Philip Mease, MD: Treatment Options for Psoriatic Arthritis

Unlike some rheumatic conditions, there is a gambit of FDA-approved treatment options for patients with psoriatic arthritis. With 10 biologic disease-modifying antirheumatic drugs along with a plethora of NSAIDs, rheumatologists are equipped with an armamentarium of therapies to treat their patients.

A sometimes unique problem in medicine, clinicians have to choose from a list of approved therapies that all have the ability to manage the disease to some degree—all the while, clinical trials for additional therapies to treat psoriatic arthritis are still ongoing.

Due to the condition presenting itself in unique ways among different patients, selecting a therapy that fits well into a patient’s current treatment algorithm can be a challenge. To find out more on how rheumatologists make the decision on which medication best fits a treatment algorithm and whether there was an oversaturation of therapies, MD Magazine® sat down with Philip Mease, MD, director of rheumatology research at the Swedish Rheumatology Research Group, at the 2019 American College of Rheumatology annual meeting in Atlanta, GA to discuss the current state of treatments for psoriatic arthritis.

MD Mag: Are treatment options for psoriatic arthritis where you would like them to be?

Mease: Part of the question has to do with when do we have enough agents that we don't really need more in the space and one of the challenges in treating psoriatic arthritis is it's very variable presentation in what we call clinical domains. So that's synovitis, enthesitis, dactylitis, skin disease, nail disease, spine disease, or spondylitis and each of those different domains may have subtly different immunologic pathophysiology driving the domain.

So what we are finding is that in individual patients we may do very well in treating say synovitis and skin disease but not so well at treating enthesitis. So, what that means is that we end up in order to achieve a state of low disease activity, which takes into account all those domains, we end up having to move around to different classes of medications. So, it's very helpful for us to have a number of choices not only within a class but also between classes of medication.

At the moment, I'm not worried that we're saturating the space and one of the exciting further new developments is going is the introduction of new oral medications in the form of the JAK inhibitor class, where we have seen very strong data for two new JAK inhibitors in PSA and ankylosing spondylitis including filgotinib and upadacitinib.