title: Psoriatic Disease: Update on Traditional Disease-modifying Antirheumatic Drugs.
abstract: We present an update on the effects of methotrexate (MTX), sulfasalazine (SSZ), leflunomide (LEF), and cyclosporine (CSA) in psoriatic arthritis (PsA) by reviewing data published from January 2010 to June 2014. The most relevant study on MTX, the Methotrexate In Psoriatic Arthritis (MIPA) trial, did not show a significant difference between this drug and placebo in improving peripheral synovitis. The trial, however, had several limitations. A cohort study on a small number of patients found that MTX does not inhibit radiographic progression. In a large observational study, 86% of LEF-treated patients met PsA Response Criteria (PsARC) at Week 24. No studies of sufficient relevance on SSZ were published in the examined time frame. In an open-label trial, CSA alone was compared to adalimumab (ADA) alone and to the combination ADA/CSA. The ADA arms showed a significantly higher response rate, but as many as 65% of CSA-treated patients were PsARC responders at Month 12. No relevant data on the effects of these 4 drugs on psoriatic enthesitis, dactylitis, or spondylitis have recently been published, and no new safety signals have been reported. Observational data from 2 registers suggest that concomitant MTX increases the retention rate of tumor necrosis factor-α inhibitors. The studies published in the examined time frame confirm that MTX, SSZ, LEF, and CSA have moderate symptom-modifying effect on psoriatic synovitis, and probably little effect on the other manifestations of PsA.
authors.affiliation: From the UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Milan; Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; and the Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy.A. Marchesoni, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; M. Ricci, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; M. Manara M, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute. marchesoni@gpini.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchesoni
authors.affiliation: From the UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Milan; Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; and the Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy.A. Marchesoni, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; M. Ricci, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; M. Manara M, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute.
authors.forename: Ennio
authors.initials: E
authors.lastname: Lubrano
authors.affiliation: From the UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Milan; Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; and the Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy.A. Marchesoni, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; M. Ricci, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; M. Manara M, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cauli
authors.affiliation: From the UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Milan; Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; and the Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy.A. Marchesoni, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; M. Ricci, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; M. Manara M, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute.
authors.forename: Massimo
authors.initials: M
authors.lastname: Ricci
authors.affiliation: From the UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute, Milan; Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; and the Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy.A. Marchesoni, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; E. Lubrano, MD, PhD, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Cauli, MD, PhD, Rheumatology Unit, Department of Medical Sciences, University of Cagliari; M. Ricci, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute; M. Manara M, MD, UOC Day Hospital of Rheumatology, G. Pini Orthopedic Institute.
authors.forename: Maria
authors.initials: M
authors.lastname: Manara
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: CYCLOSPORINE; LEFLUNOMIDE; METHOTREXATE; PSORIATIC ARTHRITIS; SULFASALAZINE