TY - JOUR

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

T2 - 2023 update

AU - Gossec, Laure

AU - Kerschbaumer, Andreas

AU - Ferreira, Ricardo J. O.

AU - Aletaha, Daniel

AU - Baraliakos, Xenofon

AU - Bertheussen, Heidi

AU - Boehncke, Wolf-Henning

AU - Esbensen, Bente Appel

AU - McInnes, Iain B.

AU - McGonagle, Dennis

AU - Winthrop, Kevin L

AU - Balanescu, Andra

AU - Balint, Peter V

AU - Burmester, Gerd R.

AU - Cañete, Juan 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, Philip 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

N1 - Publisher Copyright: © European Alliance of Associations for Rheumatology, EULAR 2024. Re-use permitted under CC BY-NC-ND. No commercial re-use. No derivatives. See rights and permissions. Published by BMJ on behalf of EULAR.

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 - Biological Therapy

KW - Biosimilar Pharmaceuticals

KW - Psoriatic Arthritis

KW - Treatment

U2 - 10.1136/ard-2024-225531

DO - 10.1136/ard-2024-225531

M3 - Journal article

C2 - 38499325

AN - SCOPUS:85188577159

VL - 83

SP - 706

EP - 719

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 6

ER -