Therapies for peripheral joint disease in psoriatic arthritis. A systematic review

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.