title: Disease-modifying Antirheumatic Drugs (DMARD) and Combination Therapy of Conventional DMARD in Patients with Spondyloarthritis and Psoriatic Arthritis with Axial Involvement.
abstract: Treatment with nonsteroidal antiinflammatory drugs (NSAID) is the recommended first-line therapy in patients with axial spondyloarthritis (axSpA); and for those patients who have persistently active disease, the introduction of tumor necrosis factor-α (TNF-α) inhibitors is indicated. Conventional nonbiological disease-modifying antirheumatic drugs (DMARD), although effective and used in clinical practice for peripheral arthritis, are not recommended. Few studies have been conducted with the aim of evaluating the effect of conventional DMARD, either alone or in combination, in axSpA. As for psoriatic arthritis (PsA), DMARD are widely used, but few trials are available about their effects on axial involvement, which is not often assessed as a primary outcome in clinical trials. In rheumatoid arthritis, combination therapy of 2 or more conventional DMARD appears to confer better response than methotrexate monotherapy, and may even be a viable alternative to TNF-α inhibitors. In peripheral PsA, combination therapy can be used after treatment failure with 1 DMARD, but few studies have been conducted. However, available evidence for the combination of conventional DMARD indicates a lack of any significant benefit on axial symptoms; thus this treatment approach does not represent an effective alternative to anti-TNF-α therapy.
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC, Rome, Italy.D. Simone, MD; M. Nowik, MD; E. Gremese, MD; G.F. Ferraccioli, MD, Professor, Chairman, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC.
authors.forename: Davide
authors.initials: D
authors.lastname: Simone
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC, Rome, Italy.D. Simone, MD; M. Nowik, MD; E. Gremese, MD; G.F. Ferraccioli, MD, Professor, Chairman, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC.
authors.forename: Marcin
authors.initials: M
authors.lastname: Nowik
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC, Rome, Italy.D. Simone, MD; M. Nowik, MD; E. Gremese, MD; G.F. Ferraccioli, MD, Professor, Chairman, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC.
authors.forename: Elisa
authors.initials: E
authors.lastname: Gremese
authors.affiliation: From the Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC, Rome, Italy.D. Simone, MD; M. Nowik, MD; E. Gremese, MD; G.F. Ferraccioli, MD, Professor, Chairman, Institute of Rheumatology and Affine Sciences, School of Medicine, Catholic University of the Sacred Heart, CIC. gf.ferraccioli@rm.unicatt.it.
authors.forename: Gianfranco F
authors.initials: GF
authors.lastname: Ferraccioli
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D012074:Remission Induction; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
keywords: AXIAL SPONDYLOARTHRITIS; COMBINATION DRUG THERAPY; DISEASE-MODIFYING ANTIRHEUMATIC DRUG; PSORIATIC ARTHRITIS; PSORIATIC SPONDYLOARTHRITIS