New guidance for treating your psoriatic arthritis patients– and your psoriasis patients who might develop PsA
The American College of Rheumatology (ACR) and National Psoriasis Foundation (NPF) have released a joint treatment guideline for psoriatic arthritis that provides evidence-based pharmacologic and non-pharmacologic recommendations on caring for treatment-naïve patients with active PsA and patients who continue to have active PsA despite treatment.
There are three key recommendations:
1. Adopt a treat-to-target approach
“Treat to target is key, because it encompasses all clinical scenarios, rather than one particular clinical situation,” says Jasvinder Singh, M.D., MPH, a rheumatologist at the University of Alabama at Birmingham who served as principal investigator for the guideline project.
“The available evidence suggests the irreversible joint damage, associated functional limitations, joint deformities and disability associated with PsA could possibly be avoided or delayed with optimal disease management using a targeted approach. A targeted approach can also improve pain, function and quality of life and social participation.”
2. Prescribe TNFi biologics as a first-line therapy
“The available evidence suggested that in the absence of certain conditions, many treatment-naïve patients would benefit from trying a TNFi biologic first,” says Dafna Gladman, M.D., a rheumatology professor of medicine at the University of Toronto and member of the NPF medical board who served as a content expert on the guideline’s core team.
3. Encourage smoking cessation
The strong recommendation for smoking cessation was based on evidence linking smoking to a reduced efficacy of biologics; the benefits of smoking cessation; and the well established link of smoking with mortality, cancers and heart and lung diseases in the general population.
- This article in our peer-reviewed journal, The Journal of Psoriasis and Psoriatic Arthritis, explains the PsA guideline methodology and all of its recommendations.
- Rheumatologist Philip Mease, M.D., one of the co-authors of the JPPA article and a Seattle-based rheumatologist who has been treating PsA patients since the 1990s, leads an informal discussion of the PsA guideline in our podcast, Psound Bytes.