Pharmakotherapie der Psoriasis-Arthritis aus dermatologischer Sicht

Psoriatic arthritis (PsA) is a common interdisciplinary challenge as well in dermatology and in rheumatology setting from both a diagnostic and therapeutic perspective. It is classified according to the CASPAR criteria and the categories of Moll & Wright. In addition to typical laboratory findings (negative rheumatoid factor and negative anti-CCP), erythemato-squamous plaques often accompanied by nail matrix and/or nail bed involvement as well as joint manifestations in the form of asymmetric oligoarthritis, dactylitis, enthesitis or axial involvement can be found. The apparative diagnostics by means of ultrasound, conventional X-ray or MRI can objectify this. Pathophysiologically, a complex systemic inflammatory response with TNF-α and interleukin 17 and 23 dominates. The Janus kinase inflammatory pathway as well as phosphodiesterase 4 as intracellular mechanisms also play an important role in inflammation and can thus be inhibited therapeutically. In the last 5 years, due to the dawn of the biologics era effective treatment options for psoriasis and psoriatic arthritis have increased rapidly. These new targeted therapy strategies have brought us much closer to the goals of optimizing symptom control, improving quality of life, and preventing structural damage. A large number of new therapeutic agents are considered in the current European guidelines and others are about to be approved. For this reason, we summarize here the current status of pharmacotherapy of PsA from a dermatological perspective.