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

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 up...

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Veröffentlicht in:ANNALS OF THE RHEUMATIC DISEASES 2020-06, Vol.79 (6), p.700-712
Hauptverfasser: Gossec, Laure, Baraliakos, Xenofon, Kerschbaumer, Andreas, de Wit, Maarten, McInnes, Iain, Dougados, Maxime, Primdahl, Jette, McGonagle, Dennis G, Aletaha, Daniel, Balanescu, Andra, Balint, Peter V, Bertheussen, Heidi, Boehncke, Wolf-Henning, Burmester, Gerd R, Canete, Juan D, Damjanov, Nemanja S, Kragstrup, Tue Wenzel, Kvien, Tore K, Landewe, Robert B.M, Lories, Rik Jozef Urbain, Marzo-Ortega, Helena, Poddubnyy, Denis, Rodrigues Manica, Santiago Andres, Schett, Georg, Veale, Douglas J, Van den Bosch, Filip E, van der Heijde, Desiree, Smolen, Josef S
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Sprache:eng
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Zusammenfassung: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.
ISSN:0003-4967