Medicines called anti-TNF drugs can help stop the joint damage caused by psoriatic arthritis from getting worse, according to new research. Doctors think that if people take these medicines soon enough after they are told they have psoriatic arthritis, it could help prevent damage to joints.

WHAT DO WE KNOW ALREADY?

Psoriatic arthritis is a type of arthritis that affects some people with a skin condition called psoriasis. When people have psoriatic arthritis their joints become swollen, stiff, painful, and difficult to move. It mostly affects the hands, wrists, and feet, although any joint can be affected. Previous studies have suggested that psoriatic arthritis affects up to in three people with psoriasis, usually several years after they first notice the symptoms of psoriasis affecting their skin.

Methotrexate is one of the treatments for psoriatic arthritis. Methotrexate helps to ease the symptoms, and doctors think it can also modify the disease course (slow down or stop the damage to joints) the way it can for rheumatoid arthritis. Anti-TNF drugs are another group of medicines used to treat psoriatic arthritis. They also ease symptoms, but less is known about whether they can stop joint damage (called ‘radiographic progression’).

It might also be possible that combining methotrexate with anti-TNF drugs could produce even better results. To find out more, researchers in France reviewed five previously published studies that included 1,110 people with psoriatic arthritis. The people in the studies took either anti-TNF drugs (with or without methotrexate) or a placebo (with or without methotrexate). After 24 weeks, the researchers looked at the results of new scans of the joints of their hands, wrists, and feet, and compared how much joint damage had occurred in the people taking anti-TNF drugs compared with those taking a placebo.

WHAT DOES THE NEW STUDY SAY?

Fewer people who took anti-TNF drugs had increased joint damage after 24 weeks compared with people who took a placebo. After 24 weeks, about 85 in 100 people who took anti-TNF drugs had joint symptoms that had not worsened, compared with about 69 in 100 people who took a placebo.

There wasn’t enough evidence to say whether combining anti-TNF drugs with methotrexate reduced progression compared with either treatment alone.

HOW RELIABLE ARE THE FINDINGS?

The researchers noted that all five of the studies they included in their review had broadly the same design and measured symptoms and joint damage in the same way, so the results should be reasonably reliable. We can’t draw any conclusions from this review about the combination of anti-TNF drugs and methotrexate, as the studies didn’t provide much information.

WHAT DOES THIS MEAN FOR ME?

The researchers say that treatment for psoriatic arthritis is likely to work best when it is started early, before there is too much damage to the joints. Anti-TNF drugs are usually only recommended for people who have already tried other treatments, or who aren’t able to take other treatments. But the authors of this study make the point that, if anti-TNF drugs can help prevent joint damage, doctors could consider using these treatments sooner than is usually the case now. This is a possibility in future, but we would need more research to be sure this was safe, as these drugs can have severe side effects.

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Date summary prepared: February 2014

Summary based on research article published on: 25 January 2013

From:  Goulabchand R, et al. Effect of tumour necrosis factor blockers on radiographic progression of psoriatic arthritis: a systematic review and meta-analysis of randomised controlled trials. Ann Rheum Dis 2014;73:414–19. doi:10.1136/annrheumdis-2012-202641

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