The European Alliance of Associations for Rheumatology's (EULAR) updated recommendations on the management of psoriatic arthritis may provide a comprehensive, personalized approach incorporating the latest pharmacologic advances and tailoring treatment strategies based on patient needs and disease manifestations.
The updated guidelines, published in the Annals of the Annals of the Rheumatic Diseases, were developed through a comprehensive review process involving a diverse international team. They incorporated a combination of evidence- and consensus-based methodologies to optimize treatment approaches across varied patient needs.
Among the key updates were seven overarching principles and 11 detailed recommendations for the pharmacologic treatment of psoriatic arthritis. The overarching principles covered individualized treatments, shared decision-making between patients and health-care providers, comprehensive care addressing comorbidities, regular assessments using validated outcome measures, early interventions, and a multidisciplinary approach.
Notably, the use of non-steroidal anti-inflammatory drugs was advised only for short-term management in mild psoriatic arthritis, whereas oral glucocorticoids were discouraged. Early use of conventional synthetic disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, was recommended among patients with peripheral arthritis. For cases unresponsive to initial conventional synthetic DMARD therapy, the guidelines prioritized biologic DMARDs without a specific preference for mechanism of action—allowing flexibility based on patient factors—followed by Janus kinase inhibitors after a lack of response on biologic DMARDs or when biologic DMARDs were deemed unsuitable.
Additionally, treatment strategies should be tailored based on specific clinical manifestations and comorbid conditions. For instance, biologic DMARDs targeting interleukin pathways were suggested in patients with significant skin involvement, while tumor necrosis factor inhibitors were prioritized for predominant axial disease. Choices for entheseal disease were also clearly delineated.
The specific recommendations also covered the importance of monitoring and adjusting therapy based on disease activity and adverse effects, patient education and self management, healthy lifestyle practices, and the need to ensure patients are up to date with vaccinations—especially prior to initiating immunosuppressive therapies.
This updated guidelines may provide a comprehensive framework for personalized, evidence-based management of prsoriatic arthritis, incorporating the latest pharmacologic advances and considering the diverse needs of patients.
The authors declared having no competing interests.
