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Withdrawing DMARDs from psoriatic arthritis patients who appear to be in remission ends in relapse for about three of four, a small prospective study has shown.
Araujo, EG, Finzel S, Englbrecht M, et al., High incidence of disease recurrence after discontinuation of disease-modifying antirheumatic drug treatment in patients with psoriatic arthritis in remission. Ann Rheum Dis. 2014. doi:10.1136/annrheumdis-2013-204229
Chances of sustaining drug-free remission in psoriatic arthritis (PsA) are low, the German authors of this study suggest, and disease modifying antirheumatic drugs (DMARDs), whether traditional or biologic, should not be stopped.
In a small, 6-month prospective study of PsA patients who had achieved continuous clinical remission, disease recurred rapidly in almost 77% when DMARDs were discontinued. This was particularly true among the males.
The observational study of 26 PsA patients at one center -- 14 taking methotrexate (MTX) monotherapy and 12 a tumor necrosis factor inhibitor (TNFi) alone or in combination with MTX – showed that disease activity (joint pain and swelling) flared within a couple of months (median 74.5 days) after the drugs were withdrawn.
Restarting the patient’s original DMARD and dose quickly restored remission in the 20 patients who had a flare.
The researchers had discontinued DMARDs when patients reached what they called continuous clinical remission, defined as the absence of musculoskeletal symptoms (Psoriasis Area Severity Index, PASI, of 0.21) and little or no skin/nail disease observed for at least 6â months.
Of those who experienced a flare, 18 were men (median age 55). Patients with longer disease duration (7.6 months vs. 3 months), more severe skin involvement, and synovial hypertrophy seen on ultrasound at baseline, were also more likely to relapse.
Length of remission did not seem to play a role in the chance of a flare. Numbers of recurrences were equal (10) among those initially treated with MTX or a TNFi.