title: Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain.
abstract: The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.
authors.affiliation: Hospital Monte Naranco and Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain. jctorre@telecable.es.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Torre-Alonso
authors.affiliation: Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.affiliation: Hospital Universitari Parc Taulí, Sabadell, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Moreno
authors.affiliation: Hospital Universitario de Basurto, Bilbao, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Galíndez
authors.affiliation: Hospital Universitario de Cabueñes, Gijón, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Babío
authors.affiliation: Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Zarco
authors.affiliation: Hospital Complejo Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Linares
authors.affiliation: Servicio de Reumatologia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Collantes-Estevez
authors.affiliation: Centro de Salud de Sotondrio, Langreo, Spain.
authors.forename: Manuel Fernández
authors.initials: MF
authors.lastname: Barrial
authors.affiliation: Centro de Salud "Ciudades", Getafe, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Hermosa
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Coto
authors.affiliation: Servicios de Medicina Interna y Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez
authors.affiliation: Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Almodóvar
authors.affiliation: Hospital Universitari Parc Taulí, Sabadell, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Luelmo
authors.affiliation: Servicios de Medicina Interna y Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: Castañeda
authors.affiliation: Hospital Universitari Parc Taulí, Sabadell, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Gratacós
mesh_terms: D015535:Arthritis, Psoriatic / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003657:Decision Making; D003697:Delphi Technique; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D012219:Rheumatology / Q000379:methods; D012307:Risk Factors; D013030:Spain
keywords: Checklist; Comorbidity; Consensus; Guidelines; Health services research; Psoriatic arthritis