It feels like a long decade has passed since March 2020. At The Rheumatologist, we closed out 2020 with a special supplement on gout. Physician Editor Phil Seo, MD, MHS, kicked off that supplement with, “COVID-19. Black Lives Matter. A new gout guideline. These are some of the things 2020 ushered in. And we’re unlikely to see them out anytime soon.”
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Almost a year later, here we are with a new wave of COVID-19, a raging culture war over vaccinations, an ongoing investigation over the Jan. 6 insurrection and a vague sense of annoyance that of course Phil Seo had to be right about this. Here’s hoping these accursed problems stay in 2021. Sadly, I assume they won’t.
As a faint consolation, we come bearing a new supplement to help ring in 2022 a bit early. This time, we focus on psoriatic arthritis.
In recent years, the world of psoriasis therapies has been blessed with an embarrassment of riches. We have now reached a point in which we are conducting clinical trials of multiple new drugs for psoriasis, and these trials are achieving a 90% improvement of psoriasis in a majority of patients (not to mention 100% clearance in a substantial minority). These medications have been a boon for many patients with psoriasis.
Patients with psoriatic arthritis and the rheumatologists who care for them have also benefited from this dramatic expansion of available agents, which now rivals the selection available for treatment of rheumatoid arthritis. Our data have become increasingly granular, which has improved our understanding of the impact of medications on specific domains of PsA, on the management of comorbid conditions and on the pathophysiology of this condition.
Saying that it’s an exciting time to be in this field is an understatement. And yet substantial challenges remain:
Despite the dramatic advances in the management of psoriasis, levels of ACR 20/50/70 responses in PsA trials continue to persist at the 60/40/20 plateau so familiar to rheumatologists. We still lack biomarkers for diagnosis or disease activity monitoring. Outcome measures have not been widely adopted in clinical practice. From a diagnostic standpoint, there remains considerable uncertainty on the ideal approach to imaging and identification of enthesitis, a core domain of disease. The entity of axial PsA remains something of an enigma. And the simultaneous control of all domains of disease and comorbid conditions all too often remains elusive.