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

Ann Rheum Dis. 2020 Jun;79(6):700-712. doi: 10.1136/annrheumdis-2020-217159.

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.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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

Substances

  • 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