The treatment of psoriatic arthritis (PsA) has evolved from NSAIDs and csDMARDs to biologics and targeted synthetic DMARDs (tsDMARDs), enabling more personalized approaches. However, due to disease complexity and comorbidities such as obesity or cardiovascular risk, response to therapy can be variable. Emerging research highlights the importance of understanding both inflammatory and non-inflammatory contributors to disease activity, especially in patients who don’t respond to initial therapies.

Treatment sequencing remains a challenge, particularly in patients who are refractory or intolerant to TNF inhibitors. While newer agents like IL-17, IL-23, and JAK inhibitors show promise—even in treatment-experienced populations—there’s still no clear algorithm for optimal sequencing. Biomarkers and machine learning are under study to predict response, but clinical judgment remains key. Some studies suggest IL-17 inhibitors may work better in patients with obesity or metabolic comorbidities. The role of musculoskeletal ultrasound, lifestyle interventions, and even dual-targeted therapy is expanding, offering potential support for those with persistent symptoms. A more individualized, mechanism-based approach—considering both inflammatory and centralized pain pathways—may help improve outcomes for patients with difficult-to-treat PsA.

Reference: Queiro R, Pinto-Tasende JA, Montilla-Morales C. Navigating Psoriatic Arthritis: Treatment Pathways and Patient-Specific Strategies for Improved Outcomes. Drugs. 2025 Jul;85(7):867-882. doi: 10.1007/s40265-025-02192-y. Epub 2025 May 11. PMID: 40350472; PMCID: PMC12185568.