2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis

Abstract

Objective To develop an evidence‐based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). Methods We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. Results The guideline covers the management of active PsA in patients who are treatment‐naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin‐12/23 inhibitors (IL‐12/23i), IL‐17 inhibitors, CTLA4‐Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat‐to‐target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. Conclusion The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.

Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities: A Literature Review

“…Patients with axial involvement showed a higher likelihood of moderate-to-severe psoriasis(body surface area ≥ 3%, 42.5% vs. 31.5%), lower prevalence of minimal disease activity (30.1% vs. 46.2%), higher nail psoriasis scores (visual analog scale; VAS 11.4 vs. 6.5), enthesitis counts (5.1 vs. 3.4), serum C-reactive protein levels (4.1 vs. 2.4 mg/L), and scores for physical function (Health Assessment Questionnaire, 0.9 vs. 0.6), pain (VAS, 47.7 vs. 36.2), and fatigue (VAS, 50.2 vs. 38.6) than patients without axial involvement. The American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF) published guidelines for PsA in 2019 [49], although nearly all recommendations were conditional since the quality of evidence was most often low or very low, and occasionally moderate.…”

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

“…However, comparative research of different drugs, important for clinical practice, is rather sparse and clinicians need some guidance in decision-making. [17][18][19][20] The European League Against Rheumatism (EULAR) developed recommendations for the pharmacological management of PsA in 2011 and updated them in 2015. These recommendations had their main focus on the musculoskeletal aspects of the disease and addressed the entire spectrum of PsA severity since they pertained to patients with very mild to very severe PsA.…”

<p>Tofacitinib in the management of active psoriatic arthritis: patient selection and perspectives</p>

“…Psoriatic arthritis (PsA) is a chronic, inflammatory musculoskeletal disease that is characterized by peripheral arthritis, enthesitis, dactylitis, and spondylitis with or without nail and skin lesions. 1,2 It is a systemic disease that develops in up to 40% of psoriasis patients in their lifetime [3][4][5] with manifestations that include pain, swelling, stiffness, and entheses of the peripheral joints and/or axial skeleton. Dactylitis, fusiform full thickness swelling of fingers or toes, can develop in about half of individuals with PsA.…”