Article Text

European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies
  1. L Gossec1,2,
  2. J S Smolen3,4,
  3. C Gaujoux-Viala5,6,
  4. Z Ash7,8,
  5. H Marzo-Ortega7,8,
  6. D van der Heijde9,
  7. O FitzGerald10,
  8. D Aletaha3,
  9. P Balint11,
  10. D Boumpas12,
  11. J Braun13,
  12. F C Breedveld9,
  13. G Burmester14,
  14. J D Cañete15,
  15. M de Wit16,
  16. H Dagfinrud17,18,
  17. K de Vlam19,
  18. M Dougados1,2,
  19. P Helliwell7,
  20. A Kavanaugh20,
  21. T K Kvien17,18,
  22. R Landewé21,
  23. T Luger22,
  24. M Maccarone23,
  25. D McGonagle7,8,
  26. N McHugh24,
  27. I B McInnes25,
  28. C Ritchlin26,
  29. J Sieper27,
  30. P P Tak28,
  31. G Valesini29,
  32. J Vencovsky30,
  33. K L Winthrop31,
  34. A Zink32,33,
  35. P Emery7,8
  1. 1Paris Descartes University, Paris, France
  2. 2APHP, Rheumatology B Department, Cochin Hospital, Paris, France
  3. 3Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  4. 42nd Department of Medicine, Hietzing Hospital, Vienna, Austria
  5. 5Paris 6 – Pierre et Marie Curie University, Paris, France
  6. 6Department of Rheumatology, Pitié-Salpêtrière Hospital, Paris, France
  7. 7Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  8. 8NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK
  9. 9Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
  10. 10Department of Rheumatology, St Vincent's University Hospital and Conway Institute, University College Dublin, Dublin, Ireland
  11. 113rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  12. 12Rheumatology, Clinical Immunology and Allergy, University of Crete, Faculty of Medicine, Heraklion, Greece
  13. 13Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, Bochum, Germany
  14. 14Department of Rheumatology and Clinical Immunology, Charité – University Medicine, Berlin, Germany
  15. 15Arthritis Unit, Department of Rheumatology, Hospital Clínic and IDIBAPS, Barcelona, Spain
  16. 16People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
  17. 17Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  18. 18Faculty of Medicine, University of Oslo, Oslo, Norway
  19. 19Department of Rheumatology, University Hospitals, Leuven, Belgium
  20. 20Division of Rheumatology, Allergy, Immunology, University of California, San Diego, California, USA
  21. 21Department of Internal Medicine/Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands
  22. 22Department of Dermatology, University Hospital Münster, Münster, Germany
  23. 23A.DI.PSO. (Associazione per la Difesa degli Psoriasici) – PE.Pso.POF (Pan European Psoriasis Patients' Organization Forum), Rome, Italy
  24. 24Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
  25. 25Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  26. 26Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA
  27. 27Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
  28. 28Division of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  29. 29Department of Internal Medicine/Rheumatology Unit, La Sapienza University of Rome, Rome, Italy
  30. 30Institute of Rheumatology, Prague, Czech Republic
  31. 31Department of Infectious Diseases, Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA
  32. 32German Rheumatism Research Centre, Berlin, Germany
  33. 33Department of Rheumatology and Clinical Immunology, Charité – University Medicine Berlin, Berlin, Germany
  1. Correspondence to Dr Laure Gossec, Service de Rhumatologie B, Hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; laure.gossec{at}


Background Psoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD).

Methods The recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement.

Results Ten recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined.

Conclusion These recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

This paper is freely available online under the BMJ Journals unlocked scheme, see

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  • LG and JSS contributed equally to the study (joint first authors)

  • Funding This study was supported by EULAR.

  • Competing interests The following authors declare that they have no potential conflict of interest: CG-V, ZA, HD, MM, DB. The following authors declare a potential conflict of interest having received grant support and/or honoraria for consultations and/or for presentations as indicated: LG: Abbott, BMS, Chugai, MSD, Pfizer, Roche, Schering-Plough, UCB, Wyeth; JSS: Abbott, BMS, Chugai, MSD, Pfizer, Roche, Sanofi-Aventis, Schering-Plough, UCB, Wyeth; HM-O: Abbott, Centocor, Chugai, MSD, Pfizer; DVDH:Abbott, Amgen, Astra Zeneca, BMS, Centocor, Chugai, Eli lilly, GSK, Merck, Novartis, Otsuka, Pfizer, Roche, Schering-Plough, UCB, Wyeth; OF: Abbott, BMS, Pfizer, Merck, UCB; DA: Abbott, Roche, Schering-Plough, BMS, UCB, Sanofi-Aventis; MB: Roche, Abbott, BMS, Wyeth; PB: Abbott, Pfizer, Roche, Sonobite, Wyeth; JB: Abbott, Centocor,Chugai, Merck, MSD, Novartis, Pfizer, Roche, UCB; FCB: Abbott, Schering-Plough, Wyeth; GB: Abbott, BMS, Chugai, MSD, Pfizer, Roche, Sanofi-Aventis, Schering Plough, UCB, Wyeth; JDC: Abbott, BMS, MSD, Roche; MdeW: Abbott, Roche, Wyeth; KdeV: Abbott, BMS, Celgene, Novartis, Pfizer, UCB; MD: Abbott, BMS, Novartis, Nordic Pharma, Pfizer, Roche, UCB, Wyeth; PH: Abbott, BMS, Pfizer, Schering Plough, UCB, Wyeth; AK: Abbott, Amgen, Centocor, Roche, UCB; TKK: Abbott, BMS, MSD, Pfizer, Roche, UCB; RL: Abbott, Amgen, BMS, Centocor, Merck, Pfizer, Schering-Plough, UCB, Wyeth; TL: Abbott, Almirall-Hermal, Basilea, BiogenIdec, Ceries, Galderma, Innéov, Janssen-Cilag, Leo Pharma, Maruho, MSD, Novartis, Palau Pharma, Pfizer, Shionogi, Symrise, Wolff; DMcG: Merck, Pfizer, Roche, Schering-Plough, Wyeth; INMcH: Abbott, Schering-Plough; IBMcI: Abbott, BMS, Merck, Pfizer, Roche; CR: Abbott, Amgen, BMS, Centocor, Pfizer, UCB; JS: Abbott, BMS, Centocor, MSD, Pfizer, Roche, Sanofi-Aventis, UCB; PPT: Abbott, Amgen, Centocor, Pfizer, Schering-Plough, Wyeth; GV: Abbott, BMS, Roche, MSD, Schering-Plough, UCB, Wyeth; JV: Abbott, BMS, MSD, Pfizer, Roche, UCB; KLW: Genentech, Wyeth; AZ: Abbott, Amgen, BMS, Essex/Schering-Plough, Merck, Pfizer, Roche, Sanofi-Aventis, UCB, Wyeth; PE: Abbott, BMS, Centocor, Pfizer, Roche, Sanofi-Aventis, Schering-Plough,UCB, Wyeth.

  • Provenance and peer review Not commissioned; externally peer reviewed.