Psoriatic arthritis (PsA) is a complex inflammatory disease with heterogeneous clinical features, which complicates psoriasis in 30% of patients. There are no diagnostic criteria or tests available. Diagnosis is most commonly made by identifying inflammatory musculoskeletal features in joints, entheses or the spine in the presence of skin and/or nail psoriasis and in the usual absence of rheumatoid factor and anti-cyclic citrullinated peptide. The evolution of psoriasis to PsA may occur in stages, although the mechanisms are unclear. In many patients, there may be little or no relationship between severity of musculoskeletal inflammation and severity of skin or nail psoriasis. The reason for this disease heterogeneity may be explained by differences in genotype, especially in the HLA region. New targeted therapies for PsA have been approved with additional therapies in development. These developments have substantially improved both short-term and long-term outcomes including a reduction in musculoskeletal and skin manifestations and in radiographic damage. With efforts underway aimed at improving our understanding of the molecular basis for the heterogeneity of PsA, a personalized approach to treating PsA may become possible.

银屑病关节炎 (PsA) 是一种复杂的炎症性疾病，具有异质性的临床特征，30% 的患者会并发银屑病。没有可用的诊断标准或测试。在皮肤和/或指甲银屑病存在且通常不存在类风湿因子和抗环瓜氨酸肽的情况下，最常通过识别关节、附着点或脊柱的炎症肌肉骨骼特征来进行诊断。银屑病向 PsA 的演变可能分阶段发生，但机制尚不清楚。在许多患者中，肌肉骨骼炎症的严重程度与皮肤或指甲银屑病的严重程度之间可能几乎没有关系。这种疾病异质性的原因可能是基因型的差异，特别是在 HLA 区域。新的 PsA 靶向疗法已获批准，其他疗法正在开发中。这些进展大大改善了短期和长期结果，包括减少肌肉骨骼和皮肤表现以及放射学损伤。随着旨在提高我们对 PsA 异质性分子基础的理解的努力，治疗 PsA 的个性化方法可能成为可能。