The goal of remission in psoriatic arthritis (PsA) has remained elusive despite the influx of a range of new therapies over the last 20 years. In contrast, therapeutic responses to agents that inhibit IL-23 or IL-17 have demonstrated impressive efficacy in psoriasis. In part, the divergent responses in these two disorders are likely related to the heterogeneity of tissue involvement in PsA and the interplay of multiple different cell populations and molecular pathways. In this narrative review, we will examine the plasticity of the immune response in PsA from the perspective of the Th17 cell and monocyte and discuss recent findings regarding the importance of CD8+ T resident cells in disease pathogenesis. We will then examine the effects of cytokines on epithelial cell and stromal populations and finally discuss new data regarding immune cell and tissue resident cell cross-talk in entheses and bone. Lastly, the potential therapeutic targets that have emerged from these investigations will be discussed.

尽管在过去 20 年涌入了一系列新疗法，但银屑病关节炎 (PsA) 的缓解目标仍然难以实现。相比之下，对抑制 IL-23 或 IL-17 的药物的治疗反应在银屑病中表现出令人印象深刻的疗效。在某种程度上，这两种疾病的不同反应可能与组织参与 PsA 的异质性以及多种不同细胞群和分子途径的相互作用有关。在这篇叙述性综述中，我们将从 Th17 细胞和单核细胞的角度检查 PsA 中免疫反应的可塑性，并讨论有关 CD8+ T 驻留细胞在疾病发病机制中的重要性的最新发现。然后，我们将检查细胞因子对上皮细胞和基质群的影响，最后讨论有关免疫细胞和组织驻留细胞在附着点和骨骼中的串扰的新数据。最后，将讨论从这些研究中出现的潜在治疗靶点。