Methotrexate plus leflunomide is a more effective treatment option for psoriatic arthritis than methotrexate monotherapy, but less well tolerated, a single-centre randomised trial shows.

Dutch researchers say their findings add to a growing body of evidence to support the “seemingly superior efficacy” of this combination therapy for patients with active disease.

“Clinicians might consider using this combination in either a step-down or -up approach depending on the situation,” said study author Dr Michelle Mulder of Sint Maartenskliniek, Nijmegen, Netherlands.

Writing in The Lancet Rheumatology, Dr Mulder and colleagues investigated the therapy in 78 patients (median age 55; 64% male) with psoriatic arthritis and active disease defined as two or more swollen joints, with dactylitis counting as one swollen joint.