Background: There is controversy surrounding the use of systemic corticosteroids in psoriatic arthritis (PsA). It’s an accepted fact that the use of systemic corticosteroids can trigger severe flare-up of erythroderma or pustular psoriasis. Nevertheless, corticosteroids have been used to achieve faster improvement of joint symptoms of PsA.
Objectives: To analyze the use of systemic corticosteroids at intermediate doses in a short regimen in patients with PsA, as well as the serious complications of psoriasis upon withdrawal.
Methods: Retrospective analysis of an observational cohort of 453 patients from a university hospital, following a specific protocol from 1992 to 2019. The following variables have been collected: corticosteroid treatment (methylprednisolone ≤16mg /day in a slow tapering regimen in 2 months), demographic and disease factors, comorbidities that could be associated (diabetes mellitus, high blood pressure, severe infections) and serious complications of psoriasis (erythroderma or pustular psoriasis). To assess the activity of psoriasis, physician global assessment is mostly used and occasionally to a lesser extent body surface area and psoriasis area severity index.
Statistical analysis (SPSS v.25): descriptive analysis, Chi-squared test for qualitative variables and t-student test for quantitative variables.
Results: In our series, 35.98% (163/453) of patients have received short corticosteroid regimen at some point in follow-up care, of which 93.8% received concomitant treatment with disease modifying antirheumatic drugs (DMARD).
Only 6.2% of the patients who received short corticosteroid regimen presented a flare-up of psoriasis, most of them mildly. No patient developed an erythroderma or severe pustular psoriasis.
After analyzing the data, a greater use of this regimen of treatment has been observed in patients with dactylitis (44.6% with dactylitis vs 27.8% without dactylitis, p<0.001) and a lower use of corticosteroids in axial PsA (14% of axial PsA vs 41% of non-axial PsA, p<0.001).
There were no significant differences in the use of corticosteroids in respect to sex, age, age of onset of PsA, duration of PsA or high blood pressure. Nor in factors of poor radiographic prognosis: number of damaged joints, mutilating PsA and carpitis.
Conclusion: In our series, no patient developed an erythroderma or severe pustular psoriasis and most of the flare-ups of psoriasis were mild. The use of systemic corticosteroids at intermediate doses in a slow tapering regimen concomitantly with DMARD can be safely used in patients with PsA.
Disclosure of Interests: None declared
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