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Extended report
European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update
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  1. L Gossec1,2,
  2. J S Smolen3,4,
  3. S Ramiro5,
  4. M de Wit6,
  5. M Cutolo7,
  6. M Dougados8,9,
  7. P Emery10,11,
  8. R Landewé12,13,
  9. S Oliver14,
  10. D Aletaha3,
  11. N Betteridge6,
  12. J Braun15,
  13. G Burmester16,
  14. J D Cañete17,
  15. N Damjanov18,
  16. O FitzGerald19,
  17. E Haglund20,21,
  18. P Helliwell22,
  19. T K Kvien23,
  20. R Lories24,25,
  21. T Luger26,
  22. M Maccarone27,
  23. H Marzo-Ortega10,11,
  24. D McGonagle10,11,
  25. I B McInnes28,
  26. I Olivieri29,
  27. K Pavelka30,
  28. G Schett31,
  29. J Sieper32,
  30. F van den Bosch33,
  31. D J Veale34,
  32. J Wollenhaupt35,
  33. A Zink36,
  34. D van der Heijde5
  1. 1Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), Paris, France
  2. 2Department of rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France
  3. 3Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  4. 4Second Department of Medicine, Hietzing Hospital, Vienna, Austria
  5. 5Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
  6. 6EULAR, representing People with Arthritis/Rheumatism in Europe (PARE), London, UK
  7. 7Research Laboratory and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto, Italy
  8. 8Medicine Faculty, Paris Descartes University, Paris, France
  9. 9Rheumatology B Department, APHP, Cochin Hospital, Paris, France
  10. 10Leeds NIHR Musculoskeletal Biomedical Research Unit, LTHT, Leeds, UK
  11. 11Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  12. 12Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Center, Amsterdam, The Netherlands
  13. 13Atrium Medical Center, Heerlen, The Netherlands
  14. 14North Devon, UK
  15. 15Rheumazentrum Ruhrgebiet, Herne and Ruhr-Universität Bochum, Herne, Germany
  16. 16Department of Rheumatology and Clinical Immunology, Charité—University Medicine Berlin, Germany
  17. 17Arthritis Unit, Department of Rheumatology, Hospital Clínic and IDIBAPS, Barcelona, Spain
  18. 18Belgrade University School of Medicine, Belgrade, Serbia
  19. 19Department of Rheumatology, St. Vincent's University Hospital and Conway Institute, University College Dublin, Dublin, Ireland
  20. 20Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
  21. 21Sweden and School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden
  22. 22Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
  23. 23Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  24. 24Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Belgium
  25. 25Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
  26. 26Department of Dermatology, University Hospital Münster, Münster, Germany
  27. 27A.DI.PSO. (Associazione per la Difesa degli Psoriasici)—PE.Pso.POF (Pan European Psoriasis Patients’ Organization Forum), Rome, Italy
  28. 28Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  29. 29Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
  30. 30Institute and Clinic of Rheumatology Charles University Prague, Czech Republic
  31. 31Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
  32. 32Department of Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
  33. 33Ghent University Hospital, Ghent, Belgium
  34. 34Centre for Arthritis and Rheumatic Disease, Dublin Academic Medical Centre, St. Vincent's University Hospital, Dublin, Ireland.
  35. 35Schoen Klinik Hamburg, Rheumatology and Clinical Immunology, Hamburg, Germany
  36. 36Department of Rheumatology and Clinical Immunology, German Rheumatism Research Centre Berlin, Charité—University Medicine Berlin, Germany
  1. Correspondence to Professor Laure Gossec, Hôpital Pitié-Salpétrière, Service de Rhumatologie, 47-83, boulevard de l'Hôpital, Paris 75013, France; laure.gossec{at}aphp.fr

Abstract

Background Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.

Methods A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.

Results The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.

Conclusions These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.

  • Psoriatic Arthritis
  • DMARDs (biologic)
  • DMARDs (synthetic)
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