What does evidence-based medicine tell us about treatments for different subtypes of psoriatic arthritis? A systematic literature review on randomized controlled trials

Abstract

Objective PsA is a heterogeneous disease with various subtypes of joint manifestations, which can affect the homogeneity of randomized controlled trials (RCTs). The aim of this systematic literature review was to evaluate the inclusion criteria, demographics and outcomes of RCTs to see whether the whole spectrum of PsA was represented. Methods Medline, EMBASE and Cochrane databases were screened for RCTs on the efficacy of any treatment for PsA up to 4 October 2016 to investigate the inclusion criteria, demographics, outcomes and efficacy. Results Two thousand and sixty-eight abstracts were identified at screening; 76 articles and 52 conference proceedings were included in the final analysis. The main inclusion criteria always included the number of active joints and never axial symptoms, enthesitis nor dactylitis. Only 10 studies provided information about subtypes, of which symmetrical polyarthritis was the main subtype. Mean ( s . d .) tender and swollen joints were between 7.8 and 35.8 (1.8–22.1) and between 5.2 and 25.2 (1.5–16.2), respectively. All studies had responses in joint counts as their primary outcome. Responses in enthesitis and dactylitis were usually secondary or tertiary outcomes. Response in BASDAI was among the outcomes in four studies. The comparison of efficacy in polyarticular vs oligoarticular disease was given in three studies, whereas no information was available for DIP joint disease or arthritis mutilans. Conclusion There is evidence in the literature to guide clinicians on how to treat PsA patients with polyarticular disease, but there is a gap in knowledge about the other subtypes. Protocol registration The study protocol is registered at PROSPERO (CRD42017053907).

From Psoriasis to Psoriatic Arthritis: Insights from Imaging on the Transition to Psoriatic Arthritis and Implications for Arthritis Prevention

“…The clinical trials use the commonly accepted definitions of these phenotypes, which have shown significant discrepancies with imaging modalities. For example, the vast majority of the clinical trials have only been focusing on the effectiveness of therapies on polyarticular phenotype in PsA, with few to none data on the axial disease, clinical enthesitis, or dactylitis as a primary outcome [52]. The efficacy data on features such as enthesitis or dactylitis has mostly been exploratory.…”

Management of particular clinical situations in psoriatic arthritis: an expert’s recommendation document based on systematic literature review and extended Delphi process

“…In the studies selected for the SLR, the rate of PsA patients with axial disease was generally low (< 15%) [95]. Specific sub-analyses of axial manifestations were often lacking, although some positive evidence for tofacitinib [96] or ustekinumab [97] is available.…”

Evaluating Inflammatory Versus Mechanical Back Pain in Individuals with Psoriatic Arthritis: A Review of the Literature

“…Symptoms of MBP often worsen with movement and exercise and appear to correlate with injury and more acute onset [ 26 ]. Typically, its insidious onset occurs at an older age than IBP and can be acute or chronic [ 27 , 79 ].…”