Aggressive Treatment vs. Standard Care in Patients with Psoriatic Arthritis

Although early and tight control of inflammation improves outcomes in patients with rheumatoid arthritis, this approach has not been studied for psoriatic arthritis. In this U.K. trial, researchers enrolled 206 adults (median age, 45) with early psoriatic arthritis (symptom duration, <24 months) and no previous treatment with disease-modifying antirheumatic drugs (DMARDs). Patients were randomized to tight control (monthly assessments and treatment adjusted according to a predefined protocol) or standard care (evaluations every 3 months and no formal measures of disease activity) for 48 weeks. The tight-control protocol entailed rapid escalation of DMARD therapy (using methotrexate plus sulfasalazine, cyclosporine, or leflunomide) with poss…