【摘要】 银屑病关节炎（PsA）需通过聚焦外周关节、中轴关节、附着点炎、指（趾）炎和关节外损害[包括皮肤和（或）指甲银屑病、葡萄膜炎、炎症性肠病以及合并症]的多维度分层管理，从而实现达标治疗。中轴关节受累患者应首选肿瘤坏死因子抑制剂（TNFi）或白细胞介素（IL）-17A抑制剂，而IL-12/23抑制剂（IL-12/23i）和细胞介素-23抑制剂（IL-23i）因临床证据不足不作为推荐；外周关节炎患者以传统合成的抗风湿病药物（csDMARDs）（如甲氨蝶呤）作为一线治疗药物，对于疾病活动度高的患者应及时升级至TNFi、IL-17i或IL-23i，临床研究结果显示早期生物制剂强化治疗较传统药物具有显著优势；附着点炎和指（趾）炎患者推荐直接使用TNFi、IL-17i或靶向合成的抗风湿病药物（tsDMARDs），避免单独使用csDMARDs；合并皮肤和（或）指甲银屑病患者需联合靶向IL-17或IL-23通路的生物制剂，对于皮损严重、体表面积评分≥10者优先选择IL-17A/F抑制剂或IL-23i。在关节外损害管理方面，葡萄膜炎患者应选用单抗类TNFi（阿达木单抗或英夫利昔单抗），而炎症性肠病（IBD）患者则禁用IL-17i。最新证据强调，根据治疗反应动态调整策略（如TNFi治疗失败后转换为IL-17i或Janus激酶抑制剂）以及结合患者个体情况制定方案是实现持续临床缓解的关键。随着酪氨酸激酶2抑制剂等新型靶向药物的研发，PsA的精准治疗体系将得到进一步完善。更多还原

【Abstract】 Psoriatic arthritis(PsA)requires a multidimensional stratified treatment approach targeting peripheral joints,axial involvement,enthesitis,dactylitis,and extra-articular manifestations including cutaneous/nail psoriasis,uveitis,inflammatory bowel disease(IBD),and comorbidities to achieve treat-to-target goals. For axial involvement,TNF inhibitors(TNFi)or IL-17A inhibitors are preferred first-line options,while IL-12/23inhibitors(IL-12/23i)and IL-23inhibitors(IL-23i)are not recommended due to insufficient clinical evidence; peripheral arthritis should be initially managed with csDMARDs(e.g,methotrexate),with timely escalation to TNFi,IL-17i or IL-23i for high disease activity,as clinical studies demonstrate superior efficacy of early intensive biologic therapy over conventional drugs; enthesitis and dactylitis patients should directly receive TNFi,IL-17i or tsDMARDs therapy,avoiding csDMARD monotherapy; patients with concomitant cutaneous/nail psoriasis require combination biologics targeting IL-17/IL-23 pathways,with IL-17A/Finhibitors or IL-23i prioritized for severe skin lesions,body surface area score(BSA)≥10. For the management of extraarticular manifestations,monoclonal TNFi(adalimumab or infliximab) are preferred for uveitis,while IL-17i is contraindicated in IBD. The latest evidence emphasizes that dynamic treatment adjustment(e.g.,switching to IL-17i or JAKinhibitors after TNFi failure)and personalized regimens tailored to individual patient characteristics are crucial for achieving sustained clinical remission.With the development of novel targeted drugs like TYK2 inhibitors,PsA’s precision treatment framework will be further refined.更多还原