EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update.
- Gossec L Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France laure.gossec@gmail.com.
- Baraliakos X Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany.
- Kerschbaumer A Division of Rheumatology, Department of Medicine 3; 2nd Department of Medicine, Hietzing Hospital, Medical University of Vienna, Vienna, Austria.
- de Wit M EULAR, Zurich, Switzerland.
- McInnes I Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
- Dougados M Hopital Cochin, Rheumatology, Université Paris Descartes, Paris, France.
- Primdahl J Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.
- McGonagle DG LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK.
- Aletaha D Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
- Balanescu A Research Center of Rheumatic Diseases, Sf Maria Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Balint PV 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
- Bertheussen H Patient Research Partner, EULAR, Oslo, Norway.
- Boehncke WH Dermatology, University Hospitals of Geneva, Geneva, Switzerland.
- Burmester GR Rheumatology and Clinical Immunology, Charite University Hospital Berlin, Berlin, Germany.
- Canete JD Arthritis Unit, Department of Rheumatology and IDIBAPS, Hospital Clinic, Barcelona, Spain.
- Damjanov NS Institute of Rheumatology, Belgrade University School of Medicine, Belgrade, Serbia.
- Kragstrup TW Department of Biomedicine, Aarhus University, Aarhus C, Denmark.
- Kvien TK Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
- Landewé RBM Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.
- Lories RJU Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Flanders, Belgium.
- Marzo-Ortega H LTHT, Leeds NIHR Biomedical Research Centre, Leeds, UK.
- Poddubnyy D Department of Rheumatology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Rodrigues Manica SA Rheumatology, Hospital de Egas Moniz, Lisboa, Portugal.
- Schett G Internal Medicine, University of Erlangen-Nuremberg, Erlangen, Germany.
- Veale DJ Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St Vincent's University Hospital, Dublin, Ireland.
- Van den Bosch FE Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research, Ghent University, Gent, Belgium.
- van der Heijde D Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
- Smolen JS Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Wien, Austria.
- 2020-05-22
Published in:
- Annals of the rheumatic diseases. - 2020
DMARDs (biologic)
psoriatic arthritis
treatment
Anti-Inflammatory Agents, Non-Steroidal
Arthritis, Psoriatic
Biological Products
Consensus
Consensus Development Conferences as Topic
Decision Making, Shared
Europe
Glucocorticoids
Humans
Interleukin-12
Interleukin-17
Interleukin-23
Janus Kinase Inhibitors
Phosphodiesterase 4 Inhibitors
Societies, Medical
Synthetic Drugs
Systematic Reviews as Topic
Tumor Necrosis Factor-alpha
English
OBJECTIVE
To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA).
METHODS
According 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.
RESULTS
The 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.
CONCLUSION
These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.
To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA).
METHODS
According 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.
RESULTS
The 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.
CONCLUSION
These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1136/annrheumdis-2020-217159
- PMID 32434812
- Persistent URL
- https://sonar.ch/global/documents/242891
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