ISSUE 1470
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Psoriatic arthritis is a chronic inflammatory arthropathy that develops in up to 40% of patients with psoriasis. Several guidelines for treatment of psoriatic arthritis have been published.1-4
NSAIDs
Nonselective NSAIDs can improve symptoms in patients with mild disease. The selective cyclooxygenase-2 (COX-2) inhibitor celecoxib (Celebrex, and generics) may also be effective; one randomized, double-blind, 12-week trial in patients with a psoriatic arthritis flare found that ACR20 response rates (20% improvement on the American College of Rheumatology scale) with celecoxib 200 or 400 mg daily were superior to those with placebo at week 2, but there was no difference between the groups at week 12.5
Adverse Effects – Worsening of skin disease has been reported when NSAIDs were started in patients
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- A Menter et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol 2011; 65:137.
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- AJ Kivitz et al. A comparison of the efficacy and safety of celecoxib 200 mg and celecoxib 400 mg once daily in treating the signs and symptoms of psoriatic arthritis. Semin Arthritis Rheum 2007; 37:164.
- P Mease. Methotrexate in psoriatic arthritis. Bull Hosp Jt Dis (2013) 2013; 71 suppl 1:S41.
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- ER Soriano and NJ McHugh. Therapies for peripheral joint disease in psoriatic arthritis. A systematic review. J Rheumatol 2006; 33:1422.
- AD Fraser et al. A randomised, double-blind, placebo controlled, multicentre trial of combination therapy with methotrexate plus ciclosporin in patients with active psoriatic arthritis. Ann Rheum Dis 2005; 64:859.
- MB Hoffman et al. Psoriasis during pregnancy: characteristics and important management recommendations. Expert Rev Clin Immunol 2015; 11:709.
- Apremilast (Otezla) for psoriatic arthritis. Med Lett Drugs Ther 2014; 56:41.
- A Kavanaugh et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann Rheum Dis 2014; 73:1020.
- A Kavanaugh et al. Longterm (52-week) results of a phase III randomized, controlled trial of apremilast in patients with psoriatic arthritis. J Rheumatol 2015; 42:479.
- R Goulabchand et al. Effect of tumor necrosis factor blockers on radiographic progression of psoriatic arthritis: a systematic review and meta-analysis of randomised controlled trials. Ann Rheum Dis 2014; 73:414.
- AS Soubrier et al. Treatment response, drug survival and safety of anti-tumour necrosis factor α therapy in 193 patients with psoriatic arthritis: a twelve-year "real life" experience. Joint Bone Spine 2015; 82:31.
- L Eder et al. Tumour necrosis factor α blockers are more effective than methotrexate in the inhibition of radiographic joint damage progression among patients with psoriatic arthritis. Ann Rheum Dis 2014; 73:1007.
- K Thorlund et al. Anti-tumor necrosis factor (TNF) drugs for the treatment of psoriatic arthritis: an indirect comparison meta-analysis. Biologics 2012; 6:417.
- Certolizumab pegol (Cimzia) and ustekinumab (Stelara) for psoriatic arthritis. Med Lett Drugs Ther 2014; 56:9.
- PJ Mease et al. Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Ann Rheum Dis 2014; 73:48.
- RE Kalb et al. Risk of serious infection with biologic and systemic treatment of psoriasis: results from the psoriasis longitudinal assessment and regiatryy (PSOLAR). JAMA Dermatol 2015 May 13 (epub).
- AL Semble et al. Safety and tolerability of tumor necrosis factor-α inhibitors in psoriasis: a narrative review. Am J Clin Dermatol 2014; 15:37.
- L Hsu et al. Antidrug antibodies in psoriasis: a systematic review. Br J Dermatol 2014; 170:261.
- IB McInnes et al. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 2013; 382:780.
- A Kavanaugh et al. Ustekinumab, an anti-IL-12/23 p40 monoclonal antibody, inhibits radiographic progression in patients with active psoriatic arthritis: results of an integrated analysis of radiographic data from the phase 3, multicentre, randomised, double-blind, placebo-controlled PSUMMIT-1 and PSUMMIT-2 trials. Ann Rheum Dis 2014; 73:1000.
- IB McInnes et al. Efficacy and safety of secukinumab, a fully human anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe psoriatic arthritis: a 24-week, randomized, double-blind, placebo-controlled, phase II proof-of-concept trial. Ann Rheum Dis 2014; 73:349.
- M Daly et al. Combination systemic therapies in psoriatic arthritis. J Dermatolog Treat 2011; 22:276.
- ML Felquer and ER Soriano. New treatment paradigms in psoriatic arthritis: an update on new therapeutics approved by the U.S. Food and Drug Administration. Curr Opin Rheumatol 2015; 27:99.
- GN Karanikolas et al. Adalimumab or cyclosporine as monotherapy and in combination in severe psoriatic arthritis: results from a prospective 12-month nonrandomized unblinded clinical trial. J Rheumatol 2011; 38:2466.

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