Ashish Mathew

Psoriatic arthritis (PsA) is a complex disease with articular, extra-articular, and extra-musculoskeletal manifestations. Despite therapeutic advances, sustained remission remains elusive for a considerable proportion of patients. This editorial examines the multifaceted reasons behind treatment resistance, evolving definitions of difficult-to-treat (D2T) PsA, and emerging strategies that promise to reshape future management [1].

ARF and its sequela, RHD remain significant global health challenges, particularly affecting children aged 5–15 years in developing countries with limited healthcare access and overcrowded living conditions [4]. The first episode of ARF usually presents in children aged 5–14 years; recurrent episodes are most common within 1 year of the first episode but can occur throughout life. The incidence of ARF varies widely, with the highest rates reported in regions such as sub-Saharan Africa, South