Treatment options: NSAIDs and DMARDs

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by arthritis and psoriasis associated with other extra-articular manifestations. PsA has been considered a milder and less disabling disease compared with rheumatoid arthritis (RA), even in some studies that showed that PsA also produces erosions and articular damage. In addition, approximately 20–40% of PsA patients have axial skeleton involvement (‘psoriatic spondylitis’), which may lead to functional limitation and deformity. Therefore, PsA has to be considered a potentially disabling disease requiring an aggressive treatment, although the lack of population-based studies using standardized classification criteria precludes a confident estimate of the precise prevalence of severe PsA. The treatment of PsA has been dealt by different medication, from initial treatment with NSAIDs to one or more synthetic disease-modifying antirheumatic drugs (DMARDs) for the suppression of inflammation in patients with recalcitrant peripheral joint disease. In clinical practice, the most widely used synthetic DMARDs are methotrexate (level of evidence B), sulfasalazine (level of evidence A), leflunomide (level of evidence A) and cyclosporine (level of evidence B). However, the efficacy of these agents in inhibiting joint erosions has not been assessed in controlled studies [1]. In addition, the effectiveness of DMARDs in treating enthesitis and dactylitis is uncertain. The present chapter revised the evidence-based results on treatment with ‘conventional’ therapy for PsA. The revision considered the various manifestations of the articular involvement (i.e., peripheral, axial, enthesitis and dactylitis) as well as the skin and nail involvement.