Diagnosis,Assessment Of Disease Severity And Progress In Therapies Of Psoriatic Arthritis

Psoriatic arthritis(PsA)is a complicated disease,which has many kinds of clinical manifestation,influencing patients’ joints,skin and nails.Management of PsA includes diagnosis,disease surveillance and selection of appropriate treatment options.In order to achieve these goals,we need to use the PsA diagnostic criteria for diagnosis and specific tools for screening to facilitate subsequent diagnosis and evaluation of patients’ conditions.This review will outline the current PsA diagnostic criteria and the most commonly used PsA screening tools,including the Toronto Psoriatic Arthritis Screening Questionnaire(TOPAS),the Psoriasis Epidemiology Screening Tool(PEST),the Psoriatic Arthritis Screening and Evaluation(PASE),and the Psoriasis and Arthritis Screening Questionnaire(PASQ).We will also review the Classification Criteria for Psoriatic Arthritis(CASPAR)and current PsA disease severity measures,such as the Disease Activity index for Psoriatic Arthritis(DAPSA),the Psoriatic Arthritis Joint Activity Index(PsAJAI)and the Composite Psoriatic Disease Activity Index(CPDAI).In the past,patients with PsA were treated with non-steroidal anti-inflammatory drugs(NSAIDS)and traditional disease-modifying antirheumatic drugs(DMARDs).However,the ability of these medications of slowing down the radiographic progression of joint disease has not been demonstrated yet.In the other hand,anti-TNF agents such as etanercept,infliximab,adalimumab,golimumab and certolizumab,are proved of effective.In addition,emerging PsA treatments include oral phosphodiesterase 4 inhibitor,apremilast;a Janus kinase(JAK)inhibitor,tofacitinib;and several new biologics that target the IL-23/IL-17 pathway including secukinumab,brodalumab,ixekizumab,and ustekinumab,etc.In this review,we will discuss about the mechanisms of action of these drugs,clinical trials results,and also the guidelines for administration.