TY - JOUR T1 - European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 499 LP - 510 DO - 10.1136/annrheumdis-2015-208337 VL - 75 IS - 3 AU - L Gossec AU - J S Smolen AU - S Ramiro AU - M de Wit AU - M Cutolo AU - M Dougados AU - P Emery AU - R Landewé AU - S Oliver AU - D Aletaha AU - N Betteridge AU - J Braun AU - G Burmester AU - J D Cañete AU - N Damjanov AU - O FitzGerald AU - E Haglund AU - P Helliwell AU - T K Kvien AU - R Lories AU - T Luger AU - M Maccarone AU - H Marzo-Ortega AU - D McGonagle AU - I B McInnes AU - I Olivieri AU - K Pavelka AU - G Schett AU - J Sieper AU - F van den Bosch AU - D J Veale AU - J Wollenhaupt AU - A Zink AU - D van der Heijde Y1 - 2016/03/01 UR - http://ard.bmj.com/content/75/3/499.abstract N2 - 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. ER -