TY - JOUR
T1 - Special Article
T2 - 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis
AU - Singh, Jasvinder A.
AU - Guyatt, Gordon
AU - Ogdie, Alexis
AU - Gladman, Dafna D.
AU - Deal, Chad
AU - Deodhar, Atul
AU - Dubreuil, Maureen
AU - Dunham, Jonathan
AU - Husni, M. Elaine
AU - Kenny, Sarah
AU - Kwan-Morley, Jennifer
AU - Lin, Janice
AU - Marchetta, Paula
AU - Mease, Philip J.
AU - Merola, Joseph F.
AU - Miner, Julie
AU - Ritchlin, Christopher T.
AU - Siaton, Bernadette
AU - Smith, Benjamin J.
AU - Van Voorhees, Abby S.
AU - Jonsson, Anna Helena
AU - Shah, Amit Aakash
AU - Sullivan, Nancy
AU - Turgunbaev, Marat
AU - Coates, Laura C.
AU - Gottlieb, Alice
AU - Magrey, Marina
AU - Nowell, W. Benjamin
AU - Orbai, Ana Maria
AU - Reddy, Soumya M.
AU - Scher, Jose U.
AU - Siegel, Evan
AU - Siegel, Michael
AU - Walsh, Jessica A.
AU - Turner, Amy S.
AU - Reston, James
N1 - Publisher Copyright:
© 2018, American College of Rheumatology
PY - 2019/1
Y1 - 2019/1
N2 - 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.
AB - 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.
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U2 - 10.1002/acr.23789
DO - 10.1002/acr.23789
M3 - Article
C2 - 30499259
AN - SCOPUS:85057837574
SN - 2151-464X
VL - 71
SP - 2
EP - 29
JO - Arthritis Care and Research
JF - Arthritis Care and Research
IS - 1
ER -