Salvarani C, Cantini F, Olivieri I
Rheumatic Disease Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S71-5.
As erosive and deforming arthritis is present in 40% of patients with psoriatic arthritis (PsA), early and aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) may be as effective in controlling the progression of the disease as it is for rheumatoid arthritis (RA). Methotrexate (MTX), sulfasalazine (SSZ), and cyclosporine (CsA) are the most widely used DMARDs in the treatment of PsA and are safe and effective in patients with active peripheral arthritis, although they do not appear to be effective on axial manifestations. No controlled study has evaluated the efficacy of these drugs on the progression of radiological damage. It has recently been demonstrated that leflunomide and anti-tumor necrosis factor (TNF) agents are effective in PsA and psoriasis. The symptomatic improvement has been important and sustained and side effects minimal. In particular, inhibitors of TNF appear to have excellent potential to treat PsA. These agents are able to slow joint damage in rheumatoid arthritis and they are effective on spinal symptoms in ankylosing spondylitis. Hopefully, these findings will prove true in PsA as well.
由于40%的银屑病关节炎（PsA）患者存在侵蚀性和变形性关节炎，使用改善病情抗风湿药（DMARDs）进行早期积极治疗在控制疾病进展方面可能与类风湿关节炎（RA）治疗同样有效。甲氨蝶呤（MTX）、柳氮磺吡啶（SSZ）和环孢素（CsA）是治疗PsA最广泛使用的DMARDs，对活动性外周关节炎患者安全有效，尽管它们似乎对轴向表现无效。尚无对照研究评估这些药物对放射学损伤进展的疗效。最近已证明来氟米特和抗肿瘤坏死因子（TNF）药物对PsA和银屑病有效。症状改善显著且持续，副作用最小。特别是，TNF抑制剂似乎具有治疗PsA的极佳潜力。这些药物能够减缓类风湿关节炎的关节损伤，对强直性脊柱炎的脊柱症状也有效。希望这些发现也能在PsA中得到证实。
