TNFs, have demonstrated significant efficacy and reasonable safety in all clinical domains of the disease, resulting in amelioration of clinical symptoms, inhibition of structural damage, and improvement of function and quality of life. A number of advances in assessment and treatment have occurred in the last few years, which are highlighted in this update. This article reviews assessment and treatment of PsA, with an emphasis on recent data.