EULAR Updates Recommendations for PsA Management

The European Alliance of Associations for Rheumatology (EULAR) recently updated its 2019 recommendations for psoriatic arthritis (PsA) treatment to integrate new pharmacological advancements and expanded data on existing drugs' efficacy and safety, according to a recent report in Annals of Rheumatic Diseases.

The update process adhered to EULAR's standardized procedures, involving a systematic literature review and a consensus meeting with 36 international experts in April 2023. This led to the determination of evidence levels and recommendation grades.

The revised recommendations consist of 7 overarching principles and 11 specific recommendations, forming a comprehensive strategy for pharmacological therapies in PsA. Key points include:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) are suggested for monotherapy only in cases of mild PsA and for short-term use. Oral glucocorticoids are not recommended.

2. For patients with peripheral arthritis, immediate initiation of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) is advised, with methotrexate the preferred option.

3. If the treatment target is not met with csDMARDs, a biological DMARD (bDMARD) should be initiated without a preference for a specific mode of action.  

4. For cases with significant skin psoriasis, the recommendations lean towards bDMARDs that target interleukin (IL)-23p40, IL-23p19, IL-17A, and IL-17A/F inhibitors.

5. Specific algorithms are proposed for managing predominant axial or entheseal disease.

6. The use of Janus kinase inhibitors is recommended mainly after bDMARD failure, considering relevant risk factors, or when bDMARDs are unsuitable.

7. Drug selection should also consider the presence of inflammatory bowel disease and uveitis, with monoclonal tumor necrosis factor inhibitors being preferred in these scenarios.

8. Guidelines on drug switching and tapering in cases of sustained remission are included.

“These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA,” the authors concluded.

Reference
Gossec L, Kerschbaumer A, Ferreira RJO, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis. Published online ahead of print May 15, 2024. doi:10.1136/ard-2024-225531