Understanding Psoriatic Arthritis
(Part V)
We now continue our discussion regarding the treatment modalities for Psoriatic Arthritis (PsA).
Injections of corticosteroids are eyed as treatment for PsA.
Local injections of glucocorticoids should be taken into consideration as adjunctive therapy in psoriatic arthritis; systemic glucocorticoids may be used with caution at the lowest effective dose.
It should be noted that glucocorticoid therapy should be used for only a short period of time. Experts do not recommend the use of systemic glucocorticoids for axial disease.
Recommendation 4: In patients with polyarthritis, a conventional synthetic disease modifying antirheumatic drugs (csDMARD) should be administered rapidly, with methotrexate should be used with patients suffering from relevant skin involvement.
Patients with polyarticular disease should get a csDMARD either as first-line drug or after only a short course of nonsteroIdal anti-inflammatory drugs (NSAIDs).
The continuous prioritisation of csDMARDs reflects the expert opinion within favoring the benefit to risk balance of csDMARDs and in particular methotrexate (MTX) over other drugs.
Data supporting the use of MTX in PsA are very limited and include only small clinical trials, as well as indirect evidence stemming from some studies.
In a systematic literature review, it is revealed that MTX has similar efficacy in joint counts, skin involvement, enthesitis, dactylitis and physical function.
Given this data, experts are looking at using MTX and other csDMARDs at the top of the preferred drugs to treat PsA.
There are patients who may have a reluctance to take MTX and may experience adverse effects.
MTX information should be part of the information given to the patient in the process of shared decision-making in relation to the treatment of PsA.
We will continue with other treatment modalities for PsA in our column next week.