Skip to main content
SpringerLink
Log in

Treatment of Psoriasis and Psoriatic Arthritis

  • Review article
  • Published:
BioDrugs Aims and scope Submit manuscript

Abstract

Skin and joint manifestations associated with psoriasis and psoriatic arthritis (PsA) can significantly impact a patient’s quality of life. Successful treatment is imperative in order to improve signs and symptoms of the disease, and to alleviate physical or psychological distress. For patients with mild psoriasis with or without PsA, topical agents and targeted phototherapy are appropriate treatments for psoriasis. Systemic therapies, such as methotrexate and phototherapy are recommended options for patients with more severe psoriasis, but their long-term use is hindered by safety concerns. Advancements in understanding the pathogenesis of psoriasis, including the role of T cells and cytokines, have been crucial to the development of biological therapies. These target the immune system and are suitable options for patients with extensive disease. Biological therapies for the treatment of psoriasis include targeted therapies (alefacept) and anti-cytokine therapies (anti-tumour necrosis factor [TNF] therapies [adalimumab, etanercept, infliximab] and a monoclonal antibody against interleukin [IL]-12 and IL-23 [ustekinumab]). Patients with PsA should be treated appropriately in order to improve symptoms and inhibit structural joint damage. Non-steroidal anti-inflammatory drugs or local intra-articular injections of corticosteroids can be used successfully in patients with mild PsA; however, neither treatment prevents the development of structural joint damage. For patients with moderate to severely active PsA, disease-modifying antirheumatic drugs (such as methotrexate), TNF inhibitor treatments (adalimumab, etanercept, infliximab and golimumab) or their combination are considered first-line treatment. This review provides a brief overview of treatment options for psoriasis and PsA, with an emphasis on the efficacy and safety of anti-TNF therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Menter A, Gottlieb A, Feldman SR, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58(5): 826–50

    Article  PubMed  Google Scholar 

  2. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007; 370(9583): 263–71

    Article  PubMed  CAS  Google Scholar 

  3. Greaves MW, Weinstein GD. Treatment of psoriasis. N Engl J Med 1995; 332(9): 581–8

    Article  PubMed  CAS  Google Scholar 

  4. Gelfand JM, Feldman SR, Stern RS, et al. Determinants of quality of life in patients with psoriasis: a study from the US population. J Am Acad Dermatol 2004; 51(5): 704–8

    Article  PubMed  Google Scholar 

  5. Rapp SR, Feldman SR, Exum ML, et al. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 1999; 41 (3 Pt 1): 401–7

    Article  PubMed  CAS  Google Scholar 

  6. Stankler L. The effect of psoriasis on the sufferer. Clin Exp Dermatol 1981; 6(3): 303–6

    Article  PubMed  CAS  Google Scholar 

  7. Chandran V, Raychaudhuri SP. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J Autoimmun 2010; 34(3): J314–21

    Article  PubMed  CAS  Google Scholar 

  8. Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis 2005; 64 Suppl 2: ii18–23; discussion ii4-5

    Article  PubMed  Google Scholar 

  9. Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol 2008; 58(5): 851–64

    Article  PubMed  Google Scholar 

  10. Gladman DD, Antoni C, Mease P, et al. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64 Suppl. 2: ii14–7

    Article  PubMed  Google Scholar 

  11. Roberson ED, Bowcock AM. Psoriasis genetics: breaking the barrier. Trends in genetics: TIG 2010; 26(9): 415–23

    Article  PubMed  CAS  Google Scholar 

  12. Bowes J, Barton A. The genetics of psoriatic arthritis: lessons from genome-wide association studies. Discov Med 2010; 10(52): 177–83

    PubMed  Google Scholar 

  13. Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med 2009; 361(5): 496–509

    Article  PubMed  CAS  Google Scholar 

  14. Fitch E, Harper E, Skorcheva I, et al. Pathophysiology of psoriasis: recent advances on IL-23 and Th17 cytokines. Curr Rheumatol Rep 2007; 9(6): 461–7

    Article  PubMed  CAS  Google Scholar 

  15. Nograles KE, Davidovici B, Krueger JG. New insights in the immunologic basis of psoriasis. Semin Cutan Med Surg 2010; 29(1): 3–9

    Article  PubMed  CAS  Google Scholar 

  16. McKenzie BS, Kastelein RA, Cua DJ. Understanding the IL-23-IL-17 immune pathway. Trends Immunol 2006; 27(1): 17–23

    Article  PubMed  CAS  Google Scholar 

  17. Liu H, Rohowsky-Kochan C. Regulation of IL-17 in human CCR6+ effector memory T cells. J Immunol 2008; 180(12): 7948–57

    PubMed  CAS  Google Scholar 

  18. Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature 2007; 445(7130): 866–73

    Article  PubMed  CAS  Google Scholar 

  19. Lande R, Gregorio J, Facchinetti V, et al. Plasmacytoid dendritic cells sense self-DNA coupled with antimicrobial peptide. Nature 2007; 449(7162): 564–9

    Article  PubMed  CAS  Google Scholar 

  20. Ganguly D, Chamilos G, Lande R, et al. Self-RNA-antimicrobial peptide complexes activate human dendritic cells through TLR7 and TLR8. J Exp Med 2009; 206(9): 1983–94

    Article  PubMed  CAS  Google Scholar 

  21. Ritchlin CT, Haas-Smith SA, Li P, et al. Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest 2003; 111(6): 821–31

    PubMed  CAS  Google Scholar 

  22. Tzu J, Kerdel F. From conventional to cutting edge: the new era of biologics in treatment of psoriasis. Dermatol Ther 2008; 21(2): 131–41

    Article  PubMed  Google Scholar 

  23. Schmitt J, Zhang Z, Wozel G, et al. Efficacy and tolerability of biologic and nonbiologic systemic treatments for moderate-to-severe psoriasis: meta-analysis of randomized controlled trials. Br J Dermatol 2008; 159(3): 513–26

    Article  PubMed  CAS  Google Scholar 

  24. Brimhall AK, King LN, Licciardone JC, et al. Safety and efficacy of alefacept, efalizumab, etanercept and infliximab in treating moderate to severe plaque psoriasis: a meta-analysis of randomized controlled trials. Br J Dermatol 2008; 159(2): 274–85

    Article  PubMed  CAS  Google Scholar 

  25. Kavanaugh A, McInnes I, Mease P, et al. Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: Twenty-four-week efficacy and safety results of a randomized, placebo-controlled study. Arthritis Rheum 2009; 60(4): 976–86

    Article  PubMed  CAS  Google Scholar 

  26. EMEA. European Medicines Agency recommends suspension of the marketing authorisation of Raptiva (efalizumab). [Online] 2009; Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2009/ 11/WC500014516.pdf

  27. FDA. FDA Statement on the Voluntary Withdrawal of Raptiva From the U.S. Market. [Online] 2009; Available from: http://www.fda.gov/NewsEvents/ Newsroom/PressAnnouncements/2009/ucm149561.htm

  28. Lebwohl M, Bagel J, Gelfand JM, et al. From the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis. J Am Acad Dermatol 2008; 58(1): 94–105

    Article  PubMed  Google Scholar 

  29. Astellas Pharma US Inc. AMEVTVE® (alefacept) Prescribing Information. Revised May 2011. [Online]; Available from: http://www.astellas.us/docs/amevive.pdf

  30. Krueger GG, Papp KA, Stough DB, et al. A randomized, double-blind, placebo-controlled phase III study evaluating efficacy and tolerability of 2 courses of alefacept in patients with chronic plaque psoriasis. J Am Acad Dermatol 2002; 47(6): 821–33

    Article  PubMed  Google Scholar 

  31. Lebwohl M, Christophers E, Langley R, et al. An international, randomized, double-blind, placebo-controlled phase 3 trial of intramuscular alefacept in patients with chronic plaque psoriasis. Arch Dermatol 2003; 139(6): 719–27

    Article  PubMed  CAS  Google Scholar 

  32. Menter A, Tyring SK, Gordon K, et al. Adalimumab therapy for moderate to severe psoriasis: A randomized, controlled phase III trial. J Am Acad Dermatol 2008; 58(1): 106–15

    Article  PubMed  Google Scholar 

  33. Saurat JH, Stingl G, Dubertret L, et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br J Dermatol 2008; 158(3): 558–66

    Article  PubMed  CAS  Google Scholar 

  34. Leonardi CL, Powers JL, Matheson RT, et al. Etanercept as monotherapy in patients with psoriasis. N Engl J Med 2003; 349(21): 2014–22

    Article  PubMed  CAS  Google Scholar 

  35. Papp KA, Tyring S, Lahfa M, et al. A global phase III randomized controlled trial of etanercept in psoriasis: safety, efficacy, and effect of dose reduction. Br J Dermatol 2005; 152(6): 1304–12

    Article  PubMed  CAS  Google Scholar 

  36. Menter A, Feldman SR, Weinstein GD, et al. A randomized comparison of continuous vs. intermittent infliximab maintenance regimens over 1 year in the treatment of moderate-to-severe plaque psoriasis. J Am Acad Dermatol 2007; 56(1): 31e1–15

    Article  Google Scholar 

  37. Reich K, Nestle FO, Papp K, et al. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Lancet 2005; 366(9494): 1367–74

    Article  PubMed  CAS  Google Scholar 

  38. Leonardi CL, Kimball AB, Papp KA, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 76-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 1). Lancet 2008; 371(9625): 1665–74

    Article  PubMed  CAS  Google Scholar 

  39. Papp KA, Langley RG, Lebwohl M, et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2). Lancet 2008; 371(9625): 1675–84

    Article  PubMed  CAS  Google Scholar 

  40. Griffiths CE, Strober BE, van de Kerkhof P, et al. Comparison of ustekinumab and etanercept for moderate-to-severe psoriasis. N Engl J Med 2010; 362(2): 118–28

    Article  PubMed  CAS  Google Scholar 

  41. Krueger GG. Clinical response to alefacept: results of a phase 3 study of intravenous administration of alefacept in patients with chronic plaque psoriasis. J Eur Acad Dermatol Venereol 2003; 17 Suppl 2:17–24

    Article  PubMed  Google Scholar 

  42. Abbott Laboratories. HUMIRA® (adalimumab). Prescribing information. [Online]; Available from: http://www.rxabbott.com/pdf/humira.pdf

  43. Amgen/Pfizer. Enbrel® (etanercept). Prescribing information. [Online]; Available from: http://pi.amgen.com/united_states/enbrel/derm/enbrel_pi.pdf

  44. Pariser DM, Leonardi CL, Gordon K, et al. Integrated safety analysis: Short-and long-term safety profiles of etanercept in patients with psoriasis. J Am Acad Dermatol 2011. Oct 18 (Epub ahead of print) http://dx.doi.org/10.1016/ j.jaad.2011.07.040

  45. Electronic Medicines Compendium. Remicade 100mg powder for concentrate for solution for infusion. Summary of Product Characteristics. Schering-Plough Ltd. [Online] 2010; Available from: http://www.medicines.org.uk/ emc/document.aspx?documentId=3236

  46. Centocor Ortho Biotech Inc. Remicade(RM) (infliximab) for IV injection. [Online] 2009; Available from: http://www.remicade.com/remicade/assets/ HCP_PPI.pdf

  47. Ostuni P, Botsios C, Punzi L, et al. Hepatitis B reactivation in a chronic hepatitis B surface antigen carrier with rheumatoid arthritis treated with infliximab and low dose methotrexate. Ann Rheum Dis 2003; 62(7): 686–7

    Article  PubMed  CAS  Google Scholar 

  48. European Medicines Agency. Stelara European public assessment report. [Online]; Available from: http://www.ema.europa.eu/ema/index.jsp?curl= pages/medicines/human/medicines/000958/human_med_001065.jsp&mid= WC0b01ac058001d125&murl=menus/medicines/medicines.jsp&jsenabled=true

  49. Centocor Ortho Biotech Inc. STELARA™ (ustekinumab). Prescribing Information. [Online]; Available from: http://www.medversation.com/med-versation/ assets/PI_MedGuides/STELARA_PI.pdf

  50. Reich K, Langley RG, Lebwohl M, et al. Cardiovascular safety of ustekinumab in patients with moderate to severe psoriasis: results of integrated analyses of data from phase II and III clinical studies. Br J Dermatol 2011; 164(4): 862–72

    Article  PubMed  CAS  Google Scholar 

  51. Kyle S, Chandler D, Griffiths CE, et al. Guideline for anti-TNF-alpha therapy in psoriatic arthritis. Rheumatology (Oxford)2005; 44(3): 390–7

    Article  CAS  Google Scholar 

  52. Woolacott N, Bravo Vergel Y, Hawkins N, et al. Etanercept and infliximab for the treatment of psoriatic arthritis: a systematic review and economic evaluation. Health technology assessment 2006; 10(31): iii–iiv, xiii-xvi, 1-239

    PubMed  CAS  Google Scholar 

  53. Partsch G, Steiner G, Leeb BF, et al. Highly increased levels of tumor necrosis factor-alpha and other proinflammatory cytokines in psoriatic arthritis synovial fluid. J Rheumatol 1997; 24(3): 518–23

    PubMed  CAS  Google Scholar 

  54. Mease PJ, Gladman DD, Ritchlin CT, et al. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 2005; 52(10): 3279–89

    Article  PubMed  CAS  Google Scholar 

  55. Genovese MC, Mease PJ, Thomson GT, et al. Safety and efficacy of adalimumab in treatment of patients with psoriatic arthritis who had failed disease modifying antirheumatic drug therapy. J Rheumatol 2007; 34(5): 1040–50

    PubMed  CAS  Google Scholar 

  56. Mease PJ, Kivitz AJ, Burch FX, et al. Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum 2004; 50(7): 2264–72

    Article  PubMed  CAS  Google Scholar 

  57. Antoni CE, Kavanaugh A, Kirkham B, et al. Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (IMPACT). Arthritis Rheum 2005; 52(4): 1227–36

    Article  PubMed  CAS  Google Scholar 

  58. Antoni C, Krueger GG, de Vlam K, et al. Infliximab improves signs and symptoms of psoriatic arthritis: results of the IMPACT 2 trial. Ann Rheum Dis 2005; 64(8): 1150–7

    Article  PubMed  CAS  Google Scholar 

  59. Sharp JT, Young DY, Bluhm GB, et al. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? Arthritis Rheum 1985; 28(12): 1326–35

    Article  PubMed  CAS  Google Scholar 

  60. Gladman DD, Mease PJ, Ritchlin CT, et al. Adalimumab for long-term treatment of psoriatic arthritis: forty-eight week data from the adalimumab effectiveness in psoriatic arthritis trial. Arthritis Rheum 2007; 56(2): 476–88

    Article  PubMed  CAS  Google Scholar 

  61. Mease PJ, Ory P, Sharp JT, et al. Adalimumab for long-term treatment of psoriatic arthritis: 2-year data from the Adalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT). Ann Rheum Dis 2009; 68(5): 702–9

    Article  PubMed  CAS  Google Scholar 

  62. Centocor Ortho Biotech Inc. SIMPONI® (golimumab). Prescribing Information. [Online]; Available from: https://www.simponi.com/sites/default/ files/pdf/prescribing-information.pdf

  63. Kurzeja M, Rudnicka L, Olszewska M. New interleukin-23 pathway inhibitors in dermatology: ustekinumab, briakinumab, and secukinumab. Am J Clin Dermatol 2011; 12(2): 113–25

    Article  PubMed  Google Scholar 

  64. Traczewski P, Rudnicka L. Briakinumab for the Treatment of Plaque Psoriasis. BioDrugs 2012; 26(1): 9–20

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Third Department of Dermatology, ‘A. Syggros’ Hospital, Athens, Greece

    Marina Papoutsaki

  2. Department of Dermatology, University of Rome Tor Vergata, Rome, Italy

    Antonio Costanzo

Authors
  1. Marina Papoutsaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Costanzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marina Papoutsaki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Papoutsaki, M., Costanzo, A. Treatment of Psoriasis and Psoriatic Arthritis. BioDrugs 27 (Suppl 1), 3–12 (2013). https://doi.org/10.1007/BF03325637

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03325637

Keywords

Search

Navigation