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To answer this question, scientists analyzed six high quality studies. The studies tested over 2300 people who had rheumatoid arthritis for more than 10 years. People had either injections of adalimumab or fake injections. Some studies also tested people taking methotrexate in combination with adalimumab or the fake injections. This Cochrane Review provides the best evidence we have today.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Topical treatment alone doesn’t always help enough in people with moderate to severe psoriasis. Then medications that have an effect throughout the entire body are considered. They can be taken as tablets or injected. Because of the possible side effects, it is a good idea to be well informed about their pros and cons.Mild plaque psoriasis can usually be effectively treated with topical medications. Additional treatment may be needed for moderate to severe psoriasis. UV light therapy is often tried first. If that doesn't help either, oral medications and injections are considered. This is called "systemic treatment" because the medicines enter the bloodstream and have an effect throughout the entire body (or “system”). The treatment typically begins with one of these drugs:Methotrexate (trade names: Lantarel, Metex, MTX Hexal, Methotrexat AL, for example)Fumaric acid esters (trade name: Fumaderm)Ciclosporin (trade names: Ciclosporin Pro, Ciqorin, Sandimmun, for example)Less common: Acitretin (trade name: Acicutan)If these medications don't provide enough relief for psoriasis or are unsuitable for some other reason, treatment with biological treatments (biologics) is possible. This group of drugs manufactured using biotechnology includes:Adalimumab (Humira)Etanercept (Benepali, Enbrel)Infliximab (Flixabi, Inflextra, Remicade, Remsima)Ixekizumab (Taltz)Secukinumab (Cosentyx)Ustekinumab (Stelara)Another option is apremilast (Otezla). It belongs to a separate class of drugs.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 18, 2017

Crohn's disease is a chronic inflammatory disease of the intestines. Crohn's disease frequently occurs in the lower part of the small intestine (the ileum), however it can affect any part of the digestive tract, from the mouth to the anus. The most common symptoms of Crohn's disease are abdominal pain, often in the lower right region of the abdomen, and diarrhea. TNF is a molecule secreted by white blood cells that increases inflammation. High levels of TNF‐alpha have been associated with the development of intestinal inflammation in Crohn's disease. TNF‐alpha blocking agents (infliximab, adalimumab, certolizumab pegol and CDP571) bind with TNF‐alpha molecules thereby neutralizing the biological activity of TNF‐alpha resulting in the healing of intestinal inflammation. All four molecules are synthetic antibodies that bind TNF. Infliximab (Remicade®) is an antibody of mouse origin that has been humanized, as is CDP571. Adalimumab (Humira®) is an antibody of human origin. Certolizumab is a humanized antibody fragment that is complexed with polyethylene glycol to extend the length of time the drug is in the body. Nine studies were reviewed. The studies compared TNF‐alpha blocking agents with placebo (inactive intravenous infusions or injections) and found that infliximab, adalimumab, and certolizumab pegol were effective in maintaining remission in patients with Crohn's disease who respond to induction therapy with these agents. There is no evidence that CDP571 is an effective maintenance therapy. The TNF‐alpha blocking agents appear to be safe for patients with Crohn's disease with equal numbers of patients receiving TNF‐alpha blocking agents or placebo reporting side effects such as headache, abdominal pain, nausea, and pain at injection site. There were some serious side effects reported with the use of these agents including infections such as tuberculosis. However, patients can be screened for inactive tuberculosis prior to treatment with TNF‐alpha. A link between long term treatment with TNF‐alpha blocking agents and cancer is possible but not proven. Data obtained from observational studies including the Crohn's Therapy, Resource, Evaluation and Assessment Tool (TREAT) registry show no increased risk of cancer with the use of TNF‐alpha blocking agents in patients with inflammatory bowel disease. The current evidence suggests that the TNF‐alpha blocking agents infliximab, adalimumab, and certolizumab pegol are effective maintenance therapy in Crohn's disease. However, the use of these medications needs to be weighed against the potential risk of serious side effects, particularly infection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by abdominal pain, urgent bowel movements and bloody diarrhea. Treatment of UC focuses on induction of remission (treatment of symptoms of active disease) and prevention of clinical relapse (resumption of symptoms of active disease) in patients in remission (known as maintenance therapy). UC has a major impact on patients' health related quality of life (HRQL). HRQL refers to a person's physical functioning, social and emotional well‐being, ability to work and freedom from disease symptoms. HRQL is significantly lower in patients with UC compared to the general population. Randomized controlled trials (RCTs) evaluating medical interventions for UC have traditionally used clinical disease activity indices which focus on subjective symptoms to define primary outcomes such as clinical remission or improvement. This focus on disease symptoms results in a failure to assess other important indicators of successful treatment such as HRQL.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

This summary will tell you about two types of medicine to treat RA: DMARDs and corticosteroids. It will explain what research has found about how well DMARDs work when taken alone or with corticosteroids to treat RA. It will also tell you what research says about the side effects of these medicines. You can use this summary to talk with your doctor about whether one of these medicines may be right for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 20, 2012

People with rheumatoid arthritis typically have permanent inflammation in several joints. The joints are painful and swollen, and gradually stiffen. Rheumatoid arthritis usually progresses slowly over many years. The aim of treatment with medication is to relieve the symptoms and prevent the progression of the disease as much as possible.In rheumatoid arthritis, various kinds of medication are used to relieve the symptoms, reduce the inflammation and to keep the joints working properly for as long as possible. There are two types of therapy: disease-modifying therapy and symptomatic therapy.Disease-modifying therapy: These medications are taken regularly for longer periods of time independent of any acute symptoms. They are known as “disease-modifying anti-rheumatic drugs” or “DMARDs” for short. Disease-modifying drugs inhibit inflammatory responses in the joints of people with rheumatoid arthritis. In this way they can at best stop – or at least delay – the progression of the disease, preventing damage to the joints. Their effect is often only noticeable after one to four months of treatment. DMARDs can be divided up into “conventional” and “biological” disease-modifying drugs.Symptomatic therapy: Medications used in symptomatic therapy are taken to relieve acute pain and inflammation. The main ones are non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen (also called paracetamol), and steroids (corticosteroids).

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 27, 2016

‐The combination of methotrexate + sulfasalazine + hydroxychloroquine and methotrexate + most biologic DMARDs improves disease activity. Other treatment combinations (methotrexate + hydroxychloroquine, methotrexate + leflunomide, methotrexate + gold injections) may improve disease activity in people who do not respond to methotrexate alone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Psoriasis is a long‐term skin disease that may develop at any age. Estimates for the United States and Europe suggest that psoriasis accounts for 4% of skin diseases in children. In most cases, the condition is mild and can be treated with creams. However, a small percentage of children have moderate to severe disease that requires drugs, such as ciclosporin or methotrexate, and some will require injections with newer biological agents, such as anti‐TNF (tumour necrosis factor) drugs. Anti‐TNF drugs (among them etanercept, infliximab, and adalimumab) are designed to reduce inflammation in the body caused by tumour necrosis factor.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Psoriatic arthritis is a condition that leads to pain and stiffness in joints. It can be caused by psoriasis, but sometimes occurs in people who don't have any visible psoriasis-related skin changes. Various treatments can relieve the symptoms and prevent damage to the joints.It is estimated that 20% of people who have psoriasis also develop pain and inflammation in certain joints at some point. The joints start hurting and may feel stiff for a while, particularly in the morning. Movement often makes the stiffness disappear within half an hour. The affected joints may also become swollen, feel warm and sensitive to the touch. If the small joints between the vertebrae (spine bones) are inflamed, it might cause back pain.Psoriatic arthritis can occur in many joints of the body. It often affects the hands, feet, elbows, knees, neck or vertebrae. More than five joints typically become inflamed, including the joints at the end of the fingers and toes. These joints are especially prone to becoming deformed in severe cases. Tendons and tendon sheaths can also become inflamed.Most people who have psoriatic arthritis also have nail psoriasis. This can lead to small dents in the nails, which may become thicker, change color or start peeling off too. Nail psoriasis is difficult to treat and sometimes mistaken for a fungal nail infection.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: May 18, 2017

Ixekizumab (trade name: Taltz) has been approved in Germany since October 2016 for the systemic treatment of moderate to severe plaque psoriasis in adults.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 29, 2017

In people with rheumatoid arthritis (RA), the immune system, which normally fights infection, attacks the joint lining making joints inflamed, swollen, stiff and painful. We looked for trials of biologics (large molecules administered by injection) or tofacitinib (small molecules given by mouth) in people with RA.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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