Management of psoriatic arthritis in 2016: a comparison of EULAR and GRAPPA recommendations.
Psoriatic arthritis (PsA) is a heterogeneous, potentially severe disease. Many therapeutic agents are now available for PsA, but treatment decisions are not always straightforward. To assist in this decision making, two sets of recommendations for the management of PsA were published in 2016 by international organizations - the European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). In both sets of recommendations, the heterogeneity of PsA is recognized and the place of various drugs in the therapeutic armamentarium is discussed. Such agents include conventional DMARDs, such as methotrexate, and targeted therapies including biologic agents, such as ustekinumab, secukinumab and TNF inhibitors, or the targeted synthetic drug apremilast. The proposed sequential use of these drugs, as well as some other aspects of PsA management, differ between the two sets of recommendations. This disparity is partly the result of a difference in the evaluation process; the focus of EULAR was primarily rheumatological, whereas that of GRAPPA was balanced between the rheumatological and dermatological aspects of disease. In this Perspectives article, we address the similarities and differences between these two sets of recommendations and the implications for patient management.
Sorbonne Universités, Université Pierre and Marie Curie - Paris 6, 4 Place Jussieu 75005, Paris, France; and at the Service de Rhumatologie, L'Assistance Publique - Hôpitaux de Paris, Pitié Salpêtrière Hôpital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Laure
L
Gossec
Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds; and at the Leeds Musculoskeletal Biomedical Research Unit, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
Laura C
LC
Coates
Department of Medical Humanities, Vrije Universiteit Medical Centre, POBox 7057, 1007 MB Amsterdam, Netherlands.
Maarten
M
de Wit
Division of Rheumatology, Allergy &Immunology, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, California 92093-0656, USA.
Arthur
A
Kavanaugh
Department of Rheumatology, Leiden University Medical Centre, POBox 9600, 2300 RC Leiden, Netherlands.
Sofia
S
Ramiro
Rheumatology Clinical Research Division, Swedish Medical Center, 601 Broadway, Suite 600, Seattle, Washington 98102, USA.
Philip J
PJ
Mease
Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, BOX 695, Rochester, New York 14642, USA.
Christopher T
CT
Ritchlin
Department of Rheumatology, Leiden University Medical Centre, POBox 9600, 2300 RC Leiden, Netherlands.
Désirée
D
van der Heijde
Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; and at the 2nd Department of Medicine, Hietzing Hospital, Wolkersbergenstraße 1, 1130 Vienna, Austria.
Josef S
JS
Smolen
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D019468:Disease Management; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D000069549:Ustekinumab / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D013792:Thalidomide; C555450:secukinumab; D000069549:Ustekinumab; C505730:apremilast; D008727:Methotrexate