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Unmet needs

Unmet needs in psoriatic arthritis

Over the past 20 years, impressive advances in the understanding of the pathogenesis of PsA, and in its diagnosis, assessment and treatment, have been achieved but areas of unmet need remain

Alberto Cauli MD PhD Giovanni Porru MD Matteo Piga MD Alberto Floris MD Alessandro Mathieu MD Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Italy

PsA belongs to the spondyloarthritis (SpA) spectrum and is a potentially disabling disease because of its capability to induce destructive lesions together with new bone formation structures; it has been reported that in half of PsA patients, the development of erosions occur within the first two years of disease.2

Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects both axial and peripheral joints, entheses and the skin.1

Outstanding advancements in the knowledge of PsA pathogenesis, diagnosis, assessment and treatment have been achieved in the last 20 years, following the availability of new effective drugs that enable physicians to influence the course of the natural disease. A great role in this advancement has been played by single scientists and physicians, but mainly by the collaborative work and studies performed by consortiums and scientific groups such as GRAPPA (Group for Research and Assessment in Psoriasis and Psoriatic Arthritis). A lot has been done but much remains to be done. This article summarises the main areas of unmet needs in PsA (Table 1).

Pathogenetic mechanisms PsA pathogenesis is influenced markedly by

the individual genetic background and by an imbalance of the immune system following environmental triggers.3–5 Several immune cells are involved in the inflammatory process, which is believed to be influenced by cells of the innate and acquired immune system6 by T cells7

interacting with antigen-

presenting cells (APC) and other resident cells; it gives rise to the inflammatory cascade,8

which finally is responsible of the

erosive lesions and new bone changes. In this context, increasing evidence suggests that a number of key cytokines/enzymes/ receptors in the immune pathway of PsA are critical and may be targeted for therapeutic purposes.

Diagnosis and orchestrated

Studies performed in cohorts of patients with diagnosis of skin psoriasis have revealed consistent differences in the prevalence of PsA, which varied from approximately 10% to 40%, differences that can be ascribed to ethnicity, study methods and classification criteria employed. Furthermore, the articular involvement is often missed or misdiagnosed as simple joint mechanical disorder in a significant proportion of psoriatic patients. Delay in diagnosis clearly affects the start of the appropriate treatment and, consequently, quality of life, function and long-term outcome. In order to minimise the risk of


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