REPORT

Psoriatic arthritis and psoriasis: treatment

Psoriatic arthritis therapy: NSAIDs and traditional DMARDs

P Nash¹, D O Clegg²

¹ Rheumatology Research Unit, Nambour Hospital, Sunshine Coast; and Department of Medicine, University of Queensland, Queensland, Australia
² Rheumatology Section, Salt Lake City Veterans Health Care System, University of Utah School of Medicine, Salt Lake City, Utah, USA

Correspondence to:
Correspondence to:
daniel.clegg{at}hsc.utah.edu
Correspondence to:
pnash{at}tpg.com.au

Non-steroidal anti-inflammatory drugs (NSAIDs) and traditional disease modifying antirheumatic drugs (DMARDs) are widely used in the treatment of psoriatic arthritis (PsA), but this is based more upon clinical experience than adequate evidence from clinical trials. This report summarises the results from available trials highlighting evidence of efficacy and deficiencies with respect to effect on joints and to a lesser degree cutaneous disease. The available published data on efficacy of NSAIDs, glucocorticoids, antimalarials, sulfasalazine, gold, methotrexate, azathioprine, and ciclosporin are detailed, as well as new data on leflunomide and other novel agents. The conclusions of this review are that evidence supports marginal efficacy of sulfasalazine and perhaps gold in the treatment of peripheral psoriatic arthropathy, and methotrexate and ciclosporin are effective for treating the skin disease although evidence for improvement of the arthropathy is empirical at best. New trials with standardised and validated outcome measures are required to better assess efficacy. Evaluating newer agents, against and in combination with traditional DMARDS, may further clarify the latter’s role in the future management of this condition.

Abbreviations: DMARD, disease modifying antirheumatic drug; ESR, erythrocyte sedimentation rate; NSAID, non-steroidal anti-inflammatory drug; PASI, Psoriasis Area and Severity Index; PsA, psoriatic arthritis; RA, rheumatoid arthritis

Keywords: disease modifying agents; drug therapy; glucocorticoids; non-steroidal anti-inflammatory drugs; psoriatic arthritis

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