Psoriatic arthritis (PsA) is increasingly being recognized to cause progressive joint damage and disability. PsA unresponsive to non-steroidal anti-inflammatory drugs (
NSAIDs), the conventional first-line choice of treatment, is usually managed with
disease-modifying antirheumatic drugs (DMARDs) especially
methotrexate. An 18-year-old HIV-negative male had progressively severe PsA of 4-month duration that was nearly confining him to a
wheel chair. He did not respond to multiple
NSAIDs, alone or in combination with
methotrexate (15 mg/week), given for 4 weeks. Addition of
prednisolone (10 mg on alternate days) controlled his symptoms within a week. The
NSAIDs could be withdrawn after 4 weeks as the treatment progressed. The doses were tapered for
methotrexate (5 mg/week) and
prednisolone (2.5 mg on alternate days) every 8 weekly subsequently during 15 months of follow-up without recurrence/
deformities or
drug toxicity. For years, the use of
corticosteroids in
psoriasis has been criticized for their propensity to exacerbate the
skin disease on withdrawal. However, monitored use of
corticosteroids, even in low doses, combined with DMARDs may be a good therapeutic option in early stage of the PsA rather than '
steroid rescue' later. This will help in early control of joint
inflammation, prevent joint damage and maintain long-term good functional capacity and quality of life. This may be useful when the cost or availability of biologics precludes their use. However, we discourage the use of
corticosteroids as monotherapy.