Written informed consent was obtained from all participants according to the Declaration of Helsinki. The baseline visit takes place as soon as possible after diagnosis, within a few weeks. Use of DMARDs prescribed for psoriasis was allowed. Patients with a new diagnosis of PsA are eligible to participate if they did not yet receive treatment with disease-modifying antirheumatic drugs (DMARDs) for PsA before the first study visit. 10 In short, DEPAR collects data to investigate the daily clinical practice of patients with PsA. We used data collected in the Dutch southwest Early Psoriatic Arthritis cohoRt (DEPAR) study, of which details are described elsewhere. Patients, setting and patient involvement Second, we aimed to compare cytokine profiles in patients responding and not responding to MTX monotherapy to determine variables that can serve as easy-to-measure therapy-response biomarkers. The current study aims to describe the response to MTX monotherapy early in the disease course of patients with PsA with oligoarthritis or polyarthritis. Due to the heterogeneous nature of PsA, it might be difficult to identify these patients based on clinical variables alone and adding laboratory variables predictive of MTX response could prove to be valuable. However, if a large proportion of patients with PsA will not respond to MTX therapy, understanding why and which patients will not respond before start of therapy is needed. The advantages of MTX in usual care as compared to TNFi are the worldwide availability, the known safety profile and low costs. 6–8 Based on the abovementioned trials, the new American College of Rheumatology/National Psoriasis Foundation guidelines recommend the use of TNFi before MTX 9 but still classify the evidence as low. 5 Multiple studies have used MTX monotherapy in their control-arm in randomised controlled trials for tumour necrosis factor inhibitor (TNFi) therapy in PsA or have investigated the MTX response in an observational cohort, with a percentage of patients reaching MDA varying from 18% to 29%. Furthermore, in the TIght COntrol of inflammation in Psoriatic Arthritis (TICOPA) trial, which compared standard care with treat-to-target therapy strategies for PsA, 4 only 22.4% of the patients achieved minimal disease activity (MDA) after 12 weeks of MTX monotherapy.
#Cms mus2 oct 2015 update trial#
However, the MIPA trial did not use the optimal doses of MTX, and its results, therefore, are heavily debated. Until now, the only randomised controlled trial, the Methotrexate in Psoriatic Arthritis (MIPA) trial, 3 found no significant effect of MTX monotherapy on several response criteria.
Both current EULAR and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis guidelines advise methotrexate (MTX) as first-line therapy for PsA, 1 2 despite lacking clear evidence, but due to positive expert experience and limitations of available studies. Inadequately treated, PsA can lead to progressive joint damage and disability.
#Cms mus2 oct 2015 update skin#
Psoriatic arthritis (PsA) is a musculoskeletal disease associated with psoriasis presenting with any or all of peripheral arthritis, axial disease, dactylitis, enthesitis, in addition to skin and nail disease.
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