Abstract
Psoriatic arthritis is a multi-domain disease, which comprises also the involvement of other tissues (enthesitis, dactylitis, sacroiliitis, spondylitis), and of course also the skin including scalp and nails. It is therefore better to speak about "psoriatic disease".
The therapy should optimally favourably influence all these manifestations which is not always the case. The biologic therapy with the inhibitors of tumor necrosis factor alpha (TNF-α) inhibitors) which is indicated after the conventional synthetic disease modifying antirheumatic drugs (csDMARD) had failed, is able to substantially influence the majority of clinical manifestations of the disease.
Nevertheless 40-60 % of patients quit the therapy with the first inhibitor TNF due to adverse events or secondary failure, after 3 years. Further approach after the first inhibitor TNF failure depends on various circumstances, like the prevailing clinical manifestations of the disease and also on patient's preferences.
What can then be considered? There are three possibilities: the combination with csDMARD, switch to other inhibitor TNF, or switch to a biologic DMARD (bDMARD) with an alternative mode of action. Currently available in the Czech Republic secukinumab blocker 17A, which is registered and has also determined a reimbursement from health insurance.
Of the others bDMARD ustekinumab has already been approved (registered) for use in both psoriasis and psoriatic arthritis, but for psoriatic arthritis the reimbursement has not yet been determined. The same applies to ixekizumab, tofacitinib and apremilast.