Is reduction or discontinuation of therapy an acceptable possibility in psoriatic arthritis?

Remission in psoriatic arthritis (PsA), albeit variably defined, is a desirable and achievable state, especially in the era of biologic therapy. Historically, studies have used remission criteria derived from rheumatoid arthritis (RA), which indicate that remission is seen in a greater percentage of patients than in RA, including the possibility of drug-free remission in some patients. The Minimal Disease Activity (MDA) measure developed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is a currently acceptable goal of therapy, taking into account PsA-specific elements such as skin disease and enthesitis. Newer PsA composite measures which include thresholds for remission are under development and are now included in prospective clinical trials. Once remission is achieved and sustained on therapy, a natural question is whether treatment can be reduced or discontinued to avoid treatment toxicities and costs. Exploratory data are being analysed from observational cohorts regarding the capacity to reduce treatment dose, dose frequency, or discontinue use of a medication whilst maintaining remission. A controlled dose-reduction and discontinuation study design is outlined, which may provide controlled evidence for such a paradigm of treatment.