Rheumatology Medical News about Psoriatic arhtritis, DMARDs, TNF

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Update on the treatment of peripheral arthritis in psoriatic arthritis
Current Rheumatology Reports, 08/24/09

Soriano ER et al. – This article discusses the advances published in the past 2 to 3 years on the evidence-based treatment of psoriatic arthritis (PsA), and new guidelines. Several national guidelines, and one international guideline were developed in recent years to help in decision making for best treatment. Most national guidelines only dealt with the use of TNF antagonists; international treatment recommendations were developed by the Group of Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). These guidelines suggested that:

Corticosteroid are only advisable in discrete circumstances and not for chronic use
Gold salts, chloroquine, and hydroxychloroquine were also not recommended for use in PsA
Initiation of therapy with standard DMARDs (sulfasalazine, leflunomide, methotrexate, or cyclosporine) was recommended for pts with:
- Moderate-to-severe peripheral arthritis defined as ≥5 swollen/tender joints damage on radiograph
- Inadequate response to NSAIDs
- Moderate-to-severe loss of physical function, and/or
- Moderate-to-severe impact on quality of life
For pts who fail to respond to at least one DMARD, any of the 3 currently available TNF inhibitors (etanercept, infliximab, or adalimumab) were recommended
Pts with poor prognosis could be considered for TNF inhibitors even if they have not failed a standard DMARD therapy