Psoriatic arthritis − is an inflammatory joint disease that occurs in about 30% of people with psoriasis. The prevalence of psoriatic arthritis in the general population ranges from 0.01-0.19% depending on the geographic location.
Pharmacological management of psoriatic arthritis includes non-steroidal anti-inflammatory drugs, glucocorticoids and cytostatics.
Learn in the article on estet-portal.com about the features of the treatment of arthritis with cytostatics, as a serious complication of psoriasis.
Diagnosis and treatment of arthritis as a complication of psoriasis
Five different types of joint involvement in psoriasis have been described: predominantly distal interphalangeal joints, deforming arthritis, symmetrical polyarthritis, asymmetric oligoarthritis, and spondyloarthritis.
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Periarticular structures may also be affected with enthesitis, tenosynovitis, dactylitis, and onycholysis. The diagnosis can be made clinically based on the Classification Criteria for Psoriatic Arthritis (CASPAR).
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These criteria include the presence of an established inflammatory disease of the musculoskeletal system and ≥3 points:
1) Psoriasis symptoms (psoriatic skin lesions detected by a rheumatologist or dermatologist), personal or family history of psoriasis − 1 point; current psoriatic changes − 2 points;
2) Dactylite − 1 point;
3) Typical psoriatic nail changes (separation of the nail, depressions in the nail plate and excessive keratosis) − 1 point;
4) Radiological evidence of periarticular bone proliferation in the form of indistinctly demarcated ossification close to the edge of the joint (however, with the exception of osteophyte formation) − 1 point;
5) negative rheumatoid factor − 1 point.
Treatment of arthritis, if found to be the underlying cause – it is psoriasis, includes non-steroidal anti-inflammatory drugs, glucocorticoids and antirheumatic drugs, disease-modifying drugs and the use of cytostatics.
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Methotrexate − synthetic basic drug from the group of cytostatics, which can be administered orally, subcutaneously or intramuscularly. It is prescribed weekly, in doses of 5 to 25 mg. At this dose and frequency, common side effects include headache, nausea, vomiting, abdominal pain, and stomatitis. Rare side effects include myelosuppression, hepatotoxicity, infection, and pulmonary fibrosis.
Daily folic acid supplementation relieves hepatotoxic and gastrointestinal side effects.
Clinical study of the effectiveness of the cytostatic methotrexate
A systematic review has been published in the Cochrane Database of Systematic Reviews in which the authors assessed the benefits and side effects of the cytostatic methotrexate in the treatment of arthritis in adults caused by psoriasis.
The authors analyzed data from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, the World Health Organization's International Clinical Trials Registry Platform, and www.clinicaltrials. gov.
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Comparison of methotrexate 15 mg/week (standard low dose) with placebo suggests that treatment of arthritis with methotrexate may provide a clinically effective treatment for this complication.
The use of cytostatics in the treatment of arthritis in psoriasis
Methotrexate may be as effective as 20 mg of the cytostatic leflunomide orally and may be more effective than cyclosporine A at 3-5 mg/kg body weight orally daily.
Oral methotrexate in the treatment of arthritis in psoriasis at a low dose (15 mg or less) for 6 months is an effective therapy in terms of a positive response to treatment, improved functional ability, reduced pain, a positive global patient disease activity score and a doctor.
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Methotrexate, unlike other cytostatics, is well tolerated by patients. The impact of methotrexate on quality of life, radiological progression of arthritis, enthesitis, and its efficacy at 6 months, the effects of high doses of methotrexate at the moment have not been adequately studied in placebo-controlled studies.
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