How early should psoriatic arthritis be treated with a TNF-blocker?
OBJECTIVE
Psoriatic arthritis (PsA) is the second most commonly identified inflammatory arthropathy in early arthritis clinics. It is a complex multisystem disease involving the skin and joints, but may also present with inflammation of the spine - spondylitis, digits - dactylitis, eyes - uveitis and ligamentous insertions - enthesitis. The skin manifestations may be mild or patchy and often precede the joint inflammation. Joint erosions, however, may occur within the first 2 years in up to half of PsA patients and an erosion rate of 11% per annum has been reported suggesting it is not a benign disease as it was once regarded.


RESULTS
Therapy with mild anti-inflammatories is only beneficial in very mild or localized disease. In cases of more widespread joint involvement systemic therapy with disease-modifying antirheumatic drugs (DMARDs) such as methotrexate may be required and in the case of extra-articular or spinal disease, in which DMARDs have failed to show efficacy, biologic therapy may be highly effective.


CONCLUSIONS
The question of how early treatment should be instituted should be decided in a specialist rheumatology referral centre following appropriate assessment. Optimal therapy with combination DMARD and biologics may result in remission rates of up to 60%.
Dublin Academic Medical Centre, Department of Rheumatology, St Vincent's University Hospital, University College Dublin, Dublin, Ireland.
Leonard
L
Harty
Douglas James
DJ
Veale
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000628:therapy*; D006801:Humans; D018124:Receptors, Tumor Necrosis Factor / Q000037:antagonists & inhibitors*; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha