Defining Difficult-to-Treat Psoriatic Arthritis: A Scoping Review

A recent scoping review published in RMD Open highlights the challenges in defining and managing difficult-to-treat psoriatic arthritis (D2T PsA). Despite advances in therapeutics, a significant subset of patients with PsA continues to experience active disease, underscoring the need for standardized definitions to guide clinical practice and research. 

The review, conducted using PRISMA-ScR guidelines, analyzed 15 studies from an initial pool of 565 references. Eligible studies focused on defining D2T PsA and active disease in English-language publications from the past decade. Analysis revealed substantial variability in how D2T PsA is characterized. Terms such as "active disease" and "resistant PsA" were used inconsistently, highlighting the lack of a unified framework. 

Key findings emphasized the heterogeneity in criteria for diagnosing and categorizing D2T PsA. Factors contributing to resistance include inflammatory and noninflammatory mechanisms, complicating treatment decisions. The absence of standardized definitions limits the ability of clinicians to identify and manage these cases effectively and poses challenges for pharmaceutical and regulatory advancements. 

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis initiative aims to address these gaps by developing consensus-based criteria for D2T PsA. This effort seeks to enhance clinical decision-making, streamline therapeutic approaches, and establish a foundation for future research. 

This review underscores the importance of clear, actionable definitions to improve outcomes for patients with D2T PsA, guiding both clinical care and innovation in the field.

Reference
Singla S, Ribeiro A, Torgutalp M, Mease PJ, Proft F. Difficult-to-treat psoriatic arthritis (D2T PsA): a scoping literature review informing a GRAPPA research project. RMD Open.  Published January 8, 2024. doi:10.1136/rmdopen-2023-003809