Psoriasis in Psoriatic Arthritis and Treatment Classes

Welcome to Rheumatology Live Cure Connections series. In "PsA and Obesity: A Veteran Patient's 10-Year Journey," moderator Catherine Bakewell, MD is joined by Elizabeth Perkins, MD and Kameillia Welch to open the series on psoriatic arthritis and obesity.

Dr. Perkins addresses how common psoriatic arthritis actually is. She says current data suggest 30% to 40% of patients with psoriasis go on to develop psoriatic arthritis, though she considers the figure a moving target. She explains the condition is often underrecognized. Patients and clinicians are still learning to distinguish it from other forms of joint pain. Psoriatic arthritis affects both joints and tendons, she says, so it can be trickier to diagnose than typical arthritis. In her own clinic, the true prevalence feels higher than published estimates suggest. That reflects how understanding of the disease has evolved with better education.

Dr. Perkins reviews the treatment landscape for psoriatic arthritis, starting with older disease-modifying antirheumatic drugs, or DMARDs. She explains these are small-molecule pills filled at a retail pharmacy that target the disease with varying degrees of efficacy and tolerability. Because DMARDs do not work equally well for every patient, she says biologics emerged to close that gap. She walks through the major biologic classes now available: five TNF inhibitors, three IL-17 inhibitors, several JAK inhibitors, and the newer IL-23 class, plus small-molecule PDE4 inhibitors, with more still in development. Dr. Perkins says this range gives patients a real chance at finding a treatment that works for them. Choosing the right one requires understanding trial data. It also means weighing each drug's risks and benefits against the patient in front of her. She notes that reaching a diagnosis can be difficult enough. Finding the right drug for a given patient is often just as hard.

The next episode in this series, "The Path to Diagnosis of Psoriatic Arthritis," features Kameillia Welch describing the journey of her disease and diagnosis.