If you have psoriatic arthritis (PsA), chances are you doctor has been using a “step-up” approach to your treatment. That means starting on the mildest available treatment option — usually a nonsteroidal anti-inflammatory drug (NSAID) — moving to methotrexate when the NSAID isn’t enough, and then progressing to the most aggressive option, a biologic drug. 

While that might seem like a reasonable approach — why take stronger medication if you don’t need to? — the downside is that you’d probably get to remission a lot faster if you started with the bigger guns.

According to a new study, published in the journal Annals of the Rheumatic Disease, 81 percent of recently diagnosed psoriatic arthritis patients who used the biologic medication golimumab (Simponi) in addition to methotrexate (MTX) reached remission within 22 weeks, meaning their disease activity score (DAS) was below 1.6. In comparison, 42 percent of those who used methotrexate alone reached remission during that time.

“In patients with early PsA, DAS remission as week 22 was almost double with golimumab plus MTX versus MTX alone,” the authors concluded.

This study was a randomized, placebo-controlled trial but fairly small (51 patients). However, earlier research also concluded that turning to a biologic drug sooner — in the older study, the drug was infliximab (Remicade) — was advantageous for people with psoriatic arthritis. 

“Methotrexate reflects current standard of care despite the factthat previous trials of methotrexate in psoriatic arthritis failed to unequivocally establish efficacy,” the researchers wrote.

They also noted that the more aggressive “treat to target” approach is now standard in rheumatoid arthritis treatment, and suggested that PsA patients would benefit from a similarly aggressive strategy.

Golimumab and infliximab are both TNF (tumor necrosis factor) inhibitors. This type of biologic drug works by targeting a protein (TNFa) that leads to inflammation, swelling, and pain. 

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