Can traditional disease-modifying anti-rheumatic drugs be withdrawn or tapered in psoriatic arthritis?

Abstract Psoriatic arthritis (PsA) is a complex, multisystem disease with musculoskeletal and skin manifestations frequently associated with features of the metabolic syndrome. For many years, treatment strategies were largely borrowed from the rheumatoid arthritis literature, with clinical trials of traditional DMARDs in PsA often inadequate and using limited outcome measures. Nonetheless, DMARDs - in particular, methotrexate - remain the treatment of first choice for most rheumatologists treating this disease, especially for those with prominent polyarticular involvement. While there is no agreed definition of remission in PsA, a number of longitudinal studies suggests that remission can be achieved in approximately 25% of patients treated with traditional DMARDs, with drug-free remission possible in <10%. There are many unanswered questions, and this review concludes by highlighting a research agenda which aims to address some of the most critical questions for physicians and patients alike faced with deciding if treatment should be withdrawn or continued when disease remission is achieved.