Abstract
Thirty-five patients with Early Psoriatic Arthritis (EPA) (17 female and 18 male; mean age 25.6 years) entered this randomised 6-month study. At the enrolment, all patients were on non-steroidal anti-inflammatory drug (NSAID) therapy on demand and were divided in two matched groups (A and B). Group A continued NSAID therapy at full dosage in the following 3 months and then added methotrexate (MTX) for another 3 months. Group B was under the combination of NSAID and MTX for the entire 6-month period. Clinical and laboratory assessment included the count of tender joints and/or entheses (TJC), the count of swollen joints and/or entheses (SJC), patient’s global assessment (PGA), physician’s global assessment (PhGA), patient’s assessment of pain (VAS), erythrocyte sedimentation rate (ESR) and serum concentration of C-reactive protein (CRP). All variables were done at baseline (T0), at 3 (T3) and at 6 months (T6). In both group A and in group B, there was a significant improvement of all variables at T3 and T6. However, in comparison to the patients of group A, patients included in group B showed a more rapid and marked improvement of TJC and SJC, which was statistically significant at T3 (p < 0.05). In contrast, the improvement of PGA, PhGA, VAS, ESR and CRP was not significantly different between groups. The early use of MTX in EPA patients markedly improves TJC and SJC. In fact, at T3, other markers used to quantify EPA disease activity, in particular PGA, PhGA, VAS, ESR and CRP, did not show significant differences in EPA patients treated with either NSAIDs or MTX. This finding suggests an incomplete control under MTX of the pathogenetic process and stimulates further interest on early use of other therapeutical approaches capable of modifying the course of disease.
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References
Gladman DD, Stafford-Brady F, Chang CH, Lewandowski K, Russell ML (1990) Longitudinal study of clinical and radiological progression in psoriatic arthritis. J Rheumatol 17:809–812
McHugh NJ, Balachrishnan C, Jones SM (2003) Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study. Rheumatology (Oxford) 42:778–783
Kane D, Stafford L, Bresnihan B, FitzGerald O (2003) A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford) 42:1460–1468
Mease PJ (2005) Psoriatic arthritis therapy advances. Curr Opin Rheumatol 17:426–432
Gladman DD (2005) Traditional and newer therapeutic options for psoriatic arthritis: an evidence-based review. Drugs 65:1223–1238
Scarpa R, Atteno M, Peluso R, Iervolino S, Di Minno MND, Del Puente A (2006) The clinical pattern of early psoriatic arthritis. Rheumatology 45(Suppl 1):i65(abstract)
Scarpa R, Cuocolo A, Peluso R, Atteno M, Gisonni P, Iervolino S, Di Minno MND, Nicolai E, Salvatore M, Del Puente A (2007) Ealy psoriatic arthritis: the clinical spectrum. J Rheumatol (in press)
Moll JHM, Wright V (1973) Psoriatic arthritis. Semin Arthritis Rheum 3:55–78
Scarpa R, Cosentini E, Manguso F, Oriente A, Peluso R, Atteno M, D’Arienzo A, Ayala F, Oriente P (2003) Psoriatic arthritis “sine psoriasis”: clinical and genetical aspects. J Rheumatol 30(12):2638–40
Jones SM, Armas JB, Cohen MG, Lovell CR, Evison G, McHugh NJ (1994) Psoriatic arthritis: outcome of disease subsets and relationship of joint disease to nail and skin disease. Br J Rheumatol 33:834–839
Maksymowych WP, Inman RD, Gladman D, Thomson G, Stone M, Karsh J, Russell AS, Spondyloarthritis Research Consortium of Canada (SPARCC) (2003) Canadian Rheumatology Association Consensus on the use of anti-tumor necrosis factor-alpha directed therapies in the treatment of spondyloarthritis. J Rheumatol 30:1356–1363
Kyle S, Chandler D, Griffiths CE, Helliwell P, Lewis J, McInnes I, Oliver S, Symmons D, McHugh N, British Society for Rheumatology Standards Guidelines Audit Working Group (SGAWG) (2005) Guideline for anti-TNF-alpha therapy in psoriatic arthritis. Rheumatology (Oxford) 44:390–397
Salvarani C, Olivieri I, Pipitone N, Cantini F, Marchesoni A, Punzi L, Scarpa R, Matucci-Cerinic M, Italian Society for Rheumatology (2006) Recommendations of the Italian Society for Rheumatology for the use of biologic TNF-alpha blocking) agents in the treatment of psoriatic arthritis. Clin Exp Rheumatol 24:70–78
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Scarpa, R., Peluso, R., Atteno, M. et al. The effectiveness of a traditional therapeutical approach in early psoriatic arthritis: results of a pilot randomised 6-month trial with methotrexate. Clin Rheumatol 27, 823–826 (2008). https://doi.org/10.1007/s10067-007-0787-7
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DOI: https://doi.org/10.1007/s10067-007-0787-7