2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis

Jasvinder A. Singh, Gordon Guyatt, Alexis Ogdie, Dafna D. Gladman, Chad Deal, Atul Deodhar, Maureen Dubreuil, Jonathan Dunham, M. Elaine Husni, Sarah Kenny, Jennifer Kwan-Morley, Janice Lin, Paula Marchetta, Philip J. Mease, Joseph F. Merola, Julie Miner, Christopher T. Ritchlin, Bernadette Siaton, Benjamin J. Smith, Abby S. Van VoorheesAnna Helena Jonsson, Amit Aakash Shah, Nancy Sullivan, Marat Turgunbaev, Laura C. Coates, Alice Gottlieb, Marina Magrey, W. Benjamin Nowell, Ana Maria Orbai, Soumya M. Reddy, Jose U. Scher, Evan Siegel, Michael Siegel, Jessica A. Walsh, Amy S. Turner, James Reston

Research output: Contribution to journalReview article

Abstract

Objective: 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). Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)31-58
Number of pages28
JournalJournal of Psoriasis and Psoriatic Arthritis
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2019

ASJC Scopus subject areas

  • Dermatology
  • Rheumatology

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    Singh, J. A., Guyatt, G., Ogdie, A., Gladman, D. D., Deal, C., Deodhar, A., Dubreuil, M., Dunham, J., Husni, M. E., Kenny, S., Kwan-Morley, J., Lin, J., Marchetta, P., Mease, P. J., Merola, J. F., Miner, J., Ritchlin, C. T., Siaton, B., Smith, B. J., ... Reston, J. (2019). 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Journal of Psoriasis and Psoriatic Arthritis, 4(1), 31-58. https://doi.org/10.1177/2475530318812244