The long-term use of azathioprine in patients with psoriatic arthritis

Despite the widespread use of methotrexate in the treatment of psoriatic ar thritis (PsA), there are patients who are either refractory, develop toxici ty to, or refuse to take methotrexate. Ln search of an alternative, we stud ied long-term tolerability of and clinical response to azathioprine (AZA) i n PsA patients in comparison with matched controls and followed them In a l ongitudinal clinic. Twenty-eight of 485 patients followed prospectively bet ween 1978 and 1998 took AZA during their clinic follow-ups. Eighteen of the 28 took AZA for 12 months and were included in the study. AZA was well tol erated by most patients, even in the long-term. Although there was no stati stically significant difference in the reduction in number of actively infl ammed joints between AZA-treated patients and controls, and AZA was no bett er in preventing progression of damage, AZA was still as good as the other medications. Consequently AZA was often given to individuals who had not re sponded to other medications in the past. We provide illustrative case repo rts in which AZA also controlled psoriasis, and we conclude that, whereas A ZA is not superior to other medications in the treatment of PsA, it may be safely used and it provides an alternative therapy for patients with PsA.