Understanding Psoriatic Arthritis
(Part VI)
We continue with the final part of our discussion on the various treatment modalities involved in Psoriatic Arthritis (PsA).
Methotrexate (MTX) remains as the most used drug in the treatment of PsA; it has high treatment maintenance over time and seems effective in the control arms of most clinical trials.
It appears that the treatment of people with PsA using MTX appears to be satisfactory. MTX is highlighted among the conventional synthetic disease modifying antirheumatism drugs (csDMARDs), especially for patients with ‘relevant’ skin problems, where the impact of the disease involves the body surface >10%, or if the PsA leads to a significant decrease in the quality of life.
MTX has been proven effective in skin psoriasis and is recommended in the treatment guidelines for psoriasis and has become the standard csDMARD for skin psoriasis in many countries.
On the other hand, MTX leads to hepatotoxicity.
The data on the beneficial effects of MTX on cardiovascular disease in PsA remains uncertain.
Taking all these situations into account, the experts felt a gradual approach to intensify PsA treatment modalities and to focus on csDMARDS, particularly the use of MTX.
Other csDMARDs have shown some effectiveness in the treatment of PsA. Other drugs that should be considered for PsA are leflunomide and sulfasalazine.
Ciclosporin is generally not recommended for PsA. If improvement does not go beyond 50% of a composite measure for PsA within 3 months or the treatment target is not reached within 6 months, such csDMARD therapy is discouraged be pursued.
The search for better evidence for the efficacy of csDMARDs as as a single mode for treatment or therapy or as combination therapy is something the experts are looking at.