Bright Futures: Medical and Treatment Developments for PsA

There is currently no cure for PsA, but new treatments are always on the horizon.

Current psoriatic arthritis (PsA) treatment includes a combination of lifestyle modifications and medications. There is currently no cure for PsA, but new treatments are always on the horizon.

Diagnosing PsA has evolved dramatically over the last few decades. It wasn’t even recognized as an autoimmune disease until the mid-to-late-90s. Today, most people are getting an appropriate diagnosis early on and receiving the treatments they need to live active and fulfilling lives.

Let’s take a look at a few of the recent developments and breakthroughs for PsA care.

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New medications

There are more new medication options available now than ever before. Having multiple options is important because there is not one drug that works for everyone with PsA. Medications available for PsA need to target many parts of the body, since the condition can affect the joints, tendons, ligaments, fingers, toes, spine, and skin. 

A new option in the treatment of moderate to severe plaque psoriasis is deucravacitinib (Sotyktu), which is the first available TYK2 inhibitor. This oral medication offers a systemic therapy that may help to reduce psoriatic symptoms.

Tofacitinib (Xeljanz) was the first medication type to consider fatigue and sleep as part of the treatment plan. Some 2022 data showed clinically significant improvements in fatigue and sleep in people who took tofacitinib.

Almost 6% of people with PsA report difficulty sleeping, so a treatment that reduces inflammation and improves sleep quality is a promising new development.

Treat-to-target approach

The American Academy of Dermatology and the National Psoriasis Foundation collaborated on 2019 guidelines for diagnosing and treating PsA. They recommend a treat-to-target approach. This means medications should be adjusted until the patient’s goals are achieved.

There’s a lot of trial-and-error within the treat-to-target approach. Most medications for PsA take several weeks or even months to take full effect, so it can be a long period of experimentation.

The ultimate goal of the treat-to-target method is remission. However, if someone has had PsA for a long time, fewer skin plaques and less joint pain may be a more realistic goal.

Although treat-to-target is a new approach for PsA, it’s been used for many other chronic and rheumatological diseases over the years. It’s now become the standard.

Promising new studies

Many promising new studies have been published in the last several years.

Target medications by T-cell type

A 2018 study showed that selecting biologics according to T-cell type showed high therapeutic responses for PsA. In other words, typing a patient’s T-cells can show which biologic would be most compatible with their body chemistry. This exciting precision technology has already shown success in the treatment of other chronic diseases.

A two-fold biologic approach

A 2019 case report depicted success with biologic medications that interfere with two different immune pathways at the same time. Think of it like stopping traffic at an intersection. If you block two roads, it creates less traffic than if only one road is blocked. This approach may also decrease the toxicity potential of the medications by requiring lower doses.

Less serious infections

A 2021 study showed a decrease in hospitalizations for blood infections, skin and soft tissue infections, and urinary tract infections in people with PsA between 2012 and 2017. Even though biologic use increased, serious infections were down overall.

According to a 2019 study, the newest classes of drugs, IL-17 and IL-12/23, had a reduced risk of infection in people who had never taken a biologic before.

The PsA-gut connection

Bacteria may play a role in PsA, too. A 2021 study with identical twins showed that an absence of Ruminococcus bromii bacteria in the gut may be linked to PsA. A 2020 research review shared that atypical levels of Candida albicans and Staphylococcus aureus bacteria may also be connected to PsA.

More research is needed to establish a connection between the gut and psoriatic disease, but the current studies are promising.

My reasons for hope

Recent developments are full of new insight into PsA treatment, and there is so much hope for the future.

Condition awareness is at an all-time high in public and medical settings. PsA is easier to diagnose and that means people have expedited access to healthcare and appropriate treatments. Today’s medications are more effective and more targeted than ever before.

As a healthcare professional, these are my hopes for the future of PsA treatment:

• One day a small, daily pill will treat all physical symptoms — not only skin plaques, but also joint pain and debilitating fatigue. The medication will stop PsA from advancing and avoid all disabilities associated with its physical symptoms.

• The anxiety and depression that comes with PsA will be discussed and addressed without prompting in our medical appointments. Mental health treatment will simply be included in the targeted treatments for our PsA.

• Treatments and technologies will be more accessible to people through a primary care doctor or even through telehealth.

• Medications will be longer-acting. All injectables will become so advanced that you’ll only need one every few months, or even less.

• Treatments will be affordable and attainable to all, even the uninsured and underinsured.

We’ve come so far in PsA treatment and management, and the future is bright. I can’t wait to see what’s to come.