INTRODUCTION: Achieving sustained remission in psoriatic arthritis (PsA) remains challenging despite the availability of multiple biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Heterogeneous disease expression, comorbidities, and variable durability of response limit treatment effectiveness. AREAS COVERED: This review summarizes contemporary and emerging pharmacologic approaches to PsA, spanning established therapies targeting tumor necrosis factor (TNF), the interleukin-23/interleukin-17 (IL-23/IL-17) axis, and Janus kinase (JAK) signaling, as well as emerging strategies such as selective tyrosine kinase 2 (TYK2) inhibition, dual JAK1/TYK2 inhibition, oral interleukin-23 receptor - targeted peptides, and novel biologic platforms. A structured literature search of PubMed, MEDLINE, and ClinicalTrials.gov was conducted for studies published between January 2000 and April 2026. Evidence from randomized controlled trials, long-term extension studies, and real-world observational cohorts informed assessment of efficacy, durability, safety, treatment sequencing, and drug survival, with emphasis on multidomain involvement and metabolic and non-inflammatory drivers of disease activity. EXPERT OPINION: Progress in PsA management will depend less on expanding therapeutic options and more on improving sustained remission rates. Phenotype- and mechanism-informed treatment selection, proactive treat-to-target implementation, and systematic reassessment of residual inflammatory versus non-inflammatory disease activity are central to optimizing long-term outcomes. Emerging therapies may refine existing strategies by improving durability and safety.
Kharouf et al. (Wed,) studied this question.