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Multidisciplinary focus on methotrexate in psoriatic disesase.
Antonio Marchesoni1, Massimo Ricci, Erica Moggio
1U.O.C. Day Hospital of Rheumatology, G. Pini Orthopaedic Institute, 20122 Milan, Italy. marchesoni@gpini.it
The Journal of Rheumatology. Supplement
|August 8, 2009
Summary
Methotrexate (MTX) is a preferred nonbiologic drug for psoriatic arthritis and skin conditions in psoriatic disease (PD). Further research is needed to confirm its efficacy and manage potential MTX toxicity, especially liver damage.
Area of Science:
- Rheumatology
- Dermatology
- Pharmacology
Background:
- Psoriatic disease (PD) encompasses various inflammatory conditions, including psoriatic arthritis and skin lesions.
- Methotrexate (MTX) is a widely used nonbiologic agent in managing autoimmune and inflammatory conditions.
Purpose of the Study:
- To establish the role and efficacy of methotrexate (MTX) in treating psoriatic disease (PD).
- To evaluate MTX's effectiveness in peripheral psoriatic arthritis, skin involvement, dactylitis, enthesitis, and spondylitis.
- To assess the safety profile of MTX in PD patients.
Main Methods:
- Review of existing clinical evidence and expert opinion on MTX use in PD.
- Analysis of MTX's impact on different facets of psoriatic disease.
- Consideration of safety concerns and toxicity, particularly hepatotoxicity.
Main Results:
- MTX is considered the nonbiologic drug of choice for peripheral psoriatic arthritis, despite limited robust evidence.
- MTX demonstrates effectiveness in improving the skin manifestations of PD.
- Further clinical trials are required to ascertain MTX's effects on psoriatic dactylitis, enthesitis, and spondylitis.
Conclusions:
- MTX is a valuable option for moderate-to-severe psoriasis and psoriatic arthritis, often used before biological therapies.
- While rheumatologists perceive MTX as relatively safe for PD, dermatologists express significant concerns regarding its toxicity.
- Precautions are essential to mitigate risks such as MTX-induced liver fibrosis and cirrhosis until more definitive data emerge.
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