Laura C Coates1, Arthur Kavanaugh2, Philip J Mease3, Enrique R Soriano4, Maria Laura Acosta-Felquer4, April W Armstrong5, Wilson Bautista-Molano6, Wolf-Henning Boehncke7, Willemina Campbell8, Alberto Cauli9, Luis R Espinoza10, Oliver FitzGerald11, Dafna D Gladman12, Alice Gottlieb13, Philip S Helliwell14, M Elaine Husni15, Thorvardur J Love16, Ennio Lubrano17, Neil McHugh18, Peter Nash19, Alexis Ogdie20, Ana-Maria Orbai21, Andrew Parkinson22, Denis O'Sullivan23, Cheryl F Rosen24, Sergio Schwartzman25, Evan L Siegel26, Sergio Toloza27, William Tuong28, Christopher T Ritchlin29. 1. Leeds Institute of Rheumatic and Musculoskeletal Medicine and University of Leeds, Leeds, UK. 2. University of California at San Diego. 3. Swedish Medical Center and University of Washington School of Medicine, Seattle, Washington. 4. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 5. University of Southern California, Keck School of Medicine, Los Angeles. 6. Hospital Militar Central and Universidad Militar Nueva Grenada, Bogotá, Colombia. 7. Geneva University Hospital, Geneva, Switzerland. 8. Toronto Western Hospital, Toronto, Ontario, Canada. 9. University of Cagliari, Monserrato Campus, Cagliari, Italy. 10. Louisiana State University Health Sciences Center, New Orleans. 11. St. Vincent's University Hospital, The Conway Institute for Biomolecular Research, and University College Dublin, Dublin, Ireland. 12. University of Toronto and Toronto Western Research Institute, Toronto, Ontario, Canada. 13. Tufts Medical Center, Boston, Massachusetts. 14. Leeds Institute of Rheumatic and Musculoskeletal Medicine and University of Leeds, Leeds, UK, and Bradford Hospitals NHS Foundation Trust, Bradford, UK. 15. Cleveland Clinic Foundation, Cleveland, Ohio. 16. University of Iceland and Landspitali University Hospital, Reykjavik, Iceland. 17. University of Molise, Campobasso, Italy. 18. Royal National Hospital for Rheumatic Diseases, Bath, UK. 19. University of Queensland, Brisbane, Queensland, Australia. 20. University of Pennsylvania, Philadelphia. 21. Johns Hopkins University School of Medicine, Baltimore, Maryland. 22. Chapel Allerton Hospital, Leeds, UK. 23. St. Vincent's University Hospital, Dublin, Ireland. 24. Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada. 25. Hospital for Special Surgery, New York, New York. 26. Arthritis and Rheumatism Associates, Rockville, Maryland. 27. Ministry of Health, San Fernando del Valle de Catamarca, Argentina. 28. University of California, Davis. 29. University of Rochester Medical Center, Rochester, New York.
Abstract
OBJECTIVE: To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA). METHODS: GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire. RESULTS: Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. CONCLUSION: We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.
OBJECTIVE: To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA). METHODS: GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire. RESULTS: Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. CONCLUSION: We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.
Authors: Philip Mease; Ernest Choy; Peter Nash; Chrysostomos Kalyvas; Matthias Hunger; Luminita Pricop; Kunal K Gandhi; Steffen M Jugl; Howard Thom Journal: Eur J Rheumatol Date: 2018-07-01