Now that psoriatic arthritis (PsA) is viewed as its own disease entity and no longer as a relative of rheumatoid arthritis, trends in PsA care have started to change. Methotrexate has become a first-line treatment for PsA patients, and at the American College of Rheumatology (ACR) annual meeting this week, the spotlight was on new disease modifying antirheumatic agents (DMARDs) for PsA. According to Dr. Laura Coates, National Institute for Health Research Clinical Lecturer in Rheumatology at the University of Leeds, United Kingdom: “It is quite an exciting time for psoriatic arthritis because we are getting new drugs that are specific for PsA. A lot of the newer drugs focus on the Il-17 pathway, which is a different part of the patient’s immune system (than what previous medications targeted) and which seems to be particularly important for psoriatic arthritis, psoriasis, and spondylitis arthritis.”
Although there is no research-based evidence to guide physicians and patients on whether a patient should receive a synthetic DMARD or a biologic DMARD the decision usually comes down to how severe the patient’s disease is and what public or private payers will provide reimbursement for. ACR annual meeting attendees heard today that there is currently a shift toward a treat-to-target approach in managing PsA, meaning that if a patient doesn’t meet a predetermined clinical outcome in a certain period of time with one treatment approach, the rheumatologist adjusts, adds to, or changes the treatment. For example, they may prescribe a higher dose (in the case of a synthetic DMARD), add another synthetic DMARD, or switch a patient to a biologic or targeted synthetic DMARD.
“Treat-to-target results in changing treatment quicker if it is not working and aiming for a very high target of patients doing really well,” said Dr. Coates.
Arthritis Consumer Experts notes that patients with PsA should play an equal role in the treatment discussion and decision-making, and fully understand how to set treatment goals and form a holistic treatment plan that they and their rheumatologist can follow.