The British Journal of Rheumatology, Vol 36, 95-99, Copyright © 1997 by British Society for Rheumatology
G Jones, M Crotty and P Brooks
The objective of this study was to use the technique of meta-analysis to
undertake a systematic review of published and unpublished randomized
controlled trials of pharmacological agents to determine their relative
efficacy and toxicity in the treatment of psoriatic arthritis. The main
outcome measure was the change in pooled disease index with component
variables derived from OMERACT. Nineteen randomized trials were identified,
of which 12 were included in the quantitative analysis with data from 792
subjects. Although all agents were better than placebo, parenteral
high-dose methotrexate, salazopyrin, azathioprine and etretinate were the
agents that achieved statistical significance (although it should be noted
that only one component variable was available for azathioprine and only
one trial with a high dropout rate was available for etretinate suggesting
some caution is necessary in interpreting these results). In all trials,
the placebo group improved over baseline (pooled improvement 0.43 disease
index (DI) units, 95% CI 0.28-0.59). There were insufficient data to
examine toxicity. In conclusion, parenteral high-dose methotrexate and
salazopyrin are the only two agents with well-demonstrated published
efficacy in psoriatic arthritis. The magnitude of the effect seen with
etretinate, oral low-dose methotrexate, azathioprine 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.
REVIEWS
Psoriatic arthritis: a quantitative overview of therapeutic options. The Psoriatic Arthritis Meta-Analysis Study Group
Menzies Centre for Population Health Research, Hobart, Tasmania.
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