Management of Patients with Psoriatic Arthritis – Analysis and Discussion of the Main Points of the EULAR Recommendations 2019

Abstract

Updated recommendations of the European League Against Rheumatism (EULAR) on the pharmacological management of psoriatic arthritis (PsA) 2019 were presented in May 2020. The recommendations are compiled in accordance with the standardized EULAR operating procedures, a systematic review of the literature, followed by a consensus meeting of 28 international members of the task force for guideline development.Updated recommendations include 6 general principles and 12 recommendations. General principles relate to the nature of PsA and the diversity of both musculoskeletal and non-musculoskeletal manifestations; emphasizes the need for joint decision-making by the patient and the doctor. The recommendations represent treatment strategies for pharmacological therapy. Nonsteroidal anti-inflammatory drugs and local injections of glucocorticoids are offered as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis, accompanied by dactylitis or joint damage, it is recommended that the usual synthetic disease-modifying antirheumatic drugs (DMARD) be started quickly. If the treatment objective is not achieved using this strategy, biological DMARD (bDMARD) should be initiated, targeting tumor necrosis factor (TNF), interleukin (IL)-17A, or IL-12/23 taking into account skin lesions. If axial disease predominates, an TNF inhibitor or an IL-17A inhibitor should be started as a first-line DMARD.The use of Janus kinase inhibitors is considered primarily after the ineffectiveness of bDMARD. Inhibition of phosphodiesterase-4 is proposed for patients who are not suitable for other drugs, usually in the context of a mild disease. The switching of drugs and dose tapering in the phase of sustained remission are considered. This guideline provides an updated consensus on the pharmacological treatment of PsA based on a combination of evidence and expert opinion.