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Medications or biologic agents that target T-cells appear to offer significant benefit to patients suffering from psoriatic arthritis (PsA), according to a new review article in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).
“Although these new immunosuppressive agents are expensive, they are the only agents that have demonstrated a decrease in radiologic progression of peripheral arthritis, and can be used to manage associated types of inflammation, as well as skin and nail disease,” said lead study author Michael Day, a resident orthopaedic surgeon with the Department of Orthopaedic Surgery at NYU Hospital for Joint Diseases.
Currently, initial treatments for PsA include nonsteroidal anti-inflammatory drugs (NSAIDs) that reduce inflammation, pain and fever.
In the near future, drugs aimed at providing more targeted therapy will allow more PsA patients to avoid progressing to end-stage arthritis and joint destruction.
Similarities between PsA and rheumatoid arthritis (RA) have spurred PsA researchers to consider early, aggressive treatment, an approach that has proved to be successful in RA patients.
Surgery may also be considered for patients who have joint deformities as a result of PsA, but so far there have been few large-scale, high-quality clinical trials, Dr. Day said.
“The disease typically follows a moderate course, but up to 48 percent of cases develop into destructive arthritis in which the inflammatory process leads to bone erosion and loss of joint architecture,” he said.
Orthopaedic surgeons play a key role on the PsA treatment team. Dr. Day added that collaboration with dermatologists, rheumatologists, internists and family physicians is essential to the successful surgical treatment of PsA.
“PsA is a systemic inflammatory disease with multi-organ system effects,” said Dr. Day. “As such it should be treated with a multi-disciplinary approach.”