Gladman Dafna D
Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
Semin Arthritis Rheum. 2003 Aug;33(1):29-37. doi: 10.1053/sarh.2002.50024.
To review the effectiveness of systemic therapies for psoriatic arthritis (PsA).
Data on the efficacy of PsA therapies from selected literature, including American and international medical journals and recent abstracts from key rheumatology meetings, were reviewed.
Most therapeutic agents used to treat PsA are used on the basis of data from patients with rheumatoid arthritis (RA), and have not been adequately assessed in patients with PsA. However, the progressively destructive nature of the disease demands aggressive treatment with agents tested specifically in PsA. Conventional agents used to treat RA, such as methotrexate and sulfasalazine, have adverse effects that often lead to drug discontinuation and may not always be effective in reducing symptoms or radiographic progression in PsA. Newer medications, such as etanercept and infliximab, specifically inhibit the actions of tumor necrosis factor, which plays a major role in joint destruction. The Food and Drug Administration has recently approved etanercept for treatment of PsA. Current data with infliximab are limited to small open-label trials; however, randomized controlled trials are underway.
PsA and RA are distinct diseases, and the efficacy and safety of an agent in RA cannot necessarily be equated with efficacy and safety in PsA. For most conventional agents, data from controlled clinical trials in PsA are scant. Etanercept is currently the only therapeutic agent with sufficient data from placebo-controlled, randomized trials to receive a Food and Drug Administration indication for the treatment of PsA.
回顾银屑病关节炎（PsA）全身治疗的有效性。
对选自美国和国际医学期刊以及关键风湿病学会议近期摘要的PsA治疗疗效数据进行回顾。
大多数用于治疗PsA的治疗药物是基于类风湿关节炎（RA）患者的数据使用的，且尚未在PsA患者中得到充分评估。然而，该疾病的进行性破坏性需要使用在PsA中专门测试的药物进行积极治疗。用于治疗RA的传统药物，如甲氨蝶呤和柳氮磺胺吡啶，有不良反应，常导致停药，且在减轻PsA症状或影像学进展方面可能并不总是有效。新型药物，如依那西普和英夫利昔单抗，特异性抑制肿瘤坏死因子的作用，肿瘤坏死因子在关节破坏中起主要作用。美国食品药品监督管理局最近批准依那西普用于治疗PsA。目前关于英夫利昔单抗的数据仅限于小型开放标签试验；然而，随机对照试验正在进行中。
PsA和RA是不同的疾病，一种药物在RA中的疗效和安全性不一定等同于在PsA中的疗效和安全性。对于大多数传统药物，PsA对照临床试验的数据很少。依那西普是目前唯一有来自安慰剂对照随机试验的充分数据、获得美国食品药品监督管理局治疗PsA适应证的治疗药物。
