MANAGEMENT OF PSORIATIC ARTHRITIS: AN OVERVIEW OF SYNTHETIC, RECOMBINANT DNA, MONOCLONAL ANTIBODY AND NATURE-DERIVED AGENTS

Psoriatic arthritis is an inflammatory condition of the skin and musculoskeletal system with cutaneous psoriasis that leads to joint deformity and disability and is commonly seen in 40-50-year-old population. Clinically, TNF-α inhibitors and JAK inhibitors form the main line of treatment of this rare disorder. A systematic review was conducted via an electronic search of Google Scholar, PubMed, Science Direct, Wiley, Embase, and Cochrane databases till May 2020 using the following keywords: “Psoriatic arthritis”, “Atrophic arthritis”, “Rheumatoid arthritis”. Published literature that explores the therapeutic methods of treating CSOM are included along with data of randomized control trials (RCTs), in-vivo studies and ELISA assays are collated in this review. 43 qualitative studies from 6 databases are included in this systematic review. Of these, 40 studies depict the efficacy of chemically synthesized, nature-derived, monoclonal antibody and recombinant DNA compounds (TNF-α inhibitors, T-cell suppressors, inhibitors of MAP kinase, and JAK) and 3 studies depict the benefits of alternative agents (ZSTK474, gold sodium thiomalate nanoparticles and whole body cryotherapy) in PsA. A critical analysis of the published literature indicates that filgotinib, golimumab, upadacitinib, etanercept, guselkumab, N, N-dimethylsphingosine, and hedera-genin are most effective in reducing arthritic pain (by 58 to 80%). This review aims to provide a comprehensive perspective on the role of diverse synthetic, recombinant DNA and nature-based agents in the modulation of inflammatory events and joint tenderness and swelling involved in the complex path physiology of PsA.