Psoriatic Arthritis

A new patient registry analysis assessed whether there were any significant differences in outcome…
shar.es
Like in RA, the anti-TNFs are transformational in their efficacy in treating peripheral arthritis, and also in other domains like the skin and the spine as well (well, maybe not as well). Higher doses may be required, and rarely, the psoriasis may worsen.
Unlike in RA, combination with MTX has not been demonstrated in clinical trials (eg IMPACT, ADEPT) to be superior to anti-TNF monotherapy, simply because MTX was not mandated in the placebo arm. This in turn is because MTX ...has not been shown to be effective in treating PsA peripheral arthritis in the MIPA trial. But this trial used what is today considered to be homeopathic doses of MTX (15mg/wk), especially considering that we may choose to hike anti-TNF doses to achieve better induction in the more severe PsA.
So, the task of elucidating whether combination with MTX is better (and therefore necessary, as in RA), is left to post-marketing forward observational studies and registry-based multiple regression analysis. These studies are subject to much selection bias and questionable statistical acrobatics, but this is a topic for another day's post.
As such, the conclusion of this study that combination with MTX in unnecessary should await confirmation (or refutation) in future prospective randomised double-blind placebo-controlled trials.
Till then, I can think of at least 3 reasons why we should combine anti-TNF treatment in PsA with a traditional DMARD like MTX:
1) It may help to prevent the development of neutralising antibodies to the anti-TNF;
2) It may allow for eventual maintenance on MTX alone, doing away with the risks, high cost and inconvenience of a biologic;
3) In clinical practice (mine at least), it is synergistic with the biologic in achieving better disease control especially in the more severe cases, and especially if given parenterally at high doses (eg subcutaneous MTX 25mg/wk).

PALACE 3 Study: Apremilast Shows 52 Wk. Efficacy in Active Psoriatic Arthritis

Apremilast, a novel phosphodiesterase 4 (PDE4) inhibiting conversion of cyclic AMP to AMP, was approved for treatment of psoriatic arthritis (PsA) after showing…
rheumnow.com
 The tradeoff for the convenience of an oral medication with a great safety profile is the somewhat lesser efficacy compared to the biologics.

 IL-12 and IL-23 Therapeutic Targets Reviewed

Researchers have clarified the contribution of IL-12 and IL-23 in immune regulation.
www.rheumatologynetwork.com

2015 saw a slew of new targets and options in the treatment of Psoriatic Arthritis and Psoriasis. The Th17 pathway is the game changer.


Secukinumab Approved for Ankylosing Spondylitis & Psoriatic Arthritis

Approval of secukinumab for ankylosing spondylitis and psoriatic arthritis marks a milestone in…
www.rheumatologynetwork.com

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