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Arthritis Rheumatol. 2019 Jan;71(1):5-32. doi: 10.1002/art.40726. Epub 2018 Nov 30.

Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis.

Author information

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.
4
University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada.
5
Cleveland Clinic, Cleveland, Ohio.
6
Oregon Health & Science University, Portland.
7
Boston Medical Center, Boston, Massachusetts.
8
New York, New York.
9
Premier Orthopaedics, Malvern, Pennsylvania.
10
Stanford University, Stanford, California.
11
Concorde Medical Group, New York, New York.
12
Swedish-Providence Health Systems and University of Washington, Seattle, Washington.
13
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
14
Comprehensive Therapy Consultants and Therapy Steps, Roswell, Georgia.
15
University of Rochester Medical Center, Rochester, New York.
16
University of Maryland School of Medicine, Baltimore.
17
Florida State University College of Medicine School of Physician Assistant Practice, Tallahassee.
18
Eastern Virginia Medical School, Norfolk.
19
American College of Rheumatology, Atlanta, Georgia.
20
ECRI Institute, Plymouth Meeting, Pennsylvania.
21
University of Oxford, Oxford, UK.
22
New York Medical College at Metropolitan Hospital, New York, New York.
23
Case Western/MetroHealth, Cleveland, Ohio.
24
Global Healthy Living Foundation, Nyack, New York.
25
Johns Hopkins University, Baltimore, Maryland.
26
New York University School of Medicine, New York, New York.
27
Arthritis & Rheumatism Associates, Rockville, Maryland.
28
National Psoriasis Foundation, Portland, Oregon.
29
University of Utah and George E. Wahlen VeteranS Affairs Medical Center, Salt Lake City, Utah.

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.

PMID:
30499246
DOI:
10.1002/art.40726

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