Is precision medicine possible in rheumatic diseases? Lessons from selective use of targeted therapies in patients with psoriatic arthritis.

Introduction

Treatment of rheumatic diseases has been greatly advanced by the introduction of biological molecular-targeted therapies. However, owing to their high heterogeneity at the molecular and clinical levels, treatment of rheumatic diseases can often be challenging. Hence, it especially important to select the most optimal targeted therapy for individual patients. There are ten biologics available for the treatment of psoriatic arthritis; however, how each of these can be used most effectively is unclear.Areas covered: We conducted a narrative review to elucidate whether stratifying psoriatic arthritis patients to select specific molecular-targeted therapies would improve treatment outcomes. We explored the potential of precision medicine in which patients with psoriatic arthritis are stratified by lymphocyte flow cytometry to select specific targeted therapies.Expert opinion: There is insufficient evidence to allow meta-analysis to stratify psoriatic arthritis patients to select specific molecular-targeted therapies. However, selecting specific biologics according to different immunophenotypes of peripheral blood lymphocytes in psoriatic arthritis was shown to produce high therapeutic responses; in other words, the potential of precision medicine was suggested. Such an approach can be applied to other diseases with various clinical features, including spondyloarthritis and systemic lupus erythematous.