Can We Prevent Psoriatic Arthritis?

The presentation addresses the potential for preventing psoriatic arthritis (PsA) in patients with psoriasis. The speaker admits the uncertainty but aims to explore current understandings and data. PsA predominantly develops in individuals with psoriasis, suggesting that effective treatments for psoriasis could potentially prevent or delay the onset of PsA. Anti-TNF therapies are generally preferred according to established guidelines, but newer biologics like anti-IL-17s and anti-IL-23s might offer superior skin benefits. Importantly, the delay in PsA development may be influenced by identifying high-risk patients using early indicators, such as fatigue or imaging results, although there is no consensus on the most effective method to do this yet.



The speaker discusses numerous studies hinting that anti-IL-23 therapies might be more effective in delaying PsA onset compared to anti-TNF agents, despite potential biases in data analysis. For example, some analyses show differing rates of PsA emergence among patients treated with various biologics. While these have generated hypotheses for further investigation, they lack definitive proof. The key takeaway is the need for prospective studies to establish concrete evidence regarding the prevention of PsA. Overall, while current data suggests a potential for anti-IL-23 therapies to benefit patients at risk of PsA, more research is needed to substantiate these claims and inform treatment decisions.