Soriano Enrique R, McHugh Neil J
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
J Rheumatol. 2006 Jul;33(7):1422-30. Epub 2006 May 15.
Traditional drug treatments for psoriatic arthritis (PsA) include nonsteroidal antiinflammatory agents (NSAID) and disease modifying antirheumatic drugs (DMARD), although the evidence base for their effectiveness is not well established. This review was compiled from a comprehensive literature search of electronic bibliographic databases for all English publications that were systematic reviews, metaanalyses, randomized controlled trials, controlled trials, and observational studies. The evidence supports NSAID for symptom relief, although data are lacking for COX-2-specific agents. No evidence exists to support systemic corticosteroids or corticosteroids by intraarticular injection, although the latter are commonly used in clinical practice. Among traditional DMARD, grade 1B evidence supports sulfasalazine, cyclosporine, and leflunomide for symptom relief, with lower-grade evidence for methotrexate. None of them slows radiographic progression. Grade 1B evidence supports improvement in symptoms, physical function, quality of life, and radiographic progression with anti-TNF antagonists (etanercept, infliximab, and adalimumab). The relative lack of evidence poses challenges in developing algorithms for treatment of peripheral arthritis in PsA.
银屑病关节炎（PsA）的传统药物治疗包括非甾体抗炎药（NSAID）和改善病情抗风湿药（DMARD），尽管其有效性的证据基础尚不充分。本综述是通过对电子文献数据库进行全面检索汇编而成，涵盖了所有英文出版物中的系统评价、荟萃分析、随机对照试验、对照试验和观察性研究。有证据支持使用NSAID缓解症状，但缺乏COX-2特异性药物的数据。尽管关节内注射皮质类固醇在临床实践中常用，但尚无证据支持使用全身皮质类固醇或关节内注射皮质类固醇。在传统DMARD中，1B级证据支持柳氮磺胺吡啶、环孢素和来氟米特缓解症状，甲氨蝶呤的证据等级较低。它们均不能减缓影像学进展。1B级证据支持抗TNF拮抗剂（依那西普、英夫利昔单抗和阿达木单抗）可改善症状、身体功能、生活质量并减缓影像学进展。证据相对不足给制定PsA外周关节炎的治疗方案带来了挑战。
