Elsevier

Joint Bone Spine

Volume 69, Issue 3, May 2002, Pages 275-281
Joint Bone Spine

ORIGINAL ARTICLE
Use of disease-modifying antirheumatic drugs in patients with psoriatic arthritis

https://doi.org/10.1016/S1297-319X(02)00396-2Get rights and content

Abstract

Few prospective placebo-controlled studies have evaluated disease-modifying antirheumatic drugs (DMARDs) in the treatment of peripheral psoriatic arthritis. Objective. To evaluate second-line treatments used in clinical practice in patients with psoriatic arthritis. Method. We studied a cross-section of 100 consecutive patients seen by hospital-based or office-based rheumatologists for psoriatic arthritis. Patients. The 55 men and 45 women had a mean age of 48 years (range, 17–79 years) and a mean disease duration of 7 years (range, 1–24 years). Results. The most commonly used DMARDs were sulfasalazine, gold, methotrexate, and hydroxychloroquine (64, 43, 41 et 17 patients, respectively). These drugs had been stopped because of inefficacy in 31%, 31%, 12%, and 53% of patients, respectively, and because of adverse events in 23%, 44%, 22%, and 41% of patients, respectively. At the time of the study, mean treatment durations were 15, 21, 34, and 12 months, respectively, and the drugs were still being used in 45%, 21%, 66%, and 6 % of patients. Conclusion. Our data confirm the value of methotrexate and salazopyrine. Methotrexate had the best risk/benefit ratio. Gold was often responsible for side effects. Hydroxychloroquine was inadequately effective and poorly tolerated.

Section snippets

Patients and methods

We conducted a cross-sectional study between January and April 1999 in 100 consecutive patients with psoriatic polyarthritis treated with at least one DMARD. Fifty patients were seen at a hospital-based rheumatology clinic and 50 by office-based rheumatologists working in the same city. For each of the 50 hospital clinic patients, the erythrocyte sedimentation rate, C-reactive protein level, and HLA B27 type were available. Our goal was to evaluate everyday practice regarding the use of DMARDs

Results

Our retrospective study included 55 men and 45 women with a mean age of 48 years (range, 17-79 years) and a mean disease duration of seven years (range, 1-24 years). All patients had peripheral manifestations of psoriatic arthritis. Age at the onset of psoriasis was known for 73 of the 100 patients; mean age at psoriasis onset was 31 years (range, 1-67 years), as compared to 40 years (range, 15-71 years) for the joint disease. The skin disease was diagnosed before the joint disease in 68% of

Discussion

The most widely used DMARDs were sulfasalazine, gold, and methotrexate. The treatment was discontinued because of inefficacy in 31%, 31%, and 12% of patients, respectively, and because of side effects in 23%, 44%, and 22%. Methotrexate seemed to have a satisfactory risk/benefit ratio despite three pulmonary events, whose nature and severity could not be determined in this retrospective study.

A critical appraisal of the therapeutic trials conducted in patients with psoriatic arthritis invites

Conclusion

The choice of treatments for psoriatic arthritis is influenced by the results of studies that showed clinical efficacy with a satisfactory safety profile. Even results from open-label studies are heeded. Our study confirms the beneficial effects of salazopyrine and methotrexate. Methotrexate offers the best risk/benefit ratio. Gold therapy is commonly associated with side effects, and few patients take hydroxychloroquine for long periods. Cyclosporine is effective and may therefore be

Acknowledgements

We thank Drs Baudens, Delambre, Ducrocq, Dutour, Godelle, Heuline, Lejeune, Leloire, Guinamard, Tison-Muchery, Toulemonde, who are rheumatologists in office-based practice.

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    1

    This work was presented at the XIIth French Congress on Rheumatology.

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