EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update

2024/03/18 by Laure Gossec, Andreas Kerschbaumer, Ricardo J O Ferreira +46 · 352 citations
Immunology and Microbiology · Medicine · #Alternative medicine #Arthritis #Dermatology #Intensive care medicine #Internal medicine #Medicine #Pathology #Psoriasis #Psoriasis: Treatment and Pathogenesis #Psoriatic arthritis #Rheumatoid Arthritis Research and Therapies #Spondyloarthritis Studies and Treatments

paper · pdf · doi:10.1136/ard-2024-225531

published in Annals of the Rheumatic Diseases 83(6), 706-719 (BMJ)

openalex publication_date 2024/03/18 · openalex created_date 2024/03/19 · openalex updated_date 2026/08/05

Abstract

OBJECTIVE: New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. METHODS: Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. RESULTS: The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. CONCLUSION: These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.

Citations

• European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update
• EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update
• ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

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