Recommendations Developed for Psoriatic Arthritis Treatment

THURSDAY, Dec. 6, 2018 — Recommendations have been developed for pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA); the evidence-based guideline was published online Nov. 30 in Arthritis & Rheumatology.

Jasvinder A. Singh, M.D., M.P.H., from the University of Alabama at Birmingham, and colleagues summarized the evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA and developed a management guideline.

The authors present recommendations to cover management of active PsA in treatment-naive patients and those who have active PsA despite treatment. The guideline addresses use of oral small molecules (OSM), tumor necrosis factor inhibitors (TNFi), interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). Recommendations include use of a treat-to-target strategy for adult patients with active PsA and starting treatment with a TNFi over an OSM, an IL-17 inhibitor biologic, and an IL-12/23i biologic. Exercise is recommended, as are cessation of smoking and weight loss for overweight/obese patients. Overall, 6 and 94 percent of the recommendations were strong and conditional, respectively, indicating the importance of active discussion between health care providers and patients for selecting optimal treatment.

“Treat-to-target is key, because it encompasses all clinical scenarios, rather than one particular clinical situation,” Singh said in a statement. “The available evidence suggests the irreversible joint damage, associated functional limitations, joint deformities, and disability associated with PsA could possibly be avoided/delayed with optimal disease management using a targeted approach.”

Several authors disclosed financial ties to the pharmaceutical industry.

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Posted: December 2018

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