Multidimensional drug therapy strategies for psoriatic arthritis
WANG Jian-xiong
XU Sheng-qian
Abstract：Psoriatic arthritis(PsA)requires a multidimensional stratified treatment approach targeting peripheral joints,axial involvement,enthesitis,dactylitis,and extra-articular manifestations including cutaneous/nail psoriasis,uveitis,inflammatory bowel disease(IBD),and comorbidities to achieve treat-to-target goals.For axial involvement,TNF inhibitors(TNFi)or IL-17A inhibitors are preferred first-line options,while IL-12/23inhibitors(IL-12/23i)and IL-23inhibitors(IL-23i)are not recommended due to insufficient clinical evidence;peripheral arthritis should be initially managed with csDMARDs(e.g,methotrexate),with timely escalation to TNFi,IL-17i or IL-23i for high disease activity,as clinical studies demonstrate superior efficacy of early intensive biologic therapy over conventional drugs;enthesitis and dactylitis patients should directly receive TNFi,IL-17i or tsDMARDs therapy,avoiding csDMARD monotherapy;patients with concomitant cutaneous/nail psoriasis require combination biologics targeting IL-17/IL-23 pathways,with IL-17A/Finhibitors or IL-23i prioritized for severe skin lesions,body surface area score(BSA)≥10.For the management of extra-articular manifestations,monoclonal TNFi(adalimumab or infliximab)are preferred for uveitis,while IL-17i is contraindicated in IBD.The latest evidence emphasizes that dynamic treatment adjustment(e.g.,switching to IL-17i or JAKinhibitors after TNFi failure)and personalized regimens tailored to individual patient characteristics are crucial for achieving sustained clinical remission.With the development of novel targeted drugs like TYK2 inhibitors,PsA's precision treatment framework will be further refined.
Keywords：psoriatic arthritistreat-to-targetmultidimensional evaluation
Publication Date：2025-09-01
Online Publishing Date：2025-10-21(First online date of this platform, not the publication date of the document)
Pages：9( 748-756 )