Mahajan Vikram K, Sharma Anju Lath, Chauhan Pushpinder S, Mehta Karaninder S, Sharma Nand Lal
Department of Dermatology, Venereology and Leprosy, Dr. R.P. Government Medical College, Kangra, (Tanda), Himachal Pradesh, India.
Indian J Dermatol. 2013 May;58(3):240. doi: 10.4103/0019-5154.110847.
Psoriatic arthritis (PsA) is increasingly being recognized to cause progressive joint damage and disability. PsA unresponsive to non-steroidal anti-inflammatory drugs (NSAIDs), the conventional first-line choice of treatment, is usually managed with disease-modifying antirheumatic drugs (DMARDs) especially methotrexate. An 18-year-old HIV-negative male had progressively severe PsA of 4-month duration that was nearly confining him to a wheel chair. He did not respond to multiple NSAIDs, alone or in combination with methotrexate (15 mg/week), given for 4 weeks. Addition of prednisolone (10 mg on alternate days) controlled his symptoms within a week. The NSAIDs could be withdrawn after 4 weeks as the treatment progressed. The doses were tapered for methotrexate (5 mg/week) and prednisolone (2.5 mg on alternate days) every 8 weekly subsequently during 15 months of follow-up without recurrence/deformities or drug toxicity. For years, the use of corticosteroids in psoriasis has been criticized for their propensity to exacerbate the skin disease on withdrawal. However, monitored use of corticosteroids, even in low doses, combined with DMARDs may be a good therapeutic option in early stage of the PsA rather than 'steroid rescue' later. This will help in early control of joint inflammation, prevent joint damage and maintain long-term good functional capacity and quality of life. This may be useful when the cost or availability of biologics precludes their use. However, we discourage the use of corticosteroids as monotherapy.
银屑病关节炎（PsA）越来越被认为会导致进行性关节损伤和残疾。对传统一线治疗选择非甾体抗炎药（NSAIDs）无反应的PsA，通常使用改善病情抗风湿药（DMARDs）尤其是甲氨蝶呤进行治疗。一名18岁的HIV阴性男性患有病程4个月且病情逐渐加重的PsA，几乎只能坐轮椅。他对多种NSAIDs单独使用或与甲氨蝶呤（15毫克/周）联合使用4周均无反应。加用泼尼松龙（隔日10毫克）在一周内控制了他的症状。随着治疗进展，4周后可停用NSAIDs。在随后15个月的随访中，甲氨蝶呤（5毫克/周）和泼尼松龙（隔日2.5毫克）的剂量每8周逐渐减少，未出现复发/畸形或药物毒性。多年来，在银屑病中使用皮质类固醇一直受到批评，因为停药时它们有加重皮肤病的倾向。然而，即使是低剂量的皮质类固醇与DMARDs联合使用并进行监测，在PsA早期可能是一个很好的治疗选择，而不是后期的“类固醇救援”。这将有助于早期控制关节炎症，预防关节损伤，并维持长期良好的功能能力和生活质量。当生物制剂的成本或可用性排除其使用时，这可能会很有用。然而，我们不鼓励将皮质类固醇作为单一疗法使用。
