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

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

doi:10.1136/annrheumdis-2020-217159

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

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 LoriesHelena 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

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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.

Original language	English
Journal	Annals of the Rheumatic Diseases
Volume	79
Issue	6
Pages (from-to)	700-712
Number of pages	13
ISSN	0003-4967
DOIs	https://doi.org/10.1136/annrheumdis-2020-217159
Publication status	Published - 2020

Keywords

DMARDs (biologic)
psoriatic arthritis
treatment

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700.1.fullFinal published version, 2.72 MBLicence: CC BY-NC

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Gossec, L., Baraliakos, X., Kerschbaumer, A., de Wit, M., McInnes, I., Dougados, M., Primdahl, J., McGonagle, D. G., Aletaha, D., Balanescu, A., Balint, P. V., Bertheussen, H., Boehncke, W.-H., Burmester, G. R., Canete, J. D., Damjanov, N. S., Kragstrup, T. W., Kvien, T. K., Landewé, R. B. M., ... Smolen, J. S. (2020). EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Annals of the Rheumatic Diseases, 79(6), 700-712. https://doi.org/10.1136/annrheumdis-2020-217159

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title = "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.",

keywords = "DMARDs (biologic), psoriatic arthritis, treatment",

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

note = "{\textcopyright} 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.",

year = "2020",

doi = "10.1136/annrheumdis-2020-217159",

language = "English",

volume = "79",

pages = "700--712",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "BMJ Publishing Group",

number = "6",

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Gossec, L, Baraliakos, X, Kerschbaumer, A, de Wit, M, McInnes, I, Dougados, M, Primdahl, J, McGonagle, DG, Aletaha, D, Balanescu, A, Balint, PV, Bertheussen, H, Boehncke, W-H, Burmester, GR, Canete, JD, Damjanov, NS, Kragstrup, TW, Kvien, TK, Landewé, RBM, Lories, RJU, Marzo-Ortega, H, Poddubnyy, D, Rodrigues Manica, SA, Schett, G, Veale, DJ, Van den Bosch, FE, van der Heijde, D & Smolen, JS 2020, 'EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update', Annals of the Rheumatic Diseases, vol. 79, no. 6, pp. 700-712. https://doi.org/10.1136/annrheumdis-2020-217159

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. / Gossec, Laure; Baraliakos, Xenofon; Kerschbaumer, Andreas et al.
In: Annals of the Rheumatic Diseases, Vol. 79, No. 6, 2020, p. 700-712.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies

T2 - 2019 update

AU - Gossec, Laure

AU - Baraliakos, Xenofon

AU - Kerschbaumer, Andreas

AU - de Wit, Maarten

AU - McInnes, Iain

AU - Dougados, Maxime

AU - Primdahl, Jette

AU - McGonagle, Dennis G

AU - Aletaha, Daniel

AU - Balanescu, Andra

AU - Balint, Peter V

AU - Bertheussen, Heidi

AU - Boehncke, Wolf-Henning

AU - Burmester, Gerd R

AU - Canete, Juan D

AU - Damjanov, Nemanja S

AU - Kragstrup, Tue Wenzel

AU - Kvien, Tore K

AU - Landewé, Robert B M

AU - Lories, Rik Jozef Urbain

AU - Marzo-Ortega, Helena

AU - Poddubnyy, Denis

AU - Rodrigues Manica, Santiago Andres

AU - Schett, Georg

AU - Veale, Douglas J

AU - Van den Bosch, Filip E

AU - van der Heijde, Désirée

AU - Smolen, Josef S

PY - 2020

Y1 - 2020

N2 - 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.

AB - 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.

KW - DMARDs (biologic)

KW - psoriatic arthritis

KW - treatment

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U2 - 10.1136/annrheumdis-2020-217159

DO - 10.1136/annrheumdis-2020-217159

M3 - Journal article

C2 - 32434812

SN - 0003-4967

VL - 79

SP - 700

EP - 712

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 6

ER -

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

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