Treatment recommendations for psoriatic arthritis

C T Ritchlin ^1*, A Kavanaugh ², D D Gladman ³, P J Mease ⁴, P Helliwell ⁵, W-H Boehncke ⁶, K de Vlam ⁷, D Fiorentino ⁸, O FitzGerald ⁹, A B Gottlieb ¹⁰, N McHugh ¹¹, P T Nash ¹², A Qureshi ¹³, E R Soriano ¹⁴ and W J Taylor ¹⁵

¹ University of Rochester Medical Center, United States
² University of California at San Diego, United States
³ University of Toronto, Canada
⁴ Seattle Rheumatology Associates, United States
⁵ University of Leeds, United Kingdom
⁶ Johann Wolfgang Goethe University, Germany
⁷ University Hospitals Leuven, Belgium
⁸ Stanford University, United States
⁹ St Vincent's University Hospital, United Kingdom
¹⁰ Tufts Medical Center, United States
¹¹ Royal National Hospital for Rheumatic Disease, United Kingdom
¹² University of Queensland, Australia
¹³ Harvard Medical School, United States
¹⁴ Hospital Italiano de Buenos Aires, Argentina
¹⁵ University of Otago/Wellington, New Zealand

^* To whom correspondence should be addressed. E-mail: christopher_ritchlin{at}urmc.rochester.edu.

Accepted 26 September 2008

Abstract

Objective: To develop comprehensive recommendations for the treatment of the various clinical manifestations of PsA based on evidence obtained from a systematic review of the literature and from consensus opinion.

Methods: Formal literature reviews of treatment for the most significant discrete clinical manifestations of PsA (skin and nails, peripheral arthritis, axial disease, dactylitis, and enthesitis) were performed and published by members of the Group for Research and Assesment of Psoriasis and Psoriatic Arthritis (GRAPPA). Treatment recommendations were drafted for each of the clinical manifestations by rheumatologists, dermatologists, and PsA patients based on the literature reviews and consensus opinion. The level of agreement for the individual treatment recommendations among GRAPPA members was assessed with an on-line questionnaire.

Results: Treatment recommendations were developed for peripheral arthritis, axial disease, psoriasis, nail disease, dactylitis, and enthesitis in the setting of PsA. Nineteen recommendations were drafted, and over 80% agreement was obtained on 16 of them. In addition, a grid that factors disease severity into each of the different disease manifestations was developed to help the clinician with treatment decisions for the individual patient from an evidenced-based perspective.

Conclusion: Treatment recommendations for the cardinal physical manifestations of PsA were developed based on a literature review and consensus between rheumatologists and dermatologists. In addition, a grid was established to assist in therapeutic reasoning and decision-making for individual patients. It is anticipated that periodic updates will take place using this framework as new data become available.