INTRODUCTION: Traditional studies on psoriatic arthritis have evaluated the response to treatment in terms of the rheumatic condition excluding the dermatologic condition. Treatment of the disease with biologic agents has been demonstrated to be effective in the control of both the arthritis and skin condition.

OBJECTIVE: To systematically review the efficacy of locally available biologic agents (etanercept and infliximab) in the treatment of rheumatic and dermatologic manifestations of psoriatic arthritis.

SEARCH STRATEGY: A MEDLINE search (from 1966 to June 2007) was performed using the following search terms: biologic agents, infliximab, etanercept, psoriasis, psoriatic arthritis and randomized clinical trials. Likewise, the Cochrane Database was also searched for existing studies on psoriatic arthritis. This was supplemented by citation tracking of published bibliographies and conference proceedings.

SELECTION CRITERIA: All randomized clinical trials evaluating the efficacy of etanercept and infliximab in Adult patients with active Psoriatic arthritis were included. Outcome assessments should include evaluation of both arthritic and dermatologic manifestations of the disease. These could be in the form of Psoriatic Arthritis Response Criteria (PsARC), American College of Rheumatology (ACR) Response Criteria (20, 50, and 70) and the Psoriatic Arthritis Severity Index (PASI) 75.

MAIN RESULTS: Nine studies were identified using the search strategy previously outlined. Of these, the four main clinical trials involving 569 patients were included in the quantitative analysis. Studies publishing the results of post hoc analysis were excluded if they did not assess for joint and dermatologic efficacy. Quantitative analysis showed that patients treated with biologic agents were more likely to experience improvement in arthritic complaints compared to placebo [PsARC RR 0.32 favoring treatment 95% CI (0.25-0.40) P