Methotrexate in psoriatic polyarthritis.

Methotrexate (MTX) is widely accepted as an effective treatment for psoriasis and chronic polyarthrides. We report data from 54 psoriatic polyarthritis patients (354 encounters) treated with MTX. 65% were males, mean age 47.9 years, mean disease duration 9.8 years for arthritis, 14.2 years for psoriasis. The MTX dose was 10-12.5 mg/week. 32 patients are still on MTX after a mean treatment time of 1.6 years. 22 patients discontinued MTX treatment: 11 felt it to be ineffective, in 6 patients there were side effects, 3 patients obtained remission, while 2 patients underwent surgery. Efficacy was good on the whole: number of swollen and tender joints, global disease activity score, ESR, and CRP all underwent a significant reduction. The intake of symptomatic drugs was reduced in 40%. Psoriasis as assessed with the Psoriasis Activity and Severity Index showed a significant improvement. Our data confirm that MTX is of value in most psoriatic polyarthritis patients (60%). In our experience, this drug, gives the maximum efficacy within 6 months of therapy.

[Clinical framework of psoriatic arthropathy. Proposal of an evaluation protocol]. / Inquadramento clinico dell'artropatia psoriasica. Proposta di un protocollo di valutazione.

Psoriatic arthropathy is an inflammatory seronegative arthritis characterized by an involvement of peripheral or axial joints in association with psoriasis. In this study the clinical features of both skin and joints have been observed simultaneously by a rheumatologist and a dermatologist. We have finally proposed a clinical protocol based on PASI to evaluate psoriasis and on a simple subset classification to estimate joint involvement.

Disodium cromoglycate versus diet in the treatment and prevention of nickel-positive pompholyx.

In some cases that have been diagnosed as contact allergy to nickel, there are repeated cutaneous eruptions of pompholyx, even in areas with no direct contact with the metal. The possible alimentary origin of dyshidrotic eczema should be considered when deciding on therapy. We have collected the clinical data for 24 patients with dyshidrotic eczema caused by nickel, to evaluate the benefit of a low-nickel diet versus treatment with oral disodium cromoglycate, comparing both objective and subjective symptoms. A low-nickel diet does not improve these patients but those treated with DSCG reacted better, from both objective and subjective point of view, than either the controls or the patients treated by diet. We next did intestinal permeability tests before therapy and after 15 days of treatment. We found that nickel uptake diminishes simultaneously with the reduction of absorption through the smaller aqueous "pores". This phenomenon was greatest after DSCG. We suggest that DSCG can help selected cases of pompholyx.