This review summarizes current and emerging treatments for psoriasis and psoriatic arthritis (PsA), highlighting how advances in understanding shared inflammatory pathways have expanded options across topical therapies, oral small molecules, conventional DMARDs, biologics, and investigational agents. Current psoriasis treatment ranges from topical corticosteroids, vitamin D analogs, roflumilast, tapinarof, and phototherapy to systemic agents such as methotrexate, cyclosporine, acitretin, apremilast, JAK/TYK2 inhibitors, and biologics targeting TNF-alpha, IL-12/23, IL-17, and IL-23. For PsA, treatment selection depends on disease severity, joint involvement, skin burden, comorbidities, prior therapies, contraindications, and patient preferences. The review emphasizes screening patients with psoriasis for PsA and using a multidisciplinary approach when both skin and joint disease are present.

The article also outlines ongoing unmet needs, especially for patients with persistent active disease, inadequate response, anti-drug antibodies, adherence challenges with topicals, cost barriers, safety concerns, and limited PsA-specific options compared with psoriasis therapies. Emerging treatments include newer JAK and TYK2 inhibitors, oral IL-23 and IL-17 pathway agents, RORγT inhibitors, nanobodies, S1P1 receptor antagonists, A3 adenosine receptor agonists, HSP90 inhibitors, and ROCK-2 inhibitors. Many of these agents may offer new mechanisms and more personalized treatment pathways, but long-term safety, cardiovascular considerations, infection risk, malignancy risk, hepatic effects, and effects on inflammatory bowel disease remain important concerns. The authors conclude that psoriasis and PsA care is becoming more individualized and complex, with future therapies likely to reshape treatment guidelines as more efficacy and safety data emerge.

Reference: Yi RC, Akbik M, Smith LR, Klionsky Y, Feldman SR. Therapeutic Advancements in Psoriasis and Psoriatic Arthritis. J Clin Med. 2025 Feb 16;14(4):1312. doi: 10.3390/jcm14041312. PMID: 40004842; PMCID: PMC11855982.

This joint position statement from the National Psoriasis Foundation (NPF) Medical Board and International Psoriasis Council (IPC) reviews evidence on whether routine latent tuberculosis (TB) infection testing is needed before or during treatment with IL-17 or IL-23 inhibitors for psoriasis. Across preclinical data, clinical trials, real-world studies, and a FAERS database search, the authors found little evidence that IL-17 or IL-23 inhibitors increase the risk of progression from latent TB infection to active TB disease. In contrast, the FAERS analysis identified extra-pulmonary internal organ TB reports with TNF inhibitors, supporting the known difference in TB risk between TNF blockade and IL-17/IL-23 inhibition.

Based on this evidence, the NPF and IPC adopted the statement that routine testing for latent TB infection is not required before or during treatment of patients with psoriasis with IL-17 or IL-23 inhibitors. The authors note that exceptions may still be appropriate in certain situations, such as patients in TB-endemic regions or those receiving other immunosuppressive medications. They argue that eliminating routine TB testing when it is not medically warranted could reduce costs, avoid false positives, lessen regulatory burden, and help patients start appropriate psoriasis treatment more efficiently.

Reference: Blauvelt A, Strober BE, Eakin GS, et al. Joint position statement from the National Psoriasis Foundation Medical Board and the International Psoriasis Council on routine testing for latent tuberculosis infection prior to and during treatment of psoriasis patients with interleukin 17 or interleukin 23 inhibitors. J Am Acad Dermatol. 2025 Nov 17:S0190-9622(25)03232-3. doi: 10.1016/j.jaad.2025.11.033. Epub ahead of print. PMID: 41260526.

This patient-facing American College of Rheumatology resource focuses on pregnancy planning for women with psoriatic arthritis. It emphasizes that the safest pregnancy planning approach includes keeping psoriatic arthritis disease activity as low as possible, reviewing medications with the care team, and using pregnancy-compatible “green list” medications when appropriate. Well-controlled disease is described as minimal skin, nail, and joint inflammation; no recent symptoms suggestive of iritis, inflammatory bowel disease, enthesitis, or dactylitis; and no flares in the past 6 months.

The resource encourages patients to discuss medications with their rheumatology or dermatology provider, maternal-fetal medicine specialist, local OB, and dermatologist. Medications are grouped into green, grey, and red categories: some are considered generally compatible, others require discussion with a rheumatologist, and others should be stopped before pregnancy. It specifically flags methotrexate and leflunomide as red-list medications, while noting that NSAIDs may be used in the first trimester but should be discussed with the rheumatologist, especially regarding discontinuation around 20 weeks of gestation.

Reference: American College of Rheumatology. Pregnancy planning for women with psoriatic arthritis. American College of Rheumatology Reproductive Health Initiative. Published 2021. Accessed June 2, 2026. DOI not available; PMID not available; PMCID not available.