RESUMEN

Biologics have revolutionized the therapy of the psoriatic disease spectrum. These new classes of drugs also allow deeper insight into the pathogenesis of the disease and highlight the existence of distinct "molecular" disease subgroups as evidenced by the spectrum of clinical response seen. Molecules associated with both the interleukin (IL)-17 and interferon (IFN)γ pathways have important functions in psoriatic inflammation, and both are targeted by drugs acting on the p40 subunit shared by IL-12 and IL-23. These IL-12 family members are upstream of pathways characterized by the production of IFNγ and IL-17 related molecules, including IL-17, IL-22, and CCL20. We here summarize the mode of action and clinical studies of the p40 inhibitor ustekinumab with focus on both psoriasis and psoriatic arthritis.

RESUMEN

Enthesitis is a characteristic feature of psoriatic arthritis (PsA) and is important in disease pathogenesis and classification. Use of clinical outcome measures for enthesitis is heterogeneous, and only 1 measure has been specifically developed and validated in PsA. Ultrasound and magnetic resonance imaging assessments of enthesitis may have advantages over clinical examination but are insufficiently studied. As part of an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), we performed a systematic literature review and identified randomized controlled trials with enthesitis outcomes in PsA. For each treatment agent we calculated treatment effect sizes (where applicable) and graded the level of evidence.

Asunto(s)

Antirreumáticos/administración & dosificación , Artritis Psoriásica/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Enfermedades Reumáticas/diagnóstico , Enfermedades Reumáticas/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Psoriásica/diagnóstico , Productos Biológicos/uso terapéutico , Femenino , Humanos , Cápsula Articular/efectos de los fármacos , Cápsula Articular/fisiopatología , Ligamentos Articulares/efectos de los fármacos , Ligamentos Articulares/fisiopatología , Masculino , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Índice de Severidad de la Enfermedad , Sociedades Médicas/normas , Tendinopatía/tratamiento farmacológico , Tendinopatía/fisiopatología , Resultado del Tratamiento

RESUMEN

Optimizing the management of acne vulgaris corresponds with improved outcomes, reduced scarring and a positive influence on the profound psychosocial disability that frequently accompanies this debilitating skin condition. Many effective, cost-effective therapies are widely available, but significant improvement or clearance can only be achieved if these agents are employed with a logical approach. Patient variability makes the definition of optimum treatment strategies difficult, but with due consideration of the pathological mechanisms driving acne in each individual patient, an appropriate combination of topical, systemic and localized therapies can be prescribed that will yield a favorable outcome. In recent years, a range of physical techniques have emerged as an adjunct to conventional treatments, and with increasing patient interest and expectation, extensive research is underway into these and novel medical therapies that may further broaden our therapeutic armamentarium. This article provides details of currently available therapies, reviews the published evidence on efficacy and considers how best to optimize outcomes with a focus on acne pathogenesis.