The Literature Review On The Efficacy And Safety Of Methotrexate In The Treatment Of Plaque Psoriasis And Psoriasis Arthritis

Psoriasis is a chronic inflammatory skin disease with main pathological involvement of human skin, and joint may be involved in some patients. The typical skin manifestations are repetitive erythema, infiltration and scales with different degrees of itching. With respect to joint damage, facet joints such as distal ends of the metacarpophalangeal joints and toes are mainly involved, sometimes, major joints such as knee and spine can be also involved.At present, the treatment of psoriasis mainly includes topical drugs, physical treatment, systematic medication, treatment of traditional Chinese medicine(TCM) and biological agents. Topical drugs mainly include glucocorticoid and vitamin D3 derivatives, physical treatment mainly includes narrow-band ultraviolet(NB-UVB) phototherapy, and systematic medication mainly includes methotrexate, acitretin and cyclosporine. When it comes to the TCM treatment, the syndrome differentiation of external use of TCM bath and oral administration of TCM is more applied. Biological agents such as infliximab are a new type of targeted therapy developed in recent years, which has a significant curative effect for severe psoriasis.Methotrexate was used in treating psoriasis starting at 50 years before, which has achieved a good therapeutic effect. Nowadays, mainly used in the treatment of severe psoriasis such as plaque and psoriasis arthropathica, methotrexate shows a good curative effect whether it is used individually or in combination with other biological agents. However, the number of randomized controlled clinical trials of methotrexate in treating psoriasis is relatively smaller and no data can strongly prove its efficacy. In the paper, the related literatures of randomized controlled clinical trials of methotrexate in treating plaque and psoriasis arthropathica that can be retrieved on PubMed were reviewed to have a careful analysis of the similarities and differences of these literatures on the dose, time and final treatment effect of methotrexate. At the same time, the possible side effects and control strategy of methotrexate in the treatment of psoriasis were systematically reviewed. Through the systematic review of this part of literatures will help to deepen our understanding to the curative effect and safety of methotrexate in the treatment of psoriasis and provide favorable evidence for the clinical treatment of psoriasis.In this paper, the related literatures of randomized controlled clinical trials of methotrexate in the treatment of plaque and psoriasis arthropathica that can be retrieved on PubMed were reviewed to have a careful analysis of the similarities and differences of these literatures on the dose, time and terminal curative effect of methotrexate. It was found that 2.5mg-30mg/w of methotrexate had a better curative effect in the treatment of chronic plaque psoriasis. The large dose of long-term methotrexate could better improve arthritis in the treatment of psoriasis arthropathica but increase the risk of adverse reactions at the same time. In addition, possible adverse reactions such as liver toxicity and bone marrow suppression caused by methotrexate in the treatment of psoriasis, as well as the prevention strategy such as folic acid supplementation and real-time detection of indicators were systematically reviewed. Through the systematic review of this part of literatures will help to deepen our understanding to the curative effect and safety of methotrexate in the treatment of psoriasis and provide favorable evidence for the clinical treatment of psoriasis.