title: Repository corticotropin injection in patients with refractory psoriatic arthritis: a case series.
abstract: OBJECTIVE
  Although numerous treatment options are available for patients with psoriatic arthritis (PsA), a need for effective and tolerable treatments remains for patients with refractory disease who have failed previous therapies and continue to experience tender and/or swollen joints, pain, and disease activity. Repository corticotropin injection (RCI) is believed to produce steroidogenic, steroid-independent, anti-inflammatory, and immunomodulatory effects in patients with rheumatic disorders, such as PsA. Limited literature exists on the use of RCI in patients with refractory PsA. The objective of this case series is to provide information on the clinical features of patients with refractory PsA and their response to RCI.
  
  
  METHODS
  Nine patients treated with RCI for refractory PsA were retrospectively identified and included in the case series.
  
  
  RESULTS
  All the nine patients experienced at least transient improvements in their active skin and joint disease. In some patients, it was necessary to titrate the RCI to an appropriate dose. RCI was used in some patients to bridge with another PsA therapy, such as apremilast or certolizumab. RCI was well tolerated, but discontinued in three patients due to preexisting conditions (hypertension and hyperglycemia).
  
  
  CONCLUSIONS
  RCI may be a safe and effective option for patients with refractory PsA who failed therapy with multiple previous treatments.
authors.affiliation: Low Country Rheumatology, North Charleston, SC, USA.
authors.forename: Alan N
authors.initials: AN
authors.lastname: Brown
keywords: adrenocorticotropic hormone; melanocortin; psoriatic arthritis biologic failures; refractory; treatment