银屑病关节炎治疗的未来是

新泽西州里奇伍德瓦利医院的风湿病学家迈克尔·格罗斯（Michael Gross）说，多年来，PSA景观发生了很多事情。“二十年前，Ambrel（Etanercept）和Remicade（英夫利昔单抗）是第一个[生物学]药物，革新PSA并使患者有机会[拥有PSA]控制。”生物药物与体内不同的细胞因子（促炎性化学物质）作斗争，目的是防止炎症。不同的细胞因子以不同的方式影响人体，这些早期生物制剂阻止了一种称为肿瘤坏死因子-Alpha（TNF-Alpha）的蛋白质。如今，研究人员说，TNF-Alpha阻滞剂可能不是PSA的一线疗法，因为市场上有更有效的药物。

截至2020年中，FDA批准了生物学药物Tremfya（Guselkumab），可以注射到您的大腿，肚子和外臂中，以治疗成人的活性PSA。Gross博士解释说，Guselkumab是一个被称为白介素阻滞剂，它专门阻止了白介素23（IL-23）。白介素 - 现在是什么？We know—it’s a mouthful! We’ll explain: IL-23 is a cytokine, or a small protein, that is thought to be a key culprit behind PsA symptoms, especially arthritic involvement.

看起来Guselkumab正在浪潮。根据2021年的研究Rheumatology与其他治疗方法相比，该药物的有效性更高，包括较旧的TNF-Alpha阻滞剂，尤其是在皮肤受累方面。额外的学习还发现，古塞尔库马布（Guselkumab）有助于减少s骨关节的炎症，又称s骨炎，这是某些具有PSA经验的人。但这不是全部。研究has found that guselkumab “led to clinically meaningful and sustained improvements in fatigue through one year.” Since inflammatory diseases like PsA can sometimes cause debilitating fatigue, this is ahugewin!

“现在的另一种选择是Apremilast，”纽约州塞奈山的风湿病学主任Stuart D. Kaplan说。Apremilast（Otezla）“阻止了一种涉及炎症的酶。”对于有活跃PSA的成年人，这可能是改变游戏规则的：“这是一种药丸，是一种非生物学的，” Gross博士说。“从某种意义上说，这是一种不错的药物，它会导致感染风险较小，并且您不需要在上面监测血液。”

For patients who aren’t fans of injectables or who don’t tolerate biologics, this may be a good option—but your doctor will know best. For one, biologics may lead to more serious side effects, including infections, according to the系统评论的Cochrane数据库。Biologics also require your doctor to run blood work before you can be cleared to start taking your injections. That said, “This drug does have GI side effects,” Dr. Gross explains, with most people experiencing nausea and diarrhea, especially when first starting treatment.

“An even newer class of drugs is the janus kinase (JAK) inhibitors, such as Xeljanz (tofacitinib), which also decrease the production of inflammatory proteins,” Kaplan says. Known as small molecule drugs, JAK inhibitors work by blocking certain enzymes (JAK1, JAK2, JAK3, and tyrosine kinase 2) that lead to inflammation. Essentially, JAK inhibitors stop certain cytokines from messaging to the body to make more inflammatory cytokines. JAK-inhibitors are taken orally and are great for patients with active PsA who also haven’t responded to other disease-modifying antirheumatic drugs (DMARDs). Worth noting: Tofacitinib has been associated with an increased risk of heart events, cancer, and serious infections (as with biologics) due to suppression of the immune system.

Recent research published in牛皮癣：目标和治疗has shown that tofacitinib may be as effective as biologics while being much more convenient (since getting medication delivered to your home and prepping for injections can make things a bit complex for people). It’s also considered a great alternative to apremilast, since it’s as effective as biologics while apremilast’s efficacy is lower, according to the study. Researchers also found that it was more effective in patients with treatment-resistant psoriatic arthritis.

risankizumab（Skyrizi）是另一种生物IL-23抑制剂，目前用于治疗中度至重度斑块牛皮癣，但notPsA, at least in the US. However, it’s been recently approved in Europe, and experts believe it’s only a matter of time before it’s available for PsA stateside. “Risankizumab is only approved for psoriasis, but it will be approved for psoriatic arthritis,” says Dr. Gross. It is currently in phase three clinical trials for PsA, under review by the FDA. The drug is said to be effective and safe, while showing “particular promise,” according to the药物疗法年鉴。

在两个临床试验事实证明，事实证明，事实证明，摄影1和2，可降低PSA患者的疾病严重程度，几乎没有副作用。在纪念品1中，接受药物治疗的患者比给定安慰剂的患者有了显着改善，在纪念品2中，其他生物制剂或DMARDS没有改善的患者也有了显着改善。试验的嫩节和肿胀关节的数量以及皮肤改善的次数增加了20％。对于尝试过没有运气的其他药物的患者，这将是一件大事。

The chatter around cannabidiol (CBD) and inflammatory diseases can’t be ignored since plenty of people turn to CBD (the second most active part of the cannabis plant—and one that doesn’t get you "high") for relief. But information is still limited, and the jury is out. While one 2021 study in the journalPain发现CBD对PSA疼痛没有显着影响，其他研究说CBD确实可能有助于缓解疼痛。至于停止炎症？格罗斯博士说：“似乎[CBD]可能在帮助疼痛方面有所使用，但没有证据可以帮助炎症。”也就是说，许多PSA患者使用CBD来控制疼痛，焦虑和其他症状，因此请密切关注研究。