The effectiveness of a traditional therapeutical approach in early psoriatic arthritis: results of a pilot randomised 6-month trial with methotrexate

Abstract

Thirty-five patients with Early Psoriatic Arthritis (EPA) (17 female and 18 male; mean age 25.6 years) entered this randomised 6-month study. At the enrolment, all patients were on non-steroidal anti-inflammatory drug (NSAID) therapy on demand and were divided in two matched groups (A and B). Group A continued NSAID therapy at full dosage in the following 3 months and then added methotrexate (MTX) for another 3 months. Group B was under the combination of NSAID and MTX for the entire 6-month period. Clinical and laboratory assessment included the count of tender joints and/or entheses (TJC), the count of swollen joints and/or entheses (SJC), patient's global assessment (PGA), physician's global assessment (PhGA), patient's assessment of pain (VAS), erythrocyte sedimentation rate (ESR) and serum concentration of C-reactive protein (CRP). All variables were done at baseline (T0), at 3 (T3) and at 6 months (T6). In both group A and in group B, there was a significant improvement of all variables at T3 and T6. However, in comparison to the patients of group A, patients included in group B showed a more rapid and marked improvement of TJC and SJC, which was statistically significant at T3 (p < 0.05). In contrast, the improvement of PGA, PhGA, VAS, ESR and CRP was not significantly different between groups. The early use of MTX in EPA patients markedly improves TJC and SJC. In fact, at T3, other markers used to quantify EPA disease activity, in particular PGA, PhGA, VAS, ESR and CRP, did not show significant differences in EPA patients treated with either NSAIDs or MTX. This finding suggests an incomplete control under MTX of the pathogenetic process and stimulates further interest on early use of other therapeutical approaches capable of modifying the course of disease.

Carotid Intima-Media Thickness in Psoriatic Arthritis

“…14 None of the subjects in the case group were on nonsteroidal antiinflammatory drugs or prednisone at the time of the study, nor were any of them receiving combined treatments (TNF-␣ blockersϩDMARDs). All PsA subjects had a clinically active disease (evaluated by the Physician Global Assessment) 15 before being treated with 1 of the 2 treatment schedules. In addition to individual treatment schedules, a trained staff member evaluated disease duration and inflammation indices (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and interleukin 6 [R&D Systems Inc, Minneapolis, Minn]) levels.…”

Epidemiology, genetics and management of psoriatic arthritis 2013: focus on developments of who develops the disease, its clinical features, and emerging treatment options

“…Results suggested some efficacy on joints and skin, but findings were inconclusive, in particular in view of small study numbers. [80][81][82] 221 active PsA patients. 83 The trial took several years to complete, and results showed no evidence that MTX improved synovitis compared to placebo.…”

The early spondyloarthritis (ESPA): Concept, role of new imaging techniques, therapeutic opportunities and research agenda

“…Only Scarpa in 2008 conducted a study on effect of traditional DMARDs in eSpa: 35 ePsA treated for six months with low dosage of methotrexate (10 mg weekly) were followed up with routine clinical and laboratory examination 25 .…”