Psoriatic arthritis (PsA) is now recognised as a potentially severe form of arthritis associated with skin and nail involvement. Targeted biological treatments have been introduced to treat it and, in many cases, are administered in combination with disease-modifying antirheumatic drugs (DMARD) such as methotrexate and ciclosporin.1 Previous randomised clinical trials of anti-tumour necrosis factor alpha drugs have failed to demonstrate that PsA patients receiving concomitant methotrexate show any greater clinical improvement than those receiving monotherapy.2,–,4 However, the Norwegian DMARD register5 and Kristensen et al6 found that the absence of concomitant methotrexate was a predictor of premature treatment discontinuation in patients with PsA. D'Angelo et al7 have reported that the addition of ciclosporin to etanercept seems to be a safe and effective treatment for PsA patients with uncontrolled cutaneous disease.

The primary objective of this open-label, randomised clinical trial was to …