TY - JOUR T1 - EULAR PsA management recommendations 2019: can the recommendations be improved? JF - Annals of the Rheumatic Diseases JO - Ann Rheum Dis SP - 700 LP - 712 DO - 10.1136/annrheumdis-2020-217236 VL - 79 IS - 6 AU - Roy M Fleischmann Y1 - 2020/06/01 UR - http://ard.bmj.com/content/79/6/700.2.abstract N2 - The European League Against Rheumatism (EULAR) has published recommendations for the treatment of psoriatic arthritis (PsA) which have been updated twice to remain timely, responding to the rapid advances in the discovery of new compounds, effective treatment strategies and evolving information on safety.1–3 Each recommendation has been supported by a systematic literature review (SLR) which formed the basis for the recommendations.4–6 Each version has had important additions and deletions; the recommendations have been increasingly useful to many stakeholders in the rheumatology community.The American College of Rheumatology/National Psoriasis Foundation (ACR/NPF) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), an international network of rheumatologists, dermatologists, radiologists, geneticists, methodologists, epidemiologists and patient research partners, have also provided direction.7–9 The strengths of the EULAR recommendations are many-fold. The recommendations have been updated to reflect new developments in treatment strategies, including efficacy and safety. Multiple experts are involved, including rheumatologists representing most European countries, patients with PsA, health professionals and a dermatologist, which allows for a wide breadth of expertise to form the recommendations. Importantly, the recommendations are based primarily on evidence from the SLR, but gives latitude for the experts to use their long-standing PsA disease experience and its treatment in developing the recommendations, not constrained by yes or no pairwise comparisons as is required by the processes used by ACR/NPF and GRAPPA.10–14 EULAR and GRAPPA use ‘recommendation’ rather than ‘guideline’, a description used by ACR/NPF. A ‘recommendation’ is a suggestion of the best course of action in a situation, while a ‘guideline’ provides broad advice in following a process but does not provide precise requirements. The difference is subtle but important; a recommendation is less restrictive compared with a guideline and provides greater flexibility.EULAR, ACR/NPF and GRAPPA have followed different processes, with … ER -