Interventions for treating psoriatic arthritis
Editorial Group: Cochrane Musculoskeletal Group
Published Online: 24 JUL 2000
Assessed as up-to-date: 15 MAR 2000
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Jones G, Crotty M, Brooks P. Interventions for treating psoriatic arthritis. Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD000212. DOI: 10.1002/14651858.CD000212.
- Publication Status: Edited (no change to conclusions)
- Published Online: 24 JUL 2000
It has been estimated that arthritis occurs in 5-7% of those with psoriasis. Relatively few clinical trials of treatment are available for psoriatic arthritis and data presentation in these trials is far from uniform making comparison difficult.
To assess the effects of sulfasalazine, auranofin, etretinate, fumaric acid, IMI gold, azathioprine, efamol marine and methotrexate, in psoriatic arthritis.
We searched MEDLINE up to February 2000, and Excerpta Medica (June 1974-95). Search terms were psoriasis, arthritis, therapy and/or controlled trial. This was supplemented by manually searching bibliographies of previously published reviews, conference proceedings, contacting drug companies and referring to the Cochrane Clinical Trials Register. All languages were included in the initial search.
All randomized trials comparing sulfasalazine, auranofin, etretinate, fumaric acid, IMI gold, azathioprine, and methotrexate, in psoriatic arthritis.
Following a published a priori protocol, the main outcome measures included individual component variables derived from Outcome Measures in Rheumatology Clinical Trials (OMERACT). These include acute phase reactants, disability, pain, patient global assessment, physician global assessment, swollen joint count, tender joint count and radiographic changes of joints in any trial of one year or longer [Tugwell 1993], and the change in pooled disease index (DI).
Only English trials were included in the review.
Data collection and analysis
Data were independently extracted from the published reports by two of the reviewers (MC, GJ). An independent blinded quality assessment was also performed.
Twenty randomized trials were identified of which thirteen were included in the quantitative analysis with data from 1022 subjects. Although all agents were better than placebo, parenteral high dose methotrexate (not included), sulfasalazine, azathioprine and etretinate were the agents that achieved statistical significance in a global index of disease activity (although it should be noted that only one component variable was available for azathioprine and only one trial was available for etretinate suggesting some caution is necessary in interpreting these results). Analysis of response in individual disease activity markers was more variable with considerable differences between different medications and responses. In all trials the placebo group improved over baseline (pooled improvement 0.39 DI units, 95% CI 0.26-0.54). There was insufficient data to examine toxicity.
Parenteral high dose methotrexate and sulfasalazine are the only two agents with well demonstrated published efficacy in psoriatic arthritis. The magnitude of the effect seen with azathioprine, etretinate, oral low dose methotrexate and perhaps colchicine suggests that they may be effective but that further multicentre clinical trials are required to establish their efficacy. Furthermore, the magnitude of the improvement observed in the placebo group strongly suggests that uncontrolled trials should not be used to guide management decisions in this condition.
Plain language summary
Interventions for treating psoriatic arthritis
It has been estimated that arthritis occurs in 5-7 % of those with psoriasis, which can cause substantial disability in some patients.
The objective was to assess the benefits of the treatment [sulfasalazine, auranofin, etretinate, fumaric acid, IMI gold, azathioprine, methotrexate] for psoriatic arthritis and to assess the side effects. Parenteral methotrexate and sulfasalazine resulted in important benefit in over half the patients for psoriatic arthritis in these studies. There was insufficient data to evaluate other therapies and to examine toxicity. Further multicentre trials are required to establish the efficacy of azathioprine, oral methotrexate, etretinate, and colchicine.
一般估計乾癬患者，約有5 – 7% 會合併乾癬性關節炎。至今少有乾癬性關節炎的臨床試驗，且臨床試驗的資料呈現也沒有一致性，因此做療效比較時也有困難。
本文評估sulfasalazine, auranofin, etretinate, fumaric acid, gold, azathioprine, efamol marine and methotrexate在治療乾癬性關節炎的療效。
搜尋包括MEDLINE (直到2000年2月)及Excerpta Medica (June 1974 – 1995)，同時手動搜尋出版之回顧文獻，研討會會議記錄以及聯繫藥廠，及Cochrane Clinical Trials Register。在初步搜尋時所有語言出版皆包括。
所有隨機試驗比較sulfasalazine, auranofin, etretinate, fumaric acid, gold, azathioprine, efamol marine and methotrexate 在乾癬性關節炎的治療超過一年。主要的結果包括Outcome Measures in Rheumatology Clinical Trials (OMERACT)的個別指標 (包括acute phase reactants, disability, pain, patient global assessment, physician global assessment, swollen joint count, tender joint數目及關節X光片變化)及總合疾病指標 (pooled disease index, DI)的改變。
20個臨床試驗被納入此篇回顧，其中13篇包括了1022位參與者在量性分析中。雖然所有藥物皆比安慰劑好，parenteral high dose methotrexate (not included), sulfasalazine, azathioprine and etretinate在整體疾病活性指標達到統計顯著差異(但解讀資料時要注意azathioprine只有一個指標及etretinate只有一個試驗)。不同藥物在不同疾病活性指標反應有許多差異。安慰劑組改善比其基礎值改善 0.39 DI單位 (95% CI 0.26 – 0.54)。資料不足以分析副作用。
在治療乾癬性關節炎時，高劑量注射methotrexate及 口服sulfasalazine文獻顯示是有療效的。azathioprine, etretinate, 口服低劑量 methotrexate及或許colchicine可能有療效，但需進一步多中心臨床試驗才能確定其療效。此外，安慰劑組也有改善，因此強烈建議無控制對照組研究的結果，不應當為治療決策。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
一般估計乾癬患者，約有5 – 7% 會合併乾癬性關節炎，並造成一些病人殘疾。本文目標為評估治療(sulfasalazine、auranofin、etretinate、fumaric acid、IMI gold、azathioprine、methotrexate)乾癬性關節炎的效益，並且評估其副作用。許多研究當中，Parenteral methotrexate以及sulfasalazine對於超過一半的乾癬性關節炎帶來重大療效。沒有足夠的數據評估其他的療法並且評估毒性。需要多中心試驗來建立azathioprine、口服methotrexate、etretinate，以及colchicine的療效。