Psoriatic arthritis: an overview

Abstract

Psoriatic arthritis (PsA) is a multifaceted immune-mediated inflammatory disease affecting approximately 30% of patients with psoriasis. Its clinical spectrum is highly heterogeneous, spanning peripheral arthritis, axial involvement, enthesitis, dactylitis, and skin/nail disease. Current management emphasizes a "treat-to-target" (T2T) strategy, utilizing validated instruments like DAPSA and MDA to achieve clinical remission or low disease activity. Despite an expanding therapeutic armamentarium, managing complex phenotypes and treatment-resistant cases remains a significant challenge. While traditional therapies have focused on IL-17A, recent evidence highlights the pathogenic role of IL-17F, which is highly expressed in the synovial tissue and skin of PsA patients. This review highlights the clinical significance of dual IL-17A and IL-17F inhibition, specifically via bimekizumab, a monoclonal antibody designed to simultaneously neutralize both isoforms and their heterodimers. Phase 3 clinical data (BE OPTIMAL and BE COMPLETE) demonstrate that dual inhibition provides superior efficacy over placebo in both biologic-naïve and bio-experienced populations. Advances in our understanding of PsA pathogenesis, particularly the introduction of dual IL-17A/F inhibition, have significantly expanded the therapeutic armamentarium and created new benchmarks for disease control. However, critical gaps remain, including the absence of predictive biomarkers and the challenge of managing treatment-resistant cases. To address these unmet needs, the modern standard of care must prioritize a personalized approach-tailoring interventions to the patient's specific phenotype, comorbidities, and preferences through a framework of shared decision-making.