Rheumatology recommendations for the management of psoriatic arthritis

Overview

Published in Clinical Rheumatology (Elmamoun et al., 2020), these recommendations from the International League of Associations for Rheumatology (ILAR) adapt existing psoriatic arthritis guidance for countries in the Americas (outside Canada and the USA) and Africa. The authors note that the main international recommendations, from EULAR and GRAPPA, were largely based on studies from well-resourced countries and may not fit settings with limited access to care and medicines.

How the recommendations were developed

The group followed the ADAPTE process for guideline adaptation in three phases: set-up; adaptation, which covered defining health questions, appraising the source recommendations and drafting; and finalisation, with external review and planning for updates. The resulting recommendations are based mainly on GRAPPA, with EULAR recommendations used where appropriate, supplemented by expert opinion and regional literature. Clinicians from rheumatology and dermatology across both regions took part.

What the guidance covers

Psoriatic arthritis is a heterogeneous disease, and the recommendations address its different clinical manifestations, including joint, skin and other musculoskeletal involvement. Throughout, the authors weigh the evidence against practical constraints such as cost, availability of treatment and health-system capacity, so that the advice is achievable where resources are scarce.

Evidence gaps

The authors found very little published data on managing psoriatic arthritis specifically in resource-poor settings, and they identify this as a priority for future research.

Why adaptation matters

Recommendations written for well-resourced health systems can be hard to follow where access to specialists, diagnostic tests and advanced therapies is limited. Adapting existing guidance, rather than writing new guidance from scratch, keeps it evidence-based while making it realistic for everyday practice in these regions.

Who it is for

Rheumatologists, dermatologists and primary care clinicians caring for patients with psoriatic disease, particularly in low- and middle-income countries.