Psoriatic Arthritis

Psoriasis and psoriatic arthritis (PsA) are chronic autoimmune diseases characterized by persistent inflammation and oxidative imbalance. Oxidative stress, caused by excessive production of reactive oxygen species (ROS) and dysfunction in antioxidant mechanisms, plays a critical role in the pathogenesis of both conditions, leading to increased inflammatory processes and tissue damage. This study aims to review current antioxidant-based therapeutic options and analyze oxidative stress biomarkers in the context of psoriasis and PsA. Based on available literature, key biomarkers, such as malondialdehyde (MDA), advanced glycation end-products (AGEs), and advanced oxidation protein products (AOPP), were identified as being elevated in patients with psoriasis and PsA. Conversely, antioxidant enzymes, such as superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), showed reduced activity, correlating with symptom severity. The study also examines the efficacy of various antioxidant therapies, including curcumin, resveratrol, coenzyme Q10, and vitamins C and E, which may aid in reducing oxidative stress and alleviating inflammation. The findings indicated that antioxidants can play a significant role in alleviating symptoms and slowing the progression of psoriasis and PsA through modulation of redox mechanisms and reduction of ROS levels. Antioxidant-based therapies offer a promising direction in treating autoimmune diseases, highlighting the need for further research on their efficacy and potential clinical application.

Rheumatic diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) are chronic autoimmune disorders characterized by persistent inflammation and oxidative stress, leading to joint damage and reduced quality of life. In recent years, increasing attention has been given to diet as a modifiable environmental factor that can complement pharmacological therapy. This review summarizes current evidence on how key dietary components-such as omega-3 fatty acids, fiber, polyphenols, and antioxidant vitamins-affect inflammatory pathways and oxidative balance. Special emphasis is placed on the Mediterranean diet, low-starch diets, and hypocaloric regimens, which have shown potential in improving disease activity. The gut microbiota emerges as a critical mediator between diet and immune function, with dietary interventions capable of restoring eubiosis and strengthening the intestinal barrier. Additionally, this paper discusses challenges in the clinical implementation of diet therapy, the need for personalized nutritional strategies, and the importance of integrating diet into holistic patient care. Collectively, findings suggest that dietary interventions may reduce disease activity, mitigate systemic inflammation, and enhance patients' overall well-being.

Psoriatic arthritis (PsA) is a progressive, multidomain and interleukin-17 (IL-17)-linked disease that results in substantial quality-of-life deficits. Thereby, we conducted a phase 2 randomized, double-blind, placebo (PBO)-controlled trial of sonelokimab (SLK), a nanobody that binds with a similarly high affinity to IL-17A and IL-17F, inhibiting all dimers. Overall, 207 patients with active PsA were randomized to SLK 120-mg or 60-mg every 4 weeks (Q4W; both with induction (WI)), or to 60-mg Q4W with no induction, PBO or adalimumab (reference arm). The primary endpoint of American College of Rheumatology (ACR) 50 at week 12 was met for SLK 60-mg and 120-mg WI (60-mg WI = 46.3% (19/41; odds ratio (OR) = 3.6; 95% confidence interval (CI) = 1.3-9.9; P < 0.05); 120-mg WI = 46.5% (20/43; OR = 4.0; 95% CI = 1.4-11.3; P < 0.01) versus PBO = 20.0% (8/40)). SLK resulted in significant benefits across the key secondary endpoints of ACR20 (60-mg WI = 78.0% (32/41; P < 0.001) and 120-mg WI = 72.1% (31/43; P = 0.002) versus PBO = 37.5% (15/40)) and Psoriasis Area and Severity Index (PASI) 90 at week 12 (60-mg WI = 76.9% (20/26; P < 0.001) and 120-mg WI = 59.3% (16/27; P = 0.003) versus PBO = 15.4% (4/26)). Robust responses were observed among patients randomized to SLK at week 24 for the high-threshold composite endpoints of ACR70 + PASI 100 (exploratory) and minimal disease activity (secondary), achieved by up to 48% (13/27; 120-mg WI) and 61% (25/41; 60-mg WI), respectively. SLK was well-tolerated; the most common treatment-emergent adverse events were nasopharyngitis (60 mg = 6.1%; 120 mg = 5.2%), upper respiratory tract infection (60 mg = 6.1%; 120 mg = 4.1%), injection-site erythema (60 mg = 3.7%; 120 mg = 3.1%) and headache (60 mg = 2.4%; 120 mg = 4.1%). Four cases of mild to moderate oral candidiasis occurred (60 mg = 2.4%; 120 mg = 2.1%). Overall, SLK delivered substantial improvements in the signs and symptoms of PsA across various outcomes and domains. ClinicalTrials.gov registration: NCT05640245 .

Beyond its typical synovio-entheseal manifestations, psoriatic arthritis (PsA) is a systemic immune-mediated disease that carries a substantial, independent risk of major adverse cardiovascular events (MACE). The complex interaction of chronic systemic inflammation, a high prevalence of traditional risk factors, and PsA treatment drugs results in this increased cardiovascular burden, which is commonly underestimated in cardiology practice. Adipokine balance, insulin signalling, and lipid metabolism are all impacted by cytokine-driven systemic inflammation, which promotes metabolic abnormalities and accelerated atherogenesis. PsA-specific therapy has a complex and significant effect on cardiovascular risk. While there is evidence that strong inflammation suppression with tumour necrosis factor-α (TNF-α) inhibitors may reduce cardiovascular risk, some medications, such as Janus kinase (JAK) inhibitors, should be carefully considered due to potential side effects. In order to outline the epidemiology and pathophysiology of the PsA-cardiovascular risk nexus, this narrative review synthesises recent data. It also offers a critical framework for managing cardiovascular risk in this susceptible group, advocating for a multidisciplinary approach that incorporates strict management of both inflammation and traditional risk factors to lessen the excessive burden of MACE.