Is Remission Possible With Psoriatic Arthritis?
Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects the joints and can be progressive and disabling. The pattern of PsA fluctuates over time, with periods of more intense symptoms and periods of remission. PsA is believed to be caused by a genetic predisposition triggered by environmental factors, such as infection or trauma.1
Is there a cure for psoriatic arthritis?
There is no known cure for PsA, although there are several treatment options that can help, and in some cases, provide remission. Remission implies the reversibility of functional impairment, minimal or no progression to joint destruction, and, at least in theory, potential to heal a damaged joint. Recent research suggests remission is possible with anti-TNF therapy, which targets tumor necrosis factor (TNF).2 Tumor necrosis factor is a cytokine or chemical messenger, that is released by the white blood cells called T lymphocytes. TNF triggers multiple actions in the body, including the ability to induce necrosis (death) of tumor cells. It also produces a wide range of inflammatory actions, such as those seen in PsA.3,4
A recent study indicated as many as 58% of PsA patients receiving treatment with an anti-TNF therapy experienced remission at 12 months. Several patient characteristics were predictors of remission, including patients of male gender and those with early morning joint stiffness. This does not conclude that female patients cannot achieve remission; simply that remission was more likely to occur in male patients in this study.2
The anti-TNF therapies are part of a group of treatments known as biologics. Biologics are drugs that have been designed to specifically hit those immunological targets that are involved in specific conditions. Prior to biologics, previous immune therapy for PsA involved drugs that have a general suppressing effect on the immune system, which consequently prevents high doses being used because of the fear of side effects. With biologics, the treatment is more targeted, which generally creates less interference with other biological functions and, theoretically, makes the treatment safer.5
Other biologic therapies target different chemical pathways that have been identified in PsA:
- Interleukins 12 and 23 (IL-12 and IL-23) – Interleukins 12 and 23 are cytokines (chemical messengers) that are produced by the T-cells that are involved in the inflammatory response. Stelara (ustekinumab) is a medication that targets these cytokines. 3,5
- Interleukin 17-A (IL-17A) – IL-17A is also a cytokine produced by T-cells that promotes inflammation. Cosentyx (secukinumab) and Taltz (ixekizumab) inhibit this cytokine.3,5
- Phosphodiesterase 4 (PDE4) inhibitor – PDE4 is an enzyme that degrades the natural regulator of the immune response. Otezla (apremilast) is a medication that inhibits PDE4.5,6