Conclusion

Numerous studies have increased our understanding of the basic pathophysiology of PsA, providing support for the clinical effects of targeted therapy, e.g., inhibition of TNF- . The consequent emerging treatments for PsA have demonstrated significant benefit for clinical signs and symptoms, inhibition of joint damage as assessed by radiographic progression, and improved quality of life and functional status. There are fewer studies documenting these benefits with traditional DMARDs, whose effectiveness does not seem as great as TNF- inhibitors. Targeted therapies that inhibit pro-inflammatory cytokines, such as the TNF- inhibitors, have proven highly effective in managing joint, enthesial and skin disease. Agents that block the cell-cell interactions required to activate T cells are effective in the skin and may benefit the joints, as well. Observation of the effectiveness of these agents has helped elucidate the pathogenesis of PsA and psoriasis which, in turn, may lead to more novel and effective interventions.

Development of these targeted therapies has also increased interest in the accurate diagnosis and classification of PsA, which would facilitate the institution of appropriate therapy in a timely fashion. Significant efforts are underway to further develop and validate outcome measures that accurately assess the effect of therapies and determine the natural history of these diseases. This effort, along with the development of evi dence-based treatment guidelines and general educational initiatives, is being led by international research consortia such GRAPPA and other groups.

The benefits of biologic agents must be weighed against their cost: patient improvement and inhibition of disease progression on one hand, versus allocating limited resources on the other. Comprehensive health economic analyses are being developed to aid our ability to see the full impact of these more effective treatments on patient function, productivity, and quality of life in the context of society as a whole.

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Natural Treatments For Psoriasis

Natural Treatments For Psoriasis

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