The American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF) have released a joint treatment guideline for psoriatic arthritis (PsA). The guideline provides evidence-based pharmacologic and non-pharmacologic recommendations on caring for treatment-naive 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
PsA can cause irreversible joint damage. This damage could be delayed or even avoided – and pain, joint function and quality of life could be improved – by using a targeted treatment 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.
According to the guideline, following a treat-to-target strategy is recommended over not following one in patients with active PsA. Health care providers should determine on a case-by-case basis if a treat-to-target approach is best for their patients.
“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,” says Singh. “A targeted approach can also improve pain, function and quality of life and social participation.”
2. Prescribe tumor necrosis factor inhibitors (TNFi) biologics as a first-line therapy
According to the guideline, a TNF alpha inhibitor biologic agent is recommended over an oral small molecule as a first-line option in treatment-naive patients with active PsA. However, certain situations may require an alternate treatment course.
“The available evidence suggested that in the absence of certain conditions, many treatment-naive 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 the 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.