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Leung YY, Korotaeva TV, Candia L, Pedersen SJ, Molano WB, Ruderman EM, Bisoendial R, Perez-Alamino R, Olsder W, Möller B, Grazio S, Gudu T, Mody GM, Pineda C, Raffayova H, Rohekar S, Goldenstein-Schainberg C, Gutierrez Urena SR, Casasola Vargas JC, Meghnathi B, Prasad R, Richette P, Miranda JRS, Malliotis N, Lindqvist U, Simon D, Ezeonyeji A, Soriano ER, FitzGerald O. Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol Suppl 2023; 50:119-130. [PMID: 36243409 DOI: 10.3899/jrheum.220315] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. METHODS A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings. RESULTS The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain. CONCLUSION Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations.
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Affiliation(s)
- Ying-Ying Leung
- Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, Duke-NUS Medical School, Singapore;
| | - Tatiana V Korotaeva
- T.V. Korotaeva, PhD, MD, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Liliana Candia
- L. Candia, MD, Universidad Juárez del Estado de Durango, Durango, Mexico
| | - Susanne Juhl Pedersen
- S.J. Pedersen, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Wilson Bautista Molano
- W.B. Molano, MD, PhD, University Hospital Fundación Santa Fe de Bogotá, Universidad el Bosque, Bogotá, Colombia
| | - Eric M Ruderman
- E.M. Ruderman, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Wendy Olsder
- W. Olsder, MSc, Eindhoven University of Technology, School of Industrial Engineering, Eindhoven, the Netherlands
| | - Burkhard Möller
- B. Möller, MD, Department of Rheumatology & Immunology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Simeon Grazio
- S. Grazio, MD, PhD, SFEBPRM, Department for Rheumatology, Physical and Rehabilitation Medicine, University Clinical Center Sestre Milosrdnice, Zagreb, Croatia
| | - Tania Gudu
- T. Gudu, Rheumatology Department, Cambridge University Hospitals NHS FT, Cambridge, UK
| | - Girish M Mody
- G.M. Mody, MD, MACR, Department of Rheumatology, University of KwaZulu-Natal, Durban, South Africa
| | - Carlos Pineda
- C. Pineda, PhD, MD, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Helena Raffayova
- H. Raffayova, MD, PhD, National Institute of Rheumatic Diseases, Piešťany, Slovakia
| | - Sherry Rohekar
- S. Rohekar, MD, Western University, London, Ontario, Canada
| | - Claudia Goldenstein-Schainberg
- C. Goldenstein-Schainberg, MD, PhD, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade Sao Paulo, Sao Paulo, Brazil
| | - Sergio R Gutierrez Urena
- S.R. Gutierrez Urena, MD, MSc, Hospital Civil de Guadalajara FAA Universidad de Guadalajara, Guadalajara, Mexico
| | | | - Bhowmik Meghnathi
- B. Meghnathi, DNB-SS, MD, Department of Rheumatology & Clinical Immunology, CIMS Hospital, Ahmedabad, India
| | - Roopa Prasad
- R. Prasad, MB BCh, University Hospital of Wales, Cardiff, UK
| | - Pascal Richette
- P. Richette, MD, PhD, Rheumatology Department, Hopital Lariboisière, Université de Paris, INSERM U1132, Paris, France
| | | | - Nikolas Malliotis
- N. Malliotis, MD, Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
| | - Ulla Lindqvist
- U. Lindqvist, MD, PhD, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - David Simon
- D. Simon, MD, Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Amara Ezeonyeji
- A. Ezeonyeji, MBBS, MRCP, MDRes, St George's University Hospital NHS Foundation Trust, London, UK
| | - Enrique R Soriano
- E.R. Soriano, MD, MSc, Rheumatology Unit, and University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Oliver FitzGerald
- O. FitzGerald, MD, FRCP, Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
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Leung YY, Korotaeva T, Candia L, Pedersen SJ, Molano WB, Ruderman EM, Bisoendial R, Perez-Alamino R, Olsder W, Möller B, Grazio S, Gudu T, Mody GM, Pineda C, Raffayova H, Rohekar S, Goldenstein-Schainberg C, Gutierrez Urena SR, Casasola Vargas JC, Meghnathi B, Prasad R, Richette P, Miranda JRS, Malliotis N, Lindqvist U, Simon D, Ezeonyeji A, Soriano ER, FitzGerald O. Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. J Rheumatol 2022; 49:1. [PMID: 36455936 DOI: 10.3899/jrheum.220315.c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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