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We read with great interest the recent publication on the comparison of the efficacy of etanercept (ETN) or etanercept plus methotrexate (MTX) versus MTX monotherapy in patients with psoriatic arthritis (SEAM-PsA trial) by Mease et al (1). The authors reported significantly greater response rates in both biologic arms versus MTX for the primary endpoint, the ACR20 response, and several secondary endpoints. Interestingly, in the discussion the authors expressed their surprise about the high efficacy level conveyed by MTX alone. This arti
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