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Therapy with cyclosporine in psoriatic arthritis
I Olivieri1, C Salvarani, F Cantini
1Servizio di Reumatologia, Azienda Ospedaliera S. Orsola Malpighi, Bologna, Italy.
Objective:
To evaluate the efficacy and toxicity of cyclosporin A (CsA) in the treatment of patients with psoriatic arthritis (PsA).
Methods:
We reviewed the literature dealing with CsA treatment of PsA.
Results:
In the 1980s, some studies evaluating CsA in severe cases of psoriasis documented an improvement in the associated arthritis. Subsequently, open prospective studies included patients with active peripheral arthritis. Using initial CsA dose of 3 to 6 mg/kg/day, improvement in the clinical parameters was noted. A controlled trial showed that CsA and methotrexate (MTX) are equally effective treatment for PsA. CsA and MTX combination was effective in PsA patients resistant to previous second-line therapy. No studies have evaluated the efficacy of CsA on axial disease and on the progression of radiological damage. The most important side effect was nephrotoxicity. However, of 170 CsA-treated patients in 16 studies, only 10 (6%) discontinued the drug because of renal side effects.
Conclusions:
CsA seems to be an effective and safe therapy for PsA. However, controlled studies on large number of patients are necessary.