Treatment

Leading Organizations Release Joint Guideline for Psoriatic Arthritis Treatment

The use of tumor necrosis factor inhibitor biologics as first-line therapy among patients with active psoriatic arthritis (PsA) is one of multiple conditional recommendations set forth in a collaborative, evidence-based guideline by the American College of Rheumatology and the National Psoriasis Foundation.1

 

More than 8 million individuals in the United States have psoriasis, with an estimated 30% developing PsA, according to the National Psoriasis Foundation. Further, PsA is heterogeneous, which can lead to challenges for specialists when considering various treatment options.

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The authors of a new guideline sought to provide evidence-based treatment recommendations for the management of active PsA in adults using pharmacologic and nonpharmacologic therapies, in an effort to help guide both clinicians and patients to optimal disease management.

 

The use of tumor necrosis factor inhibitor (TNFi) biologics as first-line therapy was one of many recommendations included to help providers and patients decide between available pharmacologic options. This is the first guideline that specifically recommends trying them first over oral small molecule (OSM) drugs.

 

“The available evidence suggested that in the absence of certain conditions, many treatment-naïve patients would benefit from trying a TNFi biologic first,” Dr Dafna Gladman, professor of medicine at the University of Toronto, and member of the National Psoriasis Foundation Medical Board who served as a content expert on the guideline’s core team, said in a press release issued by the National Psoriasis Foundation. “This doesn’t hold true once other symptoms and comorbidities are present, so OSMs can continue to be a first-line option for patients that have contraindications to TNFi treatment, as well as patients without severe PsA or psoriasis that prefer oral therapy.”2

 

Gladman added that providers should consider all active disease domains, comorbidities, and patient functional status when electing optimal therapy for a patient at any time.

 

Other key recommendations from the guideline include a conditional recommendation to use a treat-to-target approach for all patients with active PsA and smoking avoidance/cessation.

 

A treat-to-target approach addresses multiple treatment scenarios and can help improve pain, function, quality of life, and social participation, according to Dr Jasvinder Singh.

 

“Treat-to-target is key because it encompasses all clinical scenarios, rather than one particular clinical situation,” Singh, rheumatologist at the University of Alabama at Birmingham and principal investigator for the guidelines, said in the press release. “The available evidence suggests the irreversible joint damage, associated functional limitations, joint deformities and disability associated with PsA could possibly be avoided/delayed with optimal disease management using a targeted approach.”2

 

Other recommendations for vaccinations and nonpharmacologic therapies are included, as well as recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections.

 

Nearly all recommendations were deemed conditional since the quality of evidence was often graded low or very low, due to limited data. The voting panel for the recommendations consisted of rheumatologists, dermatologists, health professionals, and patients.

 

—Colleen Murphy

 

References:

  1. Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis [published online November 30, 2018]. Arthritis Rheumatol. https://doi.org/10.1002/art.40726.
  2. National Rheumatology and Psoriasis Organizations Release Joint Guideline for Treating Psoriatic Arthritis. Accessed December 4, 2018. https://www.psoriasis.org/media/press-releases/national-rheumatology-and-psoriasis-organizations-release-joint-guideline.