Since the publication of the European League Against Rheumatism ( EULAR ) 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.
A systematic literature review was performed regarding pharmacological treatment in psoriatic arthritis. 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.
The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for psoriatic arthritis 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 psoriatic arthritis into account, but focusing on musculoskeletal involvement.
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 12/23 ( IL 12/23; Ustekinumab; Stelara ) or IL-17 pathways ( Secukinumab; Cosentyx ) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor ( Apremilast; Otezla ) if bDMARDs are inappropriate.
If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used. ( Xagena )
Gossec L et al, Ann Rheum Dis 2015; Epub ahead of print