TY - JOUR
T1 - EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies
T2 - 2023 update
AU - Gossec, L.
AU - Kerschbaumer, A.
AU - Ferreira, R.J.O.
AU - Aletaha, D.
AU - Baraliakos, X.
AU - Bertheussen, H.
AU - Boehncke, W.
AU - Esbensen, B.A.
AU - McInnes, I.B.
AU - McGonagle, D.
AU - Winthrop, K.L.
AU - Balanescu, A.
AU - Balint, P.V.
AU - Burmester, G.R.
AU - Cañete, J.D.
AU - Claudepierre, Pascal
AU - Eder, Lihi
AU - Hetland, Merete Lund
AU - Iagnocco, Annamaria
AU - Kristensen, Lars Erik
AU - Lories, Rik
AU - Queiro, Rubén
AU - Mauro, Daniele
AU - Marzo-Ortega, Helena
AU - Mease, P.J.
AU - Nash, Peter
AU - Wagenaar, Wendy
AU - Savage, Laura
AU - Schett, Georg
AU - Shoop-Worrall, Stephanie J W
AU - Tanaka, Yoshiya
AU - Van den Bosch, Filip E
AU - van der Helm-van Mil, Annette
AU - Zabotti, Alen
AU - van der Heijde, Désirée
AU - Smolen, Josef S
PY - 2024
Y1 - 2024
N2 - Objective
New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA.Methods
Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined.Results
The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed.Conclusion
These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.
AB - Objective
New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA.Methods
Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined.Results
The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed.Conclusion
These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.
KW - Arthritis, Psoriatic/drug therapy
KW - Humans
KW - Antirheumatic Agents/therapeutic use
KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
KW - Methotrexate/therapeutic use
KW - Biological Products/therapeutic use
UR - https://www.scopus.com/pages/publications/85188577159
U2 - 10.1136/ard-2024-225531
DO - 10.1136/ard-2024-225531
M3 - Article
C2 - 38499325
SN - 0003-4967
VL - 83
SP - 706
EP - 719
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 6
ER -