Literature on Psoriatic Arthritis

Related ArticlesPsoriatic arthritis therapy: NSAIDs and traditional DMARDs.

Ann Rheum Dis. 2005 Mar;64 Suppl 2:ii74-7

Authors: Nash P, Clegg DO

Non-steroidal anti-inflammatory drugs (NSAIDs) and traditional disease modifying antirheumatic drugs (DMARDs) are widely used in the treatment of psoriatic arthritis (PsA), but this is based more upon clinical experience than adequate evidence from clinical trials. This report summarises the results from available trials highlighting evidence of efficacy and deficiencies with respect to effect on joints and to a lesser degree cutaneous disease. The available published data on efficacy of NSAIDs, glucocorticoids, antimalarials, sulfasalazine, gold, methotrexate, azathioprine, and ciclosporin are detailed, as well as new data on leflunomide and other novel agents. The conclusions of this review are that evidence supports marginal efficacy of sulfasalazine and perhaps gold in the treatment of peripheral psoriatic arthropathy, and methotrexate and ciclosporin are effective for treating the skin disease although evidence for improvement of the arthropathy is empirical at best. New trials with standardised and validated outcome measures are required to better assess efficacy. Evaluating newer agents, against and in combination with traditional DMARDS, may further clarify the latter’s role in the future management of this condition.

PMID: 15708943 [PubMed - indexed for MEDLINE]

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Related ArticlesClassification and diagnostic criteria for psoriatic arthritis.

Ann Rheum Dis. 2005 Mar;64 Suppl 2:ii3-8

Authors: Helliwell PS, Taylor WJ

BACKGROUND: The study of psoriatic arthritis is difficult and has lagged behind the study of other arthropathies in that there are no universally agreed or properly validated case definitions. METHOD: This paper examined the validity and practicality of the original Moll and Wright criteria and subsequent criteria sets. Key features discriminating between psoriatic and other arthropathies were reviewed. A comparative study involving patients with psoriatic arthritis and rheumatoid arthritis was used to contrast the different classification methods. RESULTS: Although the Moll and Wright criteria continue to be widely used, they have been shown to discriminate poorly between psoriatic and rheumatoid arthritis. In comparison, the most sensitive criteria were those of Vasey and Espinoza, McGonagle et al, and Gladman et al (99%), whereas the others were significantly less sensitive (between 56% and 94%). The specificity of all methods was high and statistically similar (between 93% and 99%). Models that had reasonably good accuracy even without such key variables as psoriasis or rheumatoid factor were developed. Spinal involvement continues to be a key feature of psoriatic arthritis, but dissimilarities with classic ankylosing spondylitis have been highlighted. CONCLUSIONS: Further work is required to produce classification criteria for psoriatic arthritis. A prospective study collecting clinical, radiological, human leucocyte antigen (HLA) and immunological data from both psoriatic and non-psoriatic cases should provide agreed criteria for use in psoriatic arthritis studies in the future.

PMID: 15708931 [PubMed - indexed for MEDLINE]

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Related ArticlesEthical and practical issues in conducting clinical trials in psoriasis and psoriatic arthritis.

Ann Rheum Dis. 2005 Mar;64 Suppl 2:ii46-8

Authors: Kavanaugh A

Ethical considerations are inexorably intertwined with the conduct of clinical research. As a result of progress in immunology and biotechnology, several potent novel therapeutics have recently emerged for the treatment of patients with various immunologically driven systemic inflammatory conditions, including psoriasis and psoriatic arthritis. Because of these developments, there is a need to continually assess the design of current and future research studies so that they may be conducted in the optimal and most ethical manner.

PMID: 15708936 [PubMed - indexed for MEDLINE]

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Immunopathology of psoriasis and psoriatic arthritis.

Ann Rheum Dis. 2005 Mar;64 Suppl 2:ii26-9

Authors: Veale DJ, Ritchlin C, FitzGerald O

Psoriatic arthritis (PsA) is characterised by several unique clinical features that differentiate it from rheumatoid arthritis (RA). Attempts to identify immunopathological mechanisms, some shared with psoriasis, that underlie these differences from RA have been most challenging. Recent research studies, however, highlight novel findings in PsA at the molecular, cellular, and tissue levels that form the basis for a new understanding of this relatively common form of inflammatory arthritis. In particular, the availability of new, biological antitumour necrosis factor alpha therapies have allowed further insight into the immunopathology of psoriasis and PsA. This brief review focuses on immunohistological studies in psoriatic skin, PsA synovium, and bone to demonstrate how these data advance our knowledge of disease pathogenesis.

PMID: 15708930 [PubMed - indexed for MEDLINE]

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