2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis

Author:

Singh Jasvinder A.1,Guyatt Gordon2,Ogdie Alexis3,Gladman Dafna D.4,Deal Chad5,Deodhar Atul6,Dubreuil Maureen7,Dunham Jonathan3,Husni M. Elaine5,Kenny Sarah8,Kwan-Morley Jennifer9,Lin Janice10,Marchetta Paula11,Mease Philip J.12,Merola Joseph F.13,Miner Julie14,Ritchlin Christopher T.15,Siaton Bernadette16,Smith Benjamin J.17,Van Voorhees Abby S.18,Jonsson Anna Helena13,Shah Amit Aakash19,Sullivan Nancy20,Turgunbaev Marat19,Coates Laura C.21,Gottlieb Alice22,Magrey Marina23,Nowell W. Benjamin24,Orbai Ana-Maria25,Reddy Soumya M.26,Scher Jose U.26,Siegel Evan27,Siegel Michael28,Walsh Jessica A.29,Turner Amy S.19,Reston James20

Affiliation:

1. University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama

2. McMaster University, Hamilton, Ontario, Canada

3. University of Pennsylvania, Philadelphia, PA, USA

4. University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada

5. Cleveland Clinic, Cleveland, OH, USA

6. Oregon Health & Science University, Portland, OR, USA

7. Boston Medical Center, Boston, MA, USA

8. New York, NY, USA

9. Premier Orthopaedics, Malvern, PA, USA

10. Stanford University, Stanford, CA, USA

11. Concorde Medical Group, New York, NY, USA

12. Swedish-Providence Health Systems and University of Washington, Seattle, WA, USA

13. Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

14. Comprehensive Therapy Consultants and Therapy Steps, Roswell, GA, USA

15. University of Rochester Medical Center, Rochester, NY, USA

16. University of Maryland School of Medicine, Baltimore, MA, USA

17. Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee, FL, USA

18. Eastern Virginia Medical School, Norfolk, UK

19. American College of Rheumatology, Atlanta, GA, USA

20. ECRI Institute, Plymouth Meeting, PA, USA

21. University of Oxford, Oxford, UK

22. New York Medical College at Metropolitan Hospital, New York, NY, USA

23. Case Western/MetroHealth, Cleveland, OH, USA

24. Global Healthy Living Foundation, Nyack, NY, USA

25. Johns Hopkins University, Baltimore, MA, USA

26. New York University School of Medicine, New York, NY, USA

27. Arthritis & Rheumatism Associates, Rockville, MA, USA

28. National Psoriasis Foundation, Portland, OR, USA

29. University of Utah and George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA

Abstract

Objective: To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). Methods: We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. Results: The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. Conclusion: The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.

Publisher

SAGE Publications

Subject

Dermatology,Rheumatology

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