TY - JOUR
T1 - Disease-modifying Antirheumatic Drugs (DMARD) and Combination Therapy of Conventional DMARD in Patients with Spondyloarthritis and Psoriatic Arthritis with Axial Involvement
AU - Gremese, Elisa
AU - Simone, Davide
AU - Nowik, Marcin
AU - Ferraccioli, Gianfranco
PY - 2015
Y1 - 2015
N2 - Treatment with nonsteroidal antiinflammatory drugs (NSAID) is the recommended first-line therapy in patients with axial spondyloarthritis (axSpA); and for those patients who have persistently active disease, the introduction of tumor necrosis factor-α (TNF-α) inhibitors is indicated. Conventional nonbiological disease-modifying antirheumatic drugs (DMARD), although effective and used in clinical practice for peripheral arthritis, are not recommended. Few studies have been conducted with the aim of evaluating the effect of conventional DMARD, either alone or in combination, in axSpA. As for psoriatic arthritis (PsA), DMARD are widely used, but few trials are available about their effects on axial involvement, which is not often assessed as a primary outcome in clinical trials. In rheumatoid arthritis, combination therapy of 2 or more conventional DMARD appears to confer better response than methotrexate monotherapy, and may even be a viable alternative to TNF-α inhibitors. In peripheral PsA, combination therapy can be used after treatment failure with 1 DMARD, but few studies have been conducted. However, available evidence for the combination of conventional DMARD indicates a lack of any significant benefit on axial symptoms; thus this treatment approach does not represent an effective alternative to anti-TNF-α therapy.
AB - Treatment with nonsteroidal antiinflammatory drugs (NSAID) is the recommended first-line therapy in patients with axial spondyloarthritis (axSpA); and for those patients who have persistently active disease, the introduction of tumor necrosis factor-α (TNF-α) inhibitors is indicated. Conventional nonbiological disease-modifying antirheumatic drugs (DMARD), although effective and used in clinical practice for peripheral arthritis, are not recommended. Few studies have been conducted with the aim of evaluating the effect of conventional DMARD, either alone or in combination, in axSpA. As for psoriatic arthritis (PsA), DMARD are widely used, but few trials are available about their effects on axial involvement, which is not often assessed as a primary outcome in clinical trials. In rheumatoid arthritis, combination therapy of 2 or more conventional DMARD appears to confer better response than methotrexate monotherapy, and may even be a viable alternative to TNF-α inhibitors. In peripheral PsA, combination therapy can be used after treatment failure with 1 DMARD, but few studies have been conducted. However, available evidence for the combination of conventional DMARD indicates a lack of any significant benefit on axial symptoms; thus this treatment approach does not represent an effective alternative to anti-TNF-α therapy.
KW - AXIAL SPONDYLOARTHRITIS
KW - COMBINATION DRUG THERAPY
KW - DISEASE-MODIFYING ANTIRHEUMATIC DRUG
KW - PSORIATIC ARTHRITIS
KW - PSORIATIC SPONDYLOARTHRITIS
KW - AXIAL SPONDYLOARTHRITIS
KW - COMBINATION DRUG THERAPY
KW - DISEASE-MODIFYING ANTIRHEUMATIC DRUG
KW - PSORIATIC ARTHRITIS
KW - PSORIATIC SPONDYLOARTHRITIS
UR - http://hdl.handle.net/10807/71459
U2 - 10.3899/jrheum.150640
DO - 10.3899/jrheum.150640
M3 - Article
VL - 93
SP - 65
EP - 69
JO - The Journal of rheumatology. Supplement
JF - The Journal of rheumatology. Supplement
SN - 0380-0903
ER -