Relief for Psoriatic Arthritis Patients

Psoriatic arthritis showed greater improvements with aggressive therapy than standard care in new study

/ Author:  / Reviewed by: Chris Galloway, M.D. Beth Bolt, RPh

(RxWiki News) For a minority of people with psoriasis, the possibility of developing a related form of arthritis can be a major concern. Disease treatments sometimes determine how much relief psoriatric arthritis sufferers might get from their symptoms.

According to a new study, using more powerful medications, as needed, and testing to measure those medications' effects greatly improved the health of psoriatic arthritis patients, who typically are treated far less aggressively.

"Talk to a rheumatologist about treatment options for psoriatic arthritis."

A team from the University of Leeds in the United Kingdom conducted this research.

These researchers spent 48 weeks analyzing two groups of patients, totaling 182 people, who were treated at eight United Kingdom medical facilities between 2008 and 2012. On average, the group was 45 years old and included almost equal numbers of men and women whose diagnosis of psoriatic arthritic was no more than two years old.

They were randomly placed in one of two groups. The first group was given disease-modifying anti-rheumatic drugs (DMARDs) and a strict set of guidelines and timelines for measuring improvements in their condition. 

This first group was first prescribed methotrexate, an anti-rheumatic medicine. As needed, that dosage increased to what was seen as safe levels that did not cause patients to experience side effects that they could not tolerate. If, after 12 weeks, their disease still was not under control, patients had combination DMARDs added.

If, after an additional 12 weeks passed, patients had at least three swollen or tender joints, they were placed on anti-tumor necrosis factor (TNF) therapy, also a type of anti-rheumatic medication. Patients with less than three tender or swollen joints who, nevertheless, did not meet a minimum standard for a reduction in symptoms were given more methotrexate, combined with another anti-rheumatic medication.

Meanwhile, the second group was given standard care. That meant they took methrotrexate but not on a planned time limit or any strict guidelines for measuring whether their condition improved.

Based on their investigation, these researchers concluded that patients undergoing the more aggressive, targeted treatments (the first group) were roughly 1.9 times more likely than those getting standard care to experience a 20 percent improvement in their condition.

Aggressively treated patients were 2.3 times more likely than those in the second group to experience a 50 percent improvement in their condition.

The first group also was 2.6 times more likely than the second group to experience a 70 percent improvement in its condition.

“For the first time, it has been shown that aggressive treatment of inflammation in psoriatic arthritis gives better outcomes,” said one of study's investigators, rheumatologist Philip Helliwell, MD, of the Leeds Institute of Rheumatic and Musculoskeletal Medicine.

“Patients with this disorder have to endure several different disease manifestations. This study has shown that appropriate targeted therapy can be effective across all these aspects, an important finding for the person with this disorder,” Dr. Helliwell said in a press statement.

Roughly 15 percent of psoriasis patients develop psoriatic arthritis, the researchers wrote. Psoriatic arthritis can affect and damage any bodily joints; which joints it strikes varies among patients, the researchers added.

The aim of their research, the investigators wrote, was to show that psoriatic arthritis patients benefitted from intensive, targeted therapy in ways similar to other forms of arthritis, including rheumatoid arthritis.

This preliminary study has not been approved for publication in a peer-review medical journal. It will be presented October 27 at the American College of Rheumatology Annual Meeting.

Arthritis Research UK funded this investigation.

Review Date: 
October 25, 2013
Last Updated:
December 30, 2013