Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis

Abstract

Objective To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA). Methods GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire. Results Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. Conclusion We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves

Secukinumab: A New Treatment Option for Psoriatic Arthritis

“…The clinical manifestations of PsA include arthritis, enthesitis, dactylitis, spondylitis, psoriasis, and nail disease, with approximately 50% of patients also experiencing erosive joint damage within the first 2 years [10]. Thus, therapeutic principles should comprise management of disease in each tissue compartment, with the ultimate goal of impeding disease progression and maximizing function over time [11,12].…”

“…Nevertheless, clinical experience suggests that these agents are effective at reducing inflammation and treating some symptoms and signs and they remain the recommended first-line treatment option for patients with active PsA across several current international guidelines [11,12].…”

Psoriatic arthritis: state of the art review

“…Expert opinion is that intraarticular steroid injections may be used in persistent mono-or oligoarthritis. 19 Observational evidence showed that 41% of joints improved at 3 months following use of corticosteroids, although 33% of these relapsed subsequently. 20 Oral steroids are not recommended, in part because of possible skin 'rebound' when they are withdrawn.…”

“…19 Both of these recommendations are evidence-based and both broadly suggest a similar 'step up' approach to therapy. This approach uses therapies sequentially starting with simple therapies such as non-steroidal antiinflammatory drugs for pain or topical therapies for psoriasis, followed by single disease modifying drugs (DMARDs), then combinations of standard DMARDs, and finally biologic drugs if patients fail to respond to the previous treatment.…”

Do Biologic-treated Psoriatic Arthritis Patients with Spondylitis Respond Differently with or without Concomitant Methotrexate from Patients without Spondylitis?

“…In PsA clinical trials, spine involvement and spine response to treatment is not usually assessed because patients with spondylitis are in the minority, its presentation can be quite variable, and accurate spondylitis diagnosis and assessment of response would require extensive and expensive magnetic resonance imaging (MRI), as well as clinical assessment. Thus, to establish treatment recommendations for PsA spondylitis, international groups such as the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) use data from ankylosing spondylitis (AS) trials as a surrogate for spondylitis response in PsA 20 . In AS studies, none of the traditional oral disease-modifying antirheumatic drugs (DMARD), including MTX, have demonstrated efficacy in the spinal manifestations of the disease.…”