Current concepts in the treatment of psoriatic arthritis

The researchers describe psoriatic arthritis (PsA) to be a chronic inflammatory arthropathy characterised by the association of arthritis with psoriasis. They continue by reporting that many agents have been proposed for the treatment of PsA, but that their use is based "more on clinical experience than on sound scientific evidence".In their current investigation the authors have conducted a MedLine review, using the search term "psoriatic arthritis", "drug therapy", "controlled trials" and "outcomes" and all possible acronyms for these terms to analyse the basis of current therapeutic options.Based on their review Pipitone et al consider PsA to be a condition that runs a variable clinical course. The researchers identify that mild forms can "usually" be controlled by non-steroidal anti-inflammatory drugs (NSAIDs) and that intra-articular glucocorticoid injections are indicated in patients with persistent mono- or oligoarthritis. However, the authors point out that subjects with severe and progressive articular disease that is not responsive to NSAIDs should be treated with disease-modifying anti-rheumatic drugs (DMARDs) to prevent joint damage and disability.The researchers comment that currently, methotrexate and sulphasalazine are considered the DMARDs of choice, but that the evidence for the use of methotrexate in PsA is largely empirical, "while the clinical benefit induced by sulphasalazine appears to be modest". However, according to Pipitone et al, "none of the DMARDs available to date are effective in the treatment of psoriatic pelvispondylitis; in addition, a number of patients with severe peripheral arthritis fail to respond to standard DMARDs".In their summary the researchers comment that none of the current treatments for PsA is curative, but that "significant clinical amelioration can be achieved in the vast majority of patients". Pipitone et al consider that the identification and prompt treatment of patients with severe articular disease is "crucial" for the achievement of a satisfactory clinical response and the improvement of the long-term outcome.Reference...