Psoriatic Arthritis Treatment Guidelines

Psoriatic arthritis treatment is complicated. Since there is a wide array of symptoms and various levels of severity associated with psoriatic arthritis, treatment guidelines have been needed. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has issued the first-ever international guidelines for psoriatic arthritis treatment. The guidelines were presented at the ACR Meeting in 2008.

Guidelines Based on Clinical Manifestations of Psoriatic Arthritis

The treatment recommendations were based on literature review and consensus between rheumatologists and dermatologists. The recommendations focused on the main symptoms or clinical findings associated with psoriatic arthritis:

• skin and nails
• peripheral arthritis (feet and hands)
• axial disease
• dactylitis (sausage-shaped digit)
• enthesitis

Psoriatic Arthritis Treatment Recommendations

The following recommendations were among those offered by GRAPPA:

• Treatment options for peripheral arthritis: nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular glucocorticoid injecions (steroid injections), disease-modifying anti-rheumatic drugs (DMARDs) and TNF blockers.

• For an individual patient, DMARDs are chosen based on relative effectiveness, convenience, expense of the drug, expense for monitoring the drug, time until expected benefit and potential adverse events.

• DMARDs that should be used as a first-line of defense for peripheral arthritis: sulfasalazine, leflunomide, methotrexate, cyclosporine.

• The joint-preserving effects of DMARDs observed in rheumatoid arthritis patients have not been observed in psoriatic arthritis patients.

• To treat psoriasis in patients with psoriatic arthritis, systemic corticosteroids are not typically recommended, because there is a potential for "post-steroid psoriasis flare."

• For patients with peripheral arthritis, TNF-alpha blockers should be offered to patients who failed one or more DMARDs or for patients with poor prognosis even if they did not fail a DMARD.

• No clear-cut evidence suggests combination therapy is beneficial, but a combination of medication can be tried on patients who failed one DMARD or in patients that develop joint damage even after being treated.

_Sources:

_{Treatment recommendations for psoriatic arthritis. Annals of the Rheumatic Diseases. Ritchlin CT et al. October 24, 2008.
http://ard.bmj.com/cgi/content/abstract/ard.2008.094946v1}

_{Guidelines Issued for Management of Psoriatic Arthritis. Medscape Rheumatology. Barclay L., MD. October 28, 2008.}