Ritchlin reviews treatments for psoriatic arthritis, ankylosing spondylitis
CLEVELAND — Christopher Ritchlin, MD, MPH, professor of medicine at the University of Rochester Medical Center, reviewed treatments for psoriatic arthritis, spondyloarthritis and other spondyloarthropathies at the Primary Vasculitides Pre-symposium of the Biologic Therapies VII Summit.
“With the development of new agents, we have a better idea of the mechanisms that underlie spondyloarthritis,” Ritchlin said.
He discussed bimekizumab, which showed high efficacy for skin and joints, as well as no major safety concerns, in a proof-of-concept study of patients with psoriatic arthritis that was presented at American College of Rheumatology Annual Meeting 2016. In addition, Ritchlin noted ustekinumab showed efficacy for patients with ankylosing spondylitis; tofacitinib showed efficacy for patients with psoriatic arthritis who had failed treatment with a tumor necrosis factor inhibitor (TNFi); and guselkumab was effective for all aspects of psoriatic arthritis.
Ritchlin also mentioned how challenging it can be to distinguish ankylosing spondylitis from axial spondyloarthritis. He noted both conditions have similar burden of illness, disease activity and functional impairment. In addition, the diseases have similar rates of TNFi response.
Ritchlin also compared the pathways of psoriatic arthritis and spondyloarthritis. He said spondyloarthritis tissues have more vascularity and greater infiltration of neutrophil and CD 163+ macrophages. In addition, he noted there are no citrullinated proteins in polyarticular psoriatic arthritis. As for similarities, Ritchlin said the synovial histopathology of psoriatic arthritis resembles spondyloarthritis more than rheumatoid arthritis and both groups can be differentiated from rheumatoid arthritis.
He said the interleukin(IL)-17 target is an effective strategy for psoriatic arthritis and ankylosing spondylitis, and the IL-23 target also shows promise.
“I think interleukin-17 is the new target people are looking at,” Ritchlin said. “So, we will see how that works.” – by Will Offit