Current Treatment Options in Rheumatology

, Volume 4, Issue 2, pp 183–196 | Cite as

Treatment of Enthesitis, Dactylitis and Nail Lesions in Psoriatic Arthritis

  • Ajesh B. Maharaj
  • F. Paruk
Seronegative Arthritis (N Haroon, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Seronegative Arthritis


Purpose of review

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with the skin disease, psoriasis. It is a highly heterogeneous disorder, not only in the musculoskeletal phenotype but also in its cutaneous manifestations. Enthesitis, dactylitis, and nail changes are the hallmark of the disease, and experts in the field believe that the initiating process of PsA is a deep Koebner phenomenon which triggers enthesitis and the subsequent disease process and progression. We aim to discuss the most recent advances in the treatment of enthesitis, dactylitis, and nail changes in psoriatic arthritis.

Recent findings

Various treatment regimens have been used to control the above manifestations of PsA, including conventional synthetic disease-modifying agents (csDMARDs), biologic disease-modifying agents (bDMARDs), and newer therapies which include interleukin (IL)-12/23 antagonist (ustekinumab), IL-17 antagonists (secukinumab and ixekizumab), as well as small molecules including the Janus kinase (JAK) inhibitors and phosphodiesterase-4 inhibitor (apremilast). The csDMARDs include methotrexate, sulphasalazine, leflunomide, as well as cyclosporine.


These modalities of treatment are further discussed in this review. Rapid escalation of therapy in patients who have an inadequate response to conventional therapy results in better outcomes. Future research includes specific antibodies against the p19 subunit of IL-23.


Psoriasis Psoriatic arthritis Methotrexate Biologics Secukinumab 


Compliance with Ethical Standards

Conflict of Interest

Ajesh B Maharaj, MB.BS, H. Dip.Int. Med, FCP, Cert in Rheumatology and Faranah Paruk, MBChB, FCP, Cert in Rheumatology, Ph.D. declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal studies performed by any of the authors.

Supplementary material

40674_2018_97_MOESM1_ESM.docx (35 kb)
ESM 1 (DOCX 35 kb)

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Clinical Immunology and Rheumatology, Academic Medical CenterUniversity of AmsterdamAmsterdamNetherlands
  2. 2.Department of Internal Medicine, Prince Mshiyeni Memorial Hospital and School of Clinical Medicine, College of Health Sciences, Nelson R Mandela School of MedicineUniversity of KwaZulu-NatalDurbanSouth Africa
  3. 3.Department of General Medicine, Division of Internal Medicine, College of Health Sciences, Nelson R Mandela School of MedicineUniversity of KwaZulu-NatalDurbanSouth Africa

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