Soriano Enrique R
Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, and Instituto Universitario, Escuela de Medicina Hospital Italiano de Buenos Aires, and Fundación Pedro M Catoggio para el progreso de la Reumatologia, Buenos Aires, Argentina.
J Rheumatol Suppl. 2012 Jul;89:67-70. doi: 10.3899/jrheum.120248.
Although several reviews and metaanalyses have shown lack of evidence of efficacy of traditional disease-modifying antirheumatic drugs (DMARD) in psoriatic arthritis (PsA), these drugs are very often used and are recommended by treatment guidelines around the world as first-line therapy for most patients with PsA. Some new investigations showed that higher doses of methotrexate (MTX) are more beneficial for patients with PsA with peripheral involvement. Also, observational studies have shown that retention of MTX for patients with PsA is comparable to that of patients with rheumatoid arthritis (RA), and that with MTX, remission is achievable by around 20% of patients with PsA. Sulfasalazine, leflunomide, and cyclosporine have also been shown to be effective in a small number of patients, although the overall effect on disease activity for these drugs is small. Although combination of anti-tumor necrosis factor agents with traditional DMARD is not mandatory in PsA as it is in RA, there is evidence that some extra benefit might be achieved when combinations are used, not only for the joints but for the skin. There is still room for the use of traditional DMARD in PsA, and for the time being, DMARD should still be considered as first-line therapy for most patients with PsA.
尽管多项综述和荟萃分析表明，尚无证据支持传统改善病情抗风湿药（DMARD）对银屑病关节炎（PsA）有效，但这些药物仍被广泛使用，且被全球治疗指南推荐为大多数PsA患者的一线治疗药物。一些新的研究表明，更高剂量的甲氨蝶呤（MTX）对有外周关节受累的PsA患者更有益。此外，观察性研究表明，PsA患者使用MTX的持续率与类风湿关节炎（RA）患者相当，并且使用MTX时，约20%的PsA患者可实现病情缓解。柳氮磺吡啶、来氟米特和环孢素在少数患者中也显示出有效，尽管这些药物对疾病活动的总体影响较小。虽然在PsA中，不像在RA中那样强制要求将抗肿瘤坏死因子药物与传统DMARD联合使用，但有证据表明，联合使用不仅对关节，而且对皮肤可能会带来一些额外益处。在PsA中使用传统DMARD仍有空间，目前，DMARD仍应被视为大多数PsA患者的一线治疗方法。
