The following is a summary of the “Management of Axial Disease in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations,” published in the February 2023 issue of Rheumatology by Lubrano, et al.
Axial involvement in patients with psoriatic arthritis (PsA) is a common subset of this condition, but a unanimous definition has yet to be established. It has been defined by using different criteria, ranging from the presence of at least unilateral grade 2 sacroiliitis to those used for ankylosing spondylitis (AS) or simply the presence of inflammatory low back pain (IBP). They aimed to identify and evaluate the efficacy of therapeutic interventions for treating axial disease in PsA.
This systematic review is an update of the axial PsA (axPsA) domain of the treatment recommendations project by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). The systematic review of the literature showed that new biologic and targeted synthetic disease-modifying antirheumatic drug classes, namely interleukin (IL)-17A and Janus kinase inhibitors, could be considered for the treatment of axPsA.
Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), simple analgesia, and anti-tumor necrosis factor drugs (TNF antagonists) would be used in addition to this. Conflicting evidence remains regarding using IL-12/23 and IL-23 inhibitors. Further studies are needed for a better understanding of the treatment of axPsA, as well as validated outcome measures.