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Vol. 14. Num. 2.March - April 2018
Pages 65-124
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Vol. 14. Num. 2.March - April 2018
Pages 65-124
Original Article
DOI: 10.1016/j.reumae.2016.10.007
Effectiveness of Conventional Disease-modifying Antirheumatic Drugs in Psoriatic Arthritis: A Systematic Review
Eficacia de los fármacos antirreumáticos modificadores de la enfermedad sintéticos en artritis psoriásica: una revisión sistemática
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Jesús Maesea,
Corresponding author
jmaese@telefonica.net

Corresponding author.
, Petra Díaz del Campob, Daniel Seoane-Matob, Mercedes Guerrab, Juan D. Cañetec
a Grupo de Trabajo Reumatología Basada en la Evidencia, Sociedad Española de Reumatología, Madrid, Spain
b Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
c Departamento de Reumatología, Hospital Clínic de Barcelona e IDIBAPS, Barcelona, Spain
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Figures (1)
Tables (4)
Table 1. Systematic Review and Studies Included (Inclusion Criteria, Population Characteristics, Intervention, Follow-up).
Table 2. Results of the Studies Included.
Table 3. Summary of the Evidence: Level and Quality of Evidence.
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Abstract
Background

Due to the clinical heterogeneity of psoriatic arthritis (PsA), recommendations have been developed by international groups to guide therapeutic decisions of the rheumatologist. The objective of the current systematic review (RS) was to evaluate the evidence of efficacy of disease-modifying antirheumatic drugs (DMARDs) in PsA.

Methods

Literature search in Medline, EMBASE, Cochrane Library, from 2008 to 2014. We included RS, randomized clinical trials and observational studies, in patients with PsA and an evaluation of efficiency of conventional DMARDs (methotrexate, sulfasalazine, leflunomide), according to the following outcomes: peripheral and axial symptoms; peripheral radiological damage; enthesitis according to power Doppler ultrasound or magnetic resonance imaging (enthesitis count before and after therapy); dactylitis; uveitis.

Results

Title and abstract were used to retrieve 1662 documents for this review (Medline, n=433; EMBASE n=1132; Cochrane, n=97), and 48 studies were selected for detailed reading; finally, 8 studies were included.

Conclusions

Since the studies included are not robust, and there are arguments to support the effectiveness of methotrexate, the evidence observed with the treatment of DMARDs in PsA is not conclusive.

Keywords:
Psoriatic arthritis
Disease modifying antirheumatic drugs
Systematic review
Resumen
Antecedentes

Dada la heterogeneidad clínica de la artritis psoriásica (APs), se han elaborado recomendaciones por grupos internacionales para orientar las decisiones terapéuticas del reumatólogo. Esta revisión sistemática (RS) tiene el objetivo de evaluar la evidencia sobre la eficacia de los FAME en APs.

Métodos

Búsqueda bibliográfica en Medline, Embase, Cochrane Library, desde 2008 hasta 2014. Se incluyeron RS, EC y estudios observacionales, en pacientes con APs con evaluación de eficacia de FAME sintéticos (metotrexato, sulfasalazina y leflunomida), los siguientes desenlaces: síntomas periféricos; daño estructural radiológico periférico; síntomas axiales; entesopatía por ecografía o resonancia magnética (número de entesis antes y después del estudio); dactilitis, y uveítis.

Resultados

Se recuperaron 1.662 documentos para revisar por título y «abstract» (Medline, n=433; Embase n=1.132; Cochrane, n=97), se seleccionaron 48 estudios para su lectura detallada, y se incluyeron 8 estudios.

Conclusiones

Ya que los estudios incluidos no son consistentes, y hay argumentos para apoyar la eficacia del metotrexato, la evidencia observada con el tratamiento de FAME en APs no es concluyente.

Palabras clave:
Artritis psoriásica
Fármacos antirreumáticos modificadores de la enfermedad
Revisión sistemática

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