Anti-TNF outshines other psoriatic arthritis Tx.(Guest Editorial)

It's time to start considering tumor necrosis factor inhibiting agents as early therapy, if not first line therapy, for psoriatic arthritis.

The inhibition of tumor necrosis factor (TNF) with biologic therapies is exceptionally attractive in psoriatic arthritis because there are so few alternatives.

Unlike in rheumatoid arthritis, where we have evidence that traditional disease-modifying antirheumatic drugs (DMARDs) can be effective, we have no such evidence in psoriatic arthritis.

At the same time, we know that the anti-TNF agents are particularly effective for treating manifestations of psoriatic arthritis such as axial disease, dactylitis, and enthesitis, for which DMARDS are generally not as effective.

These facts support the early initiation of TNF blockers, especially when patients have such manifestations or when they have a very aggressive course of both skin and joint disease.

Studies of etanercept--the only anti-TNF biologic currently approved for the treatment of psoriatic arthritis--suggest that the agent is associated with 50% and 73% American College of Rheumatology (ACR) 20 response rates at 3 and 6 months, respectively. ACR 50 response rates are around 50% and 37%; ACR 70 response rates are 13% and 9%, respectively.

In practice, I think that early initiation of biologics is indeed the trend. Increasing numbers of my rheumatology colleagues are opting to start their patients on biologics fairly early in the course of psoriatic arthritis because of their effectiveness, their relative low toxicity, and the fact that other therapies ...