[How to choose a basic drug for psoriatic arthritis?].

On the basis of an earlier retrospective study in 270 psoriatic arthritis (PA) patients and according to the data of the literature 1. aurotherapy for the patients having mild skin changes and active joint involvement (mainly polyarticular type), 2. sulfasalazine for the patients having moderate skin changes and moderate articular activity, 3. etretinate for the patients having widespread skin involvement and mild articular activity, 4. methotrexate for the patients having both severe skin and severe articular involvement were introduced by the authors. The experiences of prospective study of 52 patients treated with disease modifying antirheumatic drugs (DMARDs) during 3-6 months are reported (21: aurothiomalate, 13: sulfasalazine, 4: methotrexate, 14: etretinate). Morning stiffness (MS), visual analog scale (VAS), number of swollen joints (No), psoriasis area and severity index (PASI) and erythrocyte sedimentation rate (ESR) were monitored. The methotrexate proved to be the most effective in every parameters, except the ESR. Regarding PASI the etretinate was the second most effective. Among the monitored parameters ESR and VAS showed significant improvement at every drugs. Withdrawal was necessary in 7 cases during aurotherapy (7/21), in 4 cases during sulfasalazine (4/13), in 4 cases during etretinate (4/14), meanwhile there was not withdrawal during methotrexate therapy. Low frequency of skin exacerbation (4/52) doesn't contraindicate the introduction of these drugs. If the choice and monitoring of psoriatic arthritis patients is correct we can detect really good results with DMARDs in PA.