Infliximab treatment in Psoriatic Arthritis: our experience - Acta Bio ...

98 W.Troise Rioda, G. AdorniA second study (IMPACT2) was later conducted(67). In this study 200 patients randomly receivedeither infliximab or the placebo for 24 weeks. TheACR20, 50 and 70 at the 24 th week were reached by54%, 41%, 27% of the patients that were treated withinfliximab compared to 11%, 4%, 2% of those receivingthe placebo. PASI75 was reached by 60% of thegroup treated with infliximab and by 1% of the groupreceiving the placebo.The radiographic progression of the disease wasvalued through two studies (68, 69). The first study utilizedthe Sharp method that was modified for psoriaticarthritis. At the 24 th week this method showed a variationof -0.7±2.53 in patients treated with infliximabcompared to a variation of +0.82±2.62 in patients receivingthe placebo. At the 50 th week, the study showed ahalt in the radiographic progression in both patientsthat had received infliximab during all 50 weeks and inthose who had been treated from the 16 th to the 50 thweek. The second study analyzed the radiographic progressionof the disease in 72 patients. Patients were initiallyrandomized into a double-blinded study and receivedinfliximab or the placebo for 14 weeks, subsequentlyall patients blindly received infliximab up untilthe 50 th week. It emerged that, at the 50 th week, patientsin both the placebo/infliximab group and patients inthe infliximab/infliximab group did not show a worseningin the modified vdH-S total score.Treatment with Infliximab is usually well tolerated.The most common side effects of this drug includeheadaches, upper respiratory tract infections, and administrationreactions (48). A prolonged use has been associatedwith the production of anti-infliximab antibodies,which is the reason for which methotrxate is associatedto the therapy. These antibodies can reduce theefficacy of infliximab with time, making an increase inits dose necessary (70,71). Rare cases of demyelinatingpathologies, lupus-like conditions, and opportunisticinfections including tuberculosis have been described inpatients in treatment with infliximab (72).Our experienceWe treated 11 patients (7 male, 4 female), diagnosedwith psoriatic arthritis, with an infusion of 5mg/kg of infliximab at week 0, 2, and 6 and then every8 weeks, following the classic scheme (66).In this article we discuss an emblematic case of apatient treated with infliximab that showed improvementof his arthritis and dermatologic manifestations.The patient was a 61 year old male affected bypsoriatic arthritis since 1979: the psoriasis appeared in1975 (diffuse manifestations localized on his chest,back, upper and lower limbs) then followed by the appearanceof the classic symptoms of arthritis (sausagefingers, involvement of distal interphalangeal and metacarpophalangealjoints, nail alterations, involvementof the left knee).Initial treatment included 10 mg of methotrexategiven intramuscularly once a week, NSAIDs, and lowdoses of steroids which obtained a discrete resolutionof symptoms. Inflammation indexes were reduced(VES from 45 to 28 1h; PCR from 3,18 to 1,28 (NV