Treatment guidelines in psoriatic arthritis

Overview

This review in Rheumatology (Ogdie, Coates and Gladman, 2020) compares three major sets of treatment recommendations for psoriatic arthritis: the national ACR and National Psoriasis Foundation guideline (2018), the regional EULAR recommendations (2015) and the international GRAPPA recommendations (2015). It also looks more broadly at how guidelines for this disease are developed.

Why guidelines are challenging here

Psoriatic arthritis is a complex inflammatory disease affecting both the musculoskeletal system and the skin. Its heterogeneity, with different patients having different combinations of joint, spine, tendon, skin and nail involvement, makes a single treatment pathway difficult to define. Treatment options have expanded rapidly in recent years, while head-to-head comparisons between therapies remain limited.

What the comparison shows

The three documents differ in the methods used to develop them, the therapies they include, and some of their final recommendations. The review discusses how each handles the individual clinical features of the disease, how it builds a decision-making pathway from limited comparative data, and the role of treat-to-target strategies.

Evidence gaps

The authors conclude that more studies are needed to guide treatment selection and overall disease management in psoriatic arthritis.

Related guidance

For recommendations adapted to low-resource settings, see the ILAR recommendations for psoriatic arthritis, also available on Medpresso.

How to use it

By setting the three documents side by side, the review helps clinicians understand why recommendations from different organisations may point in slightly different directions, and how to interpret them when choosing treatment for an individual patient with a particular pattern of disease.

Who it is for

Rheumatologists, dermatologists and trainees seeking a concise comparison of the major psoriatic arthritis guidelines.