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The following is a summary of “EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update,” published in the May 2024 issue of Rheumatology by Gossec et al.
The emergence of new treatment mechanisms and additional efficacy and safety data necessitated an update to the EULAR 2019 recommendations for the pharmacological treatment of psoriatic arthritis (PsA).
Researchers conducted a retrospective study updating the EULAR 2019 guidelines for PsA treatment in light of new therapeutic mechanisms and additional data on existing drug efficacy and safety.
They conducted a literature review and a consensus meeting with 36 international experts using EULAR standardized operating procedures (April 2023). Subsequently, evidence levels and recommendation grades were determined.
The result showed 7 key principles and 11 specific guidelines, outlining a pharmacological treatment strategy for PsA. Non-steroidal anti-inflammatory drugs (NSAIDs) should be used as monotherapy only for mild PsA and for short durations, with oral glucocorticoids not recommended. For patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was advised, with methotrexate preferred. If treatment goals were unmet, a biological disease-modifying antirheumatic drug (bDMARD) should be introduced without preference for specific mechanisms of action. For significant skin psoriasis, bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A, and IL-17A/F inhibitors are recommended. An algorithm was provided for cases of predominant axial or entheseal disease. Janus kinase inhibitors were suggested primarily after bDMARD failure or when bDMARDs were unsuitable. Additionally, drug choices should consider inflammatory bowel disease and uveitis, with monoclonal tumor necrosis factor inhibitors proposed. Guidelines also cover drug switching and tapering in sustained remission.
Investigators concluded that the updated recommendations incorporated all available drugs into a practical and progressive framework, enhancing the pharmacological management of PsA.
Source: ard.bmj.com/content/83/6/706
