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

Abstract

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.

• Authors: Laure Gossec, Xenofon Baraliakos, Andreas Kerschbaumer, Maarten de Wit, Iain McInnes, Maxime Dougados, Jette Primdahl, Dennis G McGonagle, Daniel Aletaha, Andra Balanescu, Peter V Balint, Heidi Bertheussen, Wolf-Henning Boehncke, Gerd R Burmester, Juan D Canete, Nemanja S Damjanov, Tue Wenzel Kragstrup, Tore K Kvien, Robert B M Landewé, Rik Jozef Urbain Lories, Helena Marzo-Ortega, Denis Poddubnyy, Santiago Andres Rodrigues Manica, Georg Schett, Douglas J Veale, Filip E Van den Bosch, Désirée van der Heijde, Josef S Smolen
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 79 Issue 6 Pg. 700-712 (06 2020) ISSN: 1468-2060 [Electronic] England
• PMID: 32434812 (Publication Type: Journal Article, Practice Guideline, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Biological Products
• Glucocorticoids
• IL17A protein, human
• Interleukin-17
• Interleukin-23
• Janus Kinase Inhibitors
• Phosphodiesterase 4 Inhibitors
• Synthetic Drugs
• Tumor Necrosis Factor-alpha
• Interleukin-12

Topics

• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Arthritis, Psoriatic (drug therapy)
• Biological Products (therapeutic use)
• Consensus
• Consensus Development Conferences as Topic
• Decision Making, Shared
• Europe
• Glucocorticoids (therapeutic use)
• Humans
• Interleukin-12 (antagonists & inhibitors)
• Interleukin-17 (antagonists & inhibitors)
• Interleukin-23 (antagonists & inhibitors)
• Janus Kinase Inhibitors (therapeutic use)
• Phosphodiesterase 4 Inhibitors (therapeutic use)
• Societies, Medical
• Synthetic Drugs (therapeutic use)
• Systematic Reviews as Topic
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)