GRAPPA Releases Updated PsA Guidelines

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has updated its guidelines for treating patients with psoriatic arthritis (PsA).

The new guidelines include recommendations for all 6 key manifestations of PsA—peripheral arthritis, axial involvement, enthesitis, dactylitis, and skin and nail diseases—and related comorbidities, including cardiovascular disease, diabetes, and obesity.
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GRAPPA made the changes in response to new therapy options are available and because researchers now have a better understanding of the disease.

Researchers gathered information from patients via face-to-face meetings and online surveys to create the 6 overarching principles, which are based on the key PsA manifestations. Then researchers reviewed current literature and abstracts from research meetings to craft the new recommendations, using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) method.

Since patients with PsA usually have more than 1 manifestation, researchers urge healthcare providers to consider the most dominant manifestation when assessing treatment options. It’s also important for healthcare providers to consider patients’ comorbidities to provide the best treatment option.

The guideline recommends peripheral arthritis patients be treated with disease-modifying anti-rheumatic drugs (MARDs) and anti-tumor necrosis factor (TNF) agents. Axial disease patients should be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), sacroiliac injections, and physiotherapy. Enthesitis patients should be treated with NSAIDs and physiotherapy. Dactylitis patients should be treated with DMARDs and corticosteroid injections. Skin and nail diseases should be treated with topical ointments, phototherapy, and DMARDs.

“Further updates are anticipated as the therapeutic landscape in PsA evolves,” researchers conclude.

--Amanda Balbi

Reference:

Coates LC, Kavanaugh A, Mease PJ, et al. Group for research and assessment of psoriasis and psoriatic arthritis: Treatment recommendations for psoriatic arthritis 2015. Arthritis Rheum. Published online ahead of print January 8, 2016. doi:10.1002/art.39573.