Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis.
Antirheumatic Agents
/ administration & dosage
Arthritis, Psoriatic
/ diagnosis
Biological Products
/ administration & dosage
Clinical Decision-Making
/ methods
Drug Therapy, Combination
Humans
Immunosuppressive Agents
/ administration & dosage
Practice Guidelines as Topic
/ standards
Rheumatology
/ methods
Treatment Outcome
United States
/ epidemiology
Journal
Arthritis care & research
ISSN: 2151-4658
Titre abrégé: Arthritis Care Res (Hoboken)
Pays: United States
ID NLM: 101518086
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
12
12
2017
accepted:
11
09
2018
pubmed:
1
12
2018
medline:
15
10
2019
entrez:
1
12
2018
Statut:
ppublish
Résumé
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). 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. 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. 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.
Identifiants
pubmed: 30499259
doi: 10.1002/acr.23789
pmc: PMC8265826
mid: NIHMS1705236
doi:
Substances chimiques
Antirheumatic Agents
0
Biological Products
0
Immunosuppressive Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2-29Subventions
Organisme : Department of Health
ID : CS-2016-16-016
Pays : United Kingdom
Organisme : NIAMS NIH HHS
ID : K23 AR069127
Pays : United States
Organisme : American College of Rheumatology
Pays : International
Organisme : National Psoriasis Foundation
Pays : United States
Informations de copyright
© 2018, American College of Rheumatology.
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