Expert Review of Clinical Immunology vol:5 issue:6 pages:779-788
Psoriatic arthritis is a chronic inflammatory joint disease in patients with psoriasis and has a varying disease course. The majority of patients develop important disability and joint destruction within a few years of disease onset, necessitating the initation of disease-modifying therapy. Treatment options for peripheral disease, enthesitis and dactylitis include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), local steroids and TNF-blocking agents. Axial disease is treated with NSAIDS and TNF blockade. Major clinical response is seen in approximately 30% of patients with methotrexate or leflunomide but no structural effect has yet been documented. Anti-TNF treatment has the best number-needed-to-treat/number-needed-to harm ratio of all DMARDs in psoriatic arthritis and is able to induce clinical remission in at least 30% of patients. TNF-blocking agents have also been demonstrated to slow down or halt radiographic progression.