The case for cyclosporin a in psoriatic arthritis

Recent studies have provided compelling evidence for a central role of CD-4-positive lymphocytes in the pathogenesis of psoriasis. Cyclosporin A (CSA) which inhibits the production of certain cytokines by these cells has a potent antipsoriatic effect and recent reports indicate that treatment with anti-CD-4 antibodies is equally effective. Open studies and case reports indicate that CSA or CD-4 antibodies are also effective for inducing remission in patients with psoriatic arthritis (PSA). Although controlled trials for CSA have not yet been reported, prolonged remission in PSA patients treated on a long-term basis, and dose-dependent fluctuations in disease activity of individual patients, provide convincing evidence for the efficacy of this drug. Irreversible renal damage is the main concern in relation to long-term CSA treatment. Although an increased incidence of malignancy has not been observed in patients who have been treated exclusively with CSA for up to 10 years, longer experience is required before this possibility can be ruled out entirely.