Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2001 Nov;60(Suppl 3):iii37–iii40. doi: 10.1136/ard.60.90003.iii37

Cytokine blockers in psoriatic arthritis

P Mease
PMCID: PMC1766666  PMID: 11890650

Abstract

The cellular events underlying the pathogenesis of psoriatic arthritis (PsA) and psoriasis have not yet been fully elucidated. Nevertheless, some clues to these conditions are beginning to emerge. In particular, a growing body of data supports the role of proinflammatory cytokines, such as tumour necrosis factor (TNF), in the pathophysiology of PsA and psoriasis. Raised levels of these cytokines are found in the joints of patients with PsA, as well as in psoriatic skin lesions. Physiotherapy, non-steroidal anti-inflammatory agents, corticosteroids, and disease modifying antirheumatic agents, such as methotrexate, are the most commonly used treatments for PsA. However, the data supporting the effectiveness of these treatments are limited, and disease resolution is usually incomplete. This study examined the effects of etanercept, a TNF inhibitor, in patients with PsA. Etanercept treatment was well tolerated and resulted in significant improvement in the signs and symptoms of PsA and in psoriatic skin lesions. Infliximab, another TNF inhibitor, has also been shown to be effective in patients with PsA. Such studies confirm the importance of proinflammatory cytokines in PsA, and hold out hope for patients who require new options for the treatment of their disease.



Full Text

The Full Text of this article is available as a PDF (140.5 KB).

Figure 1  .

Figure 1  

Open in a new tab

Clinical response as assessed by Psoriatic Arthritis Response Criteria (PsARC) in patients with psoriatic arthritis treated with etanercept or placebo. p<0.0001 v placebo. Adapted from Mease,13 with permission.

Figure 2  .

Figure 2  

Open in a new tab

Area of skin affected by psoriatic lesions in a patient with PsA. (A) Before etanercept treatment; (B) after 12 weeks of etanercept treatment.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bathon J. M., Martin R. W., Fleischmann R. M., Tesser J. R., Schiff M. H., Keystone E. C., Genovese M. C., Wasko M. C., Moreland L. W., Weaver A. L. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med. 2000 Nov 30;343(22):1586–1593. doi: 10.1056/NEJM200011303432201. [DOI] [PubMed] [Google Scholar]
  2. Biondi Oriente C., Scarpa R., Pucino A., Oriente P. Psoriasis and psoriatic arthritis. Dermatological and rheumatological co-operative clinical report. Acta Derm Venereol Suppl (Stockh) 1989;146:69–71. [PubMed] [Google Scholar]
  3. Clegg D. O., Reda D. J., Mejias E., Cannon G. W., Weisman M. H., Taylor T., Budiman-Mak E., Blackburn W. D., Vasey F. B., Mahowald M. L. Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. 1996 Dec;39(12):2013–2020. doi: 10.1002/art.1780391210. [DOI] [PubMed] [Google Scholar]
  4. Danning C. L., Illei G. G., Hitchon C., Greer M. R., Boumpas D. T., McInnes I. B. Macrophage-derived cytokine and nuclear factor kappaB p65 expression in synovial membrane and skin of patients with psoriatic arthritis. Arthritis Rheum. 2000 Jun;43(6):1244–1256. doi: 10.1002/1529-0131(200006)43:6<1244::AID-ANR7>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
  5. Ellis C. N., Fradin M. S., Messana J. M., Brown M. D., Siegel M. T., Hartley A. H., Rocher L. L., Wheeler S., Hamilton T. A., Parish T. G. Cyclosporine for plaque-type psoriasis. Results of a multidose, double-blind trial. N Engl J Med. 1991 Jan 31;324(5):277–284. doi: 10.1056/NEJM199101313240501. [DOI] [PubMed] [Google Scholar]
  6. Espinoza L. R., Cuéllar M. L., Silveira L. H. Psoriatic arthritis. Curr Opin Rheumatol. 1992 Aug;4(4):470–478. [PubMed] [Google Scholar]
  7. Ettehadi P., Greaves M. W., Wallach D., Aderka D., Camp R. D. Elevated tumour necrosis factor-alpha (TNF-alpha) biological activity in psoriatic skin lesions. Clin Exp Immunol. 1994 Apr;96(1):146–151. doi: 10.1111/j.1365-2249.1994.tb06244.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Farr M., Kitas G. D., Waterhouse L., Jubb R., Felix-Davies D., Bacon P. A. Sulphasalazine in psoriatic arthritis: a double-blind placebo-controlled study. Br J Rheumatol. 1990 Feb;29(1):46–49. doi: 10.1093/rheumatology/29.1.46. [DOI] [PubMed] [Google Scholar]
  9. Fredriksson T., Pettersson U. Severe psoriasis--oral therapy with a new retinoid. Dermatologica. 1978;157(4):238–244. doi: 10.1159/000250839. [DOI] [PubMed] [Google Scholar]
  10. Gladman D. D., Farewell V. T., Nadeau C. Clinical indicators of progression in psoriatic arthritis: multivariate relative risk model. J Rheumatol. 1995 Apr;22(4):675–679. [PubMed] [Google Scholar]
  11. Gladman D. D. Psoriatic arthritis. Rheum Dis Clin North Am. 1998 Nov;24(4):829-44, x. doi: 10.1016/s0889-857x(05)70044-2. [DOI] [PubMed] [Google Scholar]
  12. Gladman D. D., Stafford-Brady F., Chang C. H., Lewandowski K., Russell M. L. Longitudinal study of clinical and radiological progression in psoriatic arthritis. J Rheumatol. 1990 Jun;17(6):809–812. [PubMed] [Google Scholar]
  13. Lipsky P. E., van der Heijde D. M., St Clair E. W., Furst D. E., Breedveld F. C., Kalden J. R., Smolen J. S., Weisman M., Emery P., Feldmann M. Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group. N Engl J Med. 2000 Nov 30;343(22):1594–1602. doi: 10.1056/NEJM200011303432202. [DOI] [PubMed] [Google Scholar]
  14. Maini R. N., Breedveld F. C., Kalden J. R., Smolen J. S., Davis D., Macfarlane J. D., Antoni C., Leeb B., Elliott M. J., Woody J. N. Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor alpha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis. Arthritis Rheum. 1998 Sep;41(9):1552–1563. doi: 10.1002/1529-0131(199809)41:9<1552::AID-ART5>3.0.CO;2-W. [DOI] [PubMed] [Google Scholar]
  15. Mease P. J., Goffe B. S., Metz J., VanderStoep A., Finck B., Burge D. J. Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet. 2000 Jul 29;356(9227):385–390. doi: 10.1016/S0140-6736(00)02530-7. [DOI] [PubMed] [Google Scholar]
  16. Moreland L. W., Schiff M. H., Baumgartner S. W., Tindall E. A., Fleischmann R. M., Bulpitt K. J., Weaver A. L., Keystone E. C., Furst D. E., Mease P. J. Etanercept therapy in rheumatoid arthritis. A randomized, controlled trial. Ann Intern Med. 1999 Mar 16;130(6):478–486. doi: 10.7326/0003-4819-130-6-199903160-00004. [DOI] [PubMed] [Google Scholar]
  17. Palit J., Hill J., Capell H. A., Carey J., Daunt S. O., Cawley M. I., Bird H. A., Nuki G. A multicentre double-blind comparison of auranofin, intramuscular gold thiomalate and placebo in patients with psoriatic arthritis. Br J Rheumatol. 1990 Aug;29(4):280–283. doi: 10.1093/rheumatology/29.4.280. [DOI] [PubMed] [Google Scholar]
  18. Partsch G., Steiner G., Leeb B. F., Dunky A., Bröll H., Smolen J. S. Highly increased levels of tumor necrosis factor-alpha and other proinflammatory cytokines in psoriatic arthritis synovial fluid. J Rheumatol. 1997 Mar;24(3):518–523. [PubMed] [Google Scholar]
  19. Partsch G., Wagner E., Leeb B. F., Bröll H., Dunky A., Smolen J. S. T cell derived cytokines in psoriatic arthritis synovial fluids. Ann Rheum Dis. 1998 Nov;57(11):691–693. doi: 10.1136/ard.57.11.691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Pringle F. A multidisciplinary approach to psoriatic arthropathy. Community Nurse. 1999 May;5(4):21–22. [PubMed] [Google Scholar]
  21. Ritchlin C., Haas-Smith S. A., Hicks D., Cappuccio J., Osterland C. K., Looney R. J. Patterns of cytokine production in psoriatic synovium. J Rheumatol. 1998 Aug;25(8):1544–1552. [PubMed] [Google Scholar]
  22. Scarpa R., Oriente P., Pucino A., Torella M., Vignone L., Riccio A., Biondi Oriente C. Psoriatic arthritis in psoriatic patients. Br J Rheumatol. 1984 Nov;23(4):246–250. doi: 10.1093/rheumatology/23.4.246. [DOI] [PubMed] [Google Scholar]
  23. Shbeeb M., Uramoto K. M., Gibson L. E., O'Fallon W. M., Gabriel S. E. The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol. 2000 May;27(5):1247–1250. [PubMed] [Google Scholar]
  24. Torre Alonso J. C., Rodriguez Perez A., Arribas Castrillo J. M., Ballina Garcia J., Riestra Noriega J. L., Lopez Larrea C. Psoriatic arthritis (PA): a clinical, immunological and radiological study of 180 patients. Br J Rheumatol. 1991 Aug;30(4):245–250. doi: 10.1093/rheumatology/30.4.245. [DOI] [PubMed] [Google Scholar]
  25. Van den Bosch F., Kruithof E., Baeten D., De Keyser F., Mielants H., Veys E. M. Effects of a loading dose regimen of three infusions of chimeric monoclonal antibody to tumour necrosis factor alpha (infliximab) in spondyloarthropathy: an open pilot study. Ann Rheum Dis. 2000 Jun;59(6):428–433. doi: 10.1136/ard.59.6.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Willkens R. F., Williams H. J., Ward J. R., Egger M. J., Reading J. C., Clements P. J., Cathcart E. S., Samuelson C. O., Jr, Solsky M. A., Kaplan S. B. Randomized, double-blind, placebo controlled trial of low-dose pulse methotrexate in psoriatic arthritis. Arthritis Rheum. 1984 Apr;27(4):376–381. doi: 10.1002/art.1780270403. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES