This page contains a Flash digital edition of a book.

Oral systemics: side effects and contraindications

This article reviews the evidence-based results on treatment with ‘conventional’ therapy for PsA, focusing on the side effects and contraindications

Ennio Lubrano MD PhD Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterised by two main domains, namely arthritis and psoriasis associated with other extra- articular manifestations.

PsA has been considered a milder and less disabling disease than rheumatoid arthritis (RA), even if some studies have shown that PsA also produces erosions and articular damage. In addition, approximately 20–40% of PsA patients have axial skeleton involvement (psoriatic spondylitis), which may lead to functional limitation and deformity. Therefore, PsA has to be considered a potentially disabling disease requiring an aggressive treatment. PsA has been treated by different medications, from treatment with non-steroidal anti-inflammatory drugs (NSAIDs) to one or more synthetic disease-modifying anti-rheumatic agents (DMARDs) for the suppression of inflammation in patients with persistent peripheral joint disease. In clinical practice, the most widely used synthetic DMARDs are methotrexate (MTX) (level of evidence B), sulphasalazine (SSZ) (level of evidence A), leflunomide (LEF) (level of evidence A) and cyclosporin A (CsA) (level of evidence B). However, the efficacy of these agents in inhibiting joint erosions has not been assessed in controlled studies.1

In addition, 6

the effectiveness of corticosteroids in treating PsA is uncertain.1

The present article reviews the evidence-based results on treatment with ‘conventional’ therapy for PsA, focusing on the side effects and contraindications.


NSAIDs are a broad group of medications widely used in the treatment of pain conditions, such as arthritis. Usually, they are the first choice of treatment for conditions such as PsA, either prescribed by the general practitioner or by the rheumatologist at any stage of the disease. Few studies have been published on the efficacy of NSAIDs for the treatment of PsA. In fact, although the use of these medications is common in the real clinical practice, data from clinical trials are poor. Among them, a COX-2 inhibitor was

assessed for the efficacy of ankylosing spondylitis (AS), showing, in particular, the possibility of slowing radiological disease progression.2

This study was

carried out on a different disease but it is the only scientific contribution on the axial component of a condition similar to PsA. The potential side effects of NSAIDs, such as gastrointestinal risk, cardiovascular (CV) events and renal toxicity, have not been studied in PsA, while their possible role on induction of skin flares has been considered. In fact, from a dermatological point of view, this treatment could be detrimental for the skin, causing skin flares. However, in routine clinical practice, PsA patients are frequently exposed to NSAIDs.3 CV events are one of the side effects of

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32