Journal Article

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

Kvien, Tore K, Schett, Georg, Rodrigues Manica, Santiago Andres, Gossec, Laure, Veale, Douglas J, Kerschbaumer, Andreas, Smolen, Josef S, Burmester, Gerd R, Baraliakos, Xenofon, Lories, Rik Jozef Urbain, Dougados, Maxime, Primdahl, Jette, Kragstrup, Tue Wenzel, Van den Bosch, Filip E, McInnes, Iain, Damjanov, Nemanja S, Balint, Peter V, Aletaha, Daniel, Boehncke, Wolf-Henning, Landewé, Robert B M, de Wit, Maarten, Marzo-Ortega, Helena, Bertheussen, Heidi, Balanescu, Andra, van der Heijde, Désirée, McGonagle, Dennis G, Poddubnyy, Denis, Canete, Juan D

2020

Overview

ObjectiveTo update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA).MethodsAccording to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined.ResultsThe updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed.ConclusionThese recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited,BMJ Publishing Group
• Subject: Agreements / Anti-Inflammatory Agents, Non-Steroidal - therapeutic use / Arthritis / Arthritis, Psoriatic - drug therapy / Biological Products - therapeutic use / Consensus / Consensus Development Conferences as Topic / Dactylitis / Decision making / Decision Making, Shared / DMARDs (biologic) / Drug delivery / Drug therapy / Drugs / Europe / Glucocorticoids / Glucocorticoids - therapeutic use / Humans / Inflammation / Interleukin 12 / Interleukin-12 - antagonists & inhibitors / Interleukin-17 - antagonists & inhibitors / Interleukin-23 - antagonists & inhibitors / Janus kinase / Janus Kinase Inhibitors - therapeutic use / Life Sciences / Literature reviews / Metabolism / Nonsteroidal anti-inflammatory drugs / Patients / Phosphodiesterase / Phosphodiesterase 4 Inhibitors - therapeutic use / Polyarthritis / Psoriasis / Psoriatic arthritis / Quality of life / Recommendation / Remission / Rheumatology / Shared decision making / Societies, Medical / Synthetic Drugs - therapeutic use / Systematic Reviews as Topic / treatment / Tumor necrosis factor / Tumor Necrosis Factor-alpha - antagonists & inhibitors / Tumor necrosis factor-TNF / Tumors