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Response to: ‘Comment on: ‘EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update’ by Gossec et al’ by Wei et al
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  1. Laure Gossec1,2,
  2. Xenofon Baraliakos3,
  3. Iain McInnes4,
  4. Andreas Kerschbaumer5,
  5. Maarten de Wit6,
  6. Maxime Dougados7,
  7. Jette Primdahl8,9,
  8. Désirée van der Heijde10,
  9. Josef S Smolen11
  1. 1Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
  2. 2APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
  3. 3Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany
  4. 4Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
  5. 5Division of Rheumatology, Department of Medicine 3, and 2nd Department of Medicine, Medical University of Vienna, Hietzing Hospital, Vienna, Austria
  6. 6EULAR past Vice President representing People with Arthritis/Rheumatism in Europe (PARE), EULAR, Amsterdam, The Netherlands
  7. 7Medicine Faculty, Paris Descartes University, Paris, France
  8. 8Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
  9. 9Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  10. 10Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  11. 11Medical University of Vienna, Vienna, Austria
  1. Correspondence to Professor Laure Gossec, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris 75005, France; laure.gossec{at}gmail.com

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We thank Wei et al1 for their correspondence on the recently published European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis (PsA).2 The authors of this correspondence raise some interesting points.

The first point relates to the role of cyclosporine A (CsA) in the treatment of patients with psoriatic disease. The authors mention that this drug is often used in Asia, in particular in skin psoriasis. They suggest that CsA could be proposed for PsA. While CsA is recommended for the management of skin psoriasis,3 EULAR’s systematic literature searches did not reveal a convincing efficacy in PsA based on two small randomised controlled trials4 5; indeed, even a randomised trial on the addition of CsA in patients who had an insufficient response to methotrexate failed to meet its primary endpoint.6 Therefore, CsA is not put forward in the EULAR recommendations for the management of PsA,2 and these recommendations do not deal with patients who only have psoriasis.

The second point of the authors’ comments relates to the definition of oligoarticular disease and, more specifically, the necessity for a full 66/68 joint count. We fully support using the 66/68 joint counts in PsA, as studies have shown that more limited joint counts may miss significant proportions of inflammation.7 The authors mentioned the Disease Activity in Psoriatic Arthritis (DAPSA) score, which is also recommended in the updated EULAR recommendations and, indeed, uses the 66/68 counts.8

Wei et al support the new recommendation for tapering of biological DMARDs in patients reaching sustained remission, but suggest that an algorithm or a tapering guidance would be useful.1 2 Currently, given the lack of data on this subject, it is difficult to propose formal tapering strategies.4 In the absence of any data for PsA, Wei et al may be referred to the EULAR RA management recommendations9 for a potential orientation, given that in RA tapering schedules have been studied.10 Tapering should be further investigated in PsA. The last point regards elderly patients and we agree with the authors that research is warranted on the management of elderly patients with PsA.

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Footnotes

  • Handling editor David S Pisetsky

  • Contributors LG, XB and JSS drafted the text. The other authors reviewed the text and commented. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement A patient was involved in this response, as part of the steering committee of the recommendations

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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