Recomendaciones sobre el uso de metotrexato en pacientes con artritis psoriásica

Hand Erosive Osteoarthritis and Distal Interphalangeal Involvement in Psoriatic Arthritis: The Place of Conservative Therapy

Hand erosive osteoarthritis (HEOA) and Psoriatic Arthritis (PsA) with DIP involvement are common diseases affecting the hand. Both of them evolve with a progressive limitation in grip due to limited range of motion of the affected joints and stenosing tenosynovitis. Pharmacological options currently available (corticosteroids and clodronate or Idrossicloroquine) for the treatment of EHOA are mostly symptomatic and currently there are no effective drugs able to modify the course of the disease. In addition, data on drug effectiveness of PsA with DIP involvement are lacking. Conservative therapy should be considered in order to reduce pain and improve hand functionality. There are many studies debating a wide range of non-pharmacological intervention in the management of HEOA: joint protection program, range of motion and strengthening exercise, hand exercise with electromagnetic therapy, application of heat with paraffin wax or balneotherapy, occupational therapy and education. Concerning conservative treatment strategies to treat PsA, on the contrary, current evidence is still weak. Further research is needed to find the correct place of physical therapy to prevent stiffness and ankylosis due to the vicious circle of inflammation-pain-immobility-rigidity.

Are biologics combined with methotrexate better than biologics monotherapy in psoriasis and psoriatic arthritis: A meta-analysis of randomized controlled trials

To investigate if the combination of biologics with methotrexate (MTX) would have better performance than biological monotherapy in clinical efficiency and safety for the treatment of psoriasis and psoriatic arthritis (PsA)， a systematic review of randomized controlled trials (RCTs) searched from the Pubmed, Cochrane Library, and Embase was conducted. Psoriasis Area and Severity Index (PASI) responses (including PASI 50, 75, and 90), and proportion of patients with Physician's Global Assessment Scale (sPGA) scored 0 or 1, were used for psoriasis assessment. The American College of Rheumatology (ACR)20/50/70 responder indices were used to assess the efficiency for treating PsA. The incidences of adverse events and antidrug antibodies' development were also recorded. A total of 15 studies with 4221 patients were included in this study. Three of the 15 RCTs were categorized as low risk of bias, nine studies as unclear, and three as high. Significant greater improvement in the combination group than monotherapy group for psoriasis was observed at week 12, week 24, and week 48, with no increased risk of severe adverse events and drug withdrawals due to adverse events. There was no significant difference in the comparison of clinical efficiency for the treatment of PsA at week 24. In conclusion, biologics plus MTX made better performance on improving the clinical efficiency for the treatment of psoriasis when compared with biologic monotherapy, without a difference in tolerability. However, this combination cannot improve the clinical efficiency of PsA treatment and more studies are warranted to elucidate relevant problems.