Etanercept the therapy of psoriatic arthritis – effective management for the long term
Department of Medicine, Section of Dermatology, University of Verona, Italy
Psoriatic arthritis (PsA) affects up to 30% of patients with psoriasis, particularly in the young population. PsA runs usually a chronic fluctuating course but can be progressive, and up to 50% of patients demonstrate at least one bone erosion within two years. Enthesitis is a common and early manifestation of PsA, especially in the lower limbs. It is typically reccurent in nature and is associated with a greater degree of radiological damage. Early recognition and treatement of PsA is very important for improving patient’s quality of life and prevent irreversible joint damage and bone erosions. Effective therapy of PsA includes NSAIDs, methotrexate and anti-TNF-ª agents, which are the only drug demonstrated to be helpful in spondylitis and capable of impeding progression of structural damage. Etanercept has been shown to be effective in both psoriasis and PsA, but the effects on enthesitis have not been proven. Recently, a randomized, double blind trial (PRESTA trial) has shown that two etanercept regimens (50 mg QW for 24 weeks or 50 mg BIW for 12 weeks and then 50 mg QW for 12 weeks) were equally effective in markedly improving enthesitis and quality of life indexes, as well as in reducing CRP levels already after 12 weeks. PsA also improved, with ACR20, ACR50 and ACR70 reached respectively by 61-66%, 41-45% and 20-22% of patients by week 12 again with comparable results with the two dosing regimens. Arthritis symptoms, including joint pain, stiffness, subject and physician global assessments, amelioreted significantly by week 12 and the improvement further increased by week 24. Psoriasis cleared more rapidly with the step down regimen compared to the 50 mg QW regimen. In conclusion, thi study confirms the efficacy of etanercept in the therapy of psoriasis and PsA, including enthesial inflammation.
Girolomoni G. 3