Journal article
2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis
- Abstract:
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Objective
To develop an evidence‐based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF).
Methods
We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations.
Results
The guideline covers the management of active PsA in patients who are treatment‐naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin‐12/23 inhibitors (IL‐12/23i), IL‐17 inhibitors, CTLA4‐Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat‐to‐target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment.
Conclusion
The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
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(Preview, Accepted manuscript, 544.5KB, Terms of use)
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- Publisher copy:
- 10.1002/acr.23789
Authors
- Publisher:
- Wiley
- Journal:
- Arthritis Care and Research More from this journal
- Volume:
- 71
- Issue:
- 1
- Pages:
- 2-29
- Publication date:
- 2018-11-30
- Acceptance date:
- 2018-09-11
- DOI:
- EISSN:
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2151-4658
- ISSN:
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2151-464X
- Pmid:
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30499259
- Language:
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English
- Keywords:
- Pubs id:
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pubs:950767
- UUID:
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uuid:9fbd9198-af83-4c96-bb5e-d15257241d1a
- Local pid:
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pubs:950767
- Source identifiers:
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950767
- Deposit date:
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2019-06-06
Terms of use
- Copyright holder:
- American College of Rheumatology
- Copyright date:
- 2018
- Rights statement:
- © 2018, American College of Rheumatology.
- Notes:
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This is the accepted manuscript version of the article. The final version is available online from Wiley at: https://doi.org/10.1002/acr.23789
This article was published simultaneously in the Journal of Psoriasis and Psoriatic Arthritis (https://doi.org/10.1177/2475530318812244) and Arthritis & Rheumatology (https://doi.org/10.1002/art.40726).
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