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Practice Guideline
. 2016 Mar;75(3):499-510.
doi: 10.1136/annrheumdis-2015-208337. Epub 2015 Dec 7.

European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update

L Gossec  1 , J S Smolen  2 , S Ramiro  3 , M de Wit  4 , M Cutolo  5 , M Dougados  6 , P Emery  7 , R Landewé  8 , S Oliver  9 , D Aletaha  10 , N Betteridge  4 , J Braun  11 , G Burmester  12 , J D Cañete  13 , N Damjanov  14 , O FitzGerald  15 , E Haglund  16 , P Helliwell  17 , T K Kvien  18 , R Lories  19 , T Luger  20 , M Maccarone  21 , H Marzo-Ortega  7 , D McGonagle  7 , I B McInnes  22 , I Olivieri  23 , K Pavelka  24 , G Schett  25 , J Sieper  26 , F van den Bosch  27 , D J Veale  28 , J Wollenhaupt  29 , A Zink  30 , D van der Heijde  3
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Practice Guideline

European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update

L Gossec et al. Ann Rheum Dis. 2016 Mar.

Abstract

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.

Keywords: DMARDs (biologic); DMARDs (synthetic); Psoriatic Arthritis.

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