Targeting Structural Damage in Psoriatic Arthritis: The Impact of Early Recognition and Timely Intervention - Episode 9
Inhibiting Structural Damage in Psoriatic Arthritis With TNF Inhibitors and IL-17 Inhibitors
Experts discuss how treatment decisions in psoriatic arthritis increasingly balance current disease severity with long-term risk, highlighting the structural protection offered by TNF and IL-17 inhibitors, the growing preference for IL-17s in dermatology due to rapid efficacy and skin clearance, and the rising use of IL-23 inhibitors for their favorable safety, dosing convenience, and emerging joint efficacy—factors that are shaping more personalized and proactive therapeutic strategies.
In managing psoriatic arthritis, treatment decisions are often guided by both current disease severity and future risk of progression. When a patient presents with erosive disease or is considered high-risk—based on factors like such as elevated CRP, high joint counts, family history, or the presence of enthesitis and dactylitis—clinicians typically prioritize therapies that have demonstrated an ability to inhibit structural damage. Agents such as TNF inhibitors and IL-17 inhibitors are well-supported by data in this regard and are commonly used to prevent long-term joint deterioration and preserve physical function.
In dermatology, the treatment landscape has shifted significantly over time. While TNF inhibitors were once frequently used, they are now rarely prescribed unless required by step-therapy policies. IL-17 inhibitors have become the preferred option for many clinicians due to their superior efficacy in clearing skin lesions and comparable joint effectiveness. Additionally, the convenience and quick onset of these medications make them appealing for patients with both skin and joint involvement. Findings from hHead-to-head trials have confirmed their joint efficacy, supporting their broader adoption across specialties.
There has also been a growing preference for IL-23 inhibitors, particularly in dermatologic settings. These agents are favored for their excellent safety profile, infrequent dosing schedules, and strong patient adherence seen in data from real-world studies. While IL-17 inhibitors may offer slightly better skin outcomes in some cases, IL-23 inhibitors are increasingly viewed as a balanced option for treating psoriatic disease. Their favorable safety and dosing profiles make them especially attractive in busy clinical environments, and emerging data suggest they may soon rival or surpass older classes in treating both skin and joint manifestations. As evidence continues to evolve, these factors play a central role in shaping early and individualized treatment strategies.
