Abstract
Psoriatic arthritis (PsA) is a heterogeneous, potentially severe disease. Many therapeutic agents are now available for PsA, but treatment decisions are not always straightforward. To assist in this decision making, two sets of recommendations for the management of PsA were published in 2016 by international organizations — the European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). In both sets of recommendations, the heterogeneity of PsA is recognized and the place of various drugs in the therapeutic armamentarium is discussed. Such agents include conventional DMARDs, such as methotrexate, and targeted therapies including biologic agents, such as ustekinumab, secukinumab and TNF inhibitors, or the targeted synthetic drug apremilast. The proposed sequential use of these drugs, as well as some other aspects of PsA management, differ between the two sets of recommendations. This disparity is partly the result of a difference in the evaluation process; the focus of EULAR was primarily rheumatological, whereas that of GRAPPA was balanced between the rheumatological and dermatological aspects of disease. In this Perspectives article, we address the similarities and differences between these two sets of recommendations and the implications for patient management.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Chandran, V. & Raychaudhuri, S. P. Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis. J. Autoimmun. 34, J314–J321 (2010).
Boehncke, W. H. & Menter, A. Burden of disease: psoriasis and psoriatic arthritis. Am. J. Clin. Dermatol. 14, 377–388 (2013).
Frleta, M., Siebert, S. & McInnes, I. B. The interleukin-17 pathway in psoriasis and psoriatic arthritis: disease pathogenesis and possibilities of treatment. Curr. Rheumatol. Rep. http://dx.doi.org/10.1007/s11926-014-0414-y (2014).
Krueger, G. et al. The impact of psoriasis on quality of life: results of a 1998 national psoriasis foundation patient-membership survey. Arch. Dermatol. 137, 280–284 (2001).
Gossec, L. et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann. Rheum. Dis. 75, 499–510 (2016).
Coates, L. C. et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis: treatment recommendations for psoriatic arthritis 2015. Arthritis Rheumatol. 68, 1060–1071 (2016).
Gossec, L. et al. European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies. Ann. Rheum. Dis. 71, 4–12 (2012).
Ritchlin, C. T. et al. Treatment recommendations for psoriatic arthritis. Ann. Rheum. Dis. 68, 1387–1394 (2009).
van der Heijde, D. et al. 2014 update of the EULAR standardised operating procedures for EULAR-endorsed recommendations. Ann. Rheum. Dis. 74, 8–13 (2015).
Coates, L. et al. New GRAPPA and EULAR recommendations for the management of psoriatic arthritis: process and challenges faced. Rheumatology (Oxford) (In press).
de Wit, M. P. et al. European League Against Rheumatism recommendations for the inclusion of patient representatives in scientific projects. Ann. Rheum. Dis. 70, 722–726 (2011).
Cheung, P. P. et al. Recommendations for the involvement of Patient Research Partners (PRP) in OMERACT working groups. A report from the OMERACT 2014 working group on PRP. J. Rheumatol. 43, 187–193 (2016).
Smolen, J. S., van der Heijde, D., Machold, K. P., Aletaha, D. & Landewé, R. Proposal for a new nomenclature of disease-modifying antirheumatic drugs. Ann. Rheum. Dis. 73, 3–5 (2014).
Shaw, A. T. & Gravallese, E. M. Mediators of inflammation and bone remodeling in rheumatic disease. Semin. Cell Dev. Biol. 49, 2–10 (2016).
Schünemann, H. J. et al. GRADE Guidelines: 16. GRADE evidence to decision frameworks for tests in clinical practice and public health. J. Clin. Epidemiol. 76, 89–98 (2016).
Ash, Z. et al. A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis. Ann. Rheum. Dis. 71, 319–326 (2012).
Eder, L. et al. Predictors of response to intra-articular steroid injection in psoriatic arthritis. Rheumatology (Oxford) 49, 1367–1373 (2010).
Braun, J. et al. 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann. Rheum. Dis. 70, 896–904 (2011).
Bond, S. J., Farewell, V. T., Schentag, C. T. & Gladman, D. D. Predictors for radiological damage in psoriatic arthritis: results from a single centre. Ann. Rheum. Dis. 66, 370–376 (2007).
McHugh, N. J., Balachrishnan, C. & Jones, S. M. Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study. Rheumatology (Oxford) 42, 778–783 (2003).
Gladman, D. D. et al. Risk factors for radiographic progression in psoriatic arthritis: subanalysis of the randomized controlled trial ADEPT. Arthritis Res. Ther. 12, R113 (2010).
Cresswell, L., Chandran, V., Farewell, V. T. & Gladman, D. D. Inflammation in an individual joint predicts damage to that joint in psoriatic arthritis. Ann. Rheum. Dis. 70, 305–308 (2011).
Smolen, J. S. et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force. Ann. Rheum. Dis. 73, 6–16 (2014).
Coates, L. C. et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet 386, 2489–2498 (2015).
Acosta Felquer, M. L. et al. Remission criteria and activity indices in psoriatic arthritis. Clin. Rheumatol. 33, 1323–1330 (2014).
Van den Bosch, F., Kavanaugh, A., Kron, M., Kupper, H. & Mease, P. J. Clinical remission in patients with active psoriatic arthritis treated with adalimumab and correlations in joint and skin manifestations. J. Rheumatol. 42, 952–959 (2015).
Cantini, F., Niccoli, L., Cassarè, E., Kaloudi, O. & Nannini, C. Sustained maintenance of clinical remission after adalimumab dose reduction in patients with early psoriatic arthritis: a long-term follow-up study. Biologics 6, 201–206 (2012).
Coates, L. C. & Helliwell, P. S. Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data. Arthritis Care Res. 62, 965–969 (2010).
Coates, L. C., Cook, R., Lee, K.-A., Chandran, V. & Gladman, D. D. Frequency, predictors, and prognosis of sustained minimal disease activity in an observational psoriatic arthritis cohort. Arthritis Care Res. 62, 970–976 (2010).
Coates, L. C., Fransen, J. & Helliwell, P. S. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann. Rheum. Dis. 69, 48–53 (2010).
Haddad, A. et al. Minimal disease activity and anti-tumor necrosis factor therapy in psoriatic arthritis. Arthritis Care Res. 67, 842–847 (2015).
Schoels, M., Aletaha, D., Alasti, F. & Smolen, J. S. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann. Rheum. Dis. 75, 811–818 (2016).
Salaffi, F., Ciapetti, A., Carotti, M., Gasparini, S. & Gutierrez, M. Disease activity in psoriatic arthritis: comparison of the discriminative capacity and construct validity of six composite indices in a real world. Biomed. Res. Int. 2014, 528105 (2014).
Husic, R. et al. Disparity between ultrasound and clinical findings in psoriatic arthritis. Ann. Rheum. Dis. 73, 1529–1536 (2014).
Coates, L. C. & Helliwell, P. S. Defining low disease activity states in psoriatic arthritis using novel composite disease instruments. J. Rheumatol. 43, 371–375 (2016).
Coates, L. C., Kavanaugh, A., Ritchlin, C. T. & GRAPPA Treatment Guideline Committee. Systematic review of treatments for psoriatic arthritis: 2014 update for the GRAPPA. J. Rheumatol. 41, 2273–2276 (2014).
Kingsley, G. H. et al. A randomized placebo-controlled trial of methotrexate in psoriatic arthritis. Rheumatology (Oxford) 51, 1368–1377 (2012).
Pincus, T., Bergman, M. J. & Yazici, Y. Limitations of clinical trials in chronic diseases: is the efficacy of methotrexate (MTX) underestimated in polyarticular psoriatic arthritis on the basis of limitations of clinical trials more than on limitations of MTX, as was seen in rheumatoid arthritis? Clin. Exp. Rheumatol. 33 (Suppl. 93), S82–S93 (2015).
Lie, E. et al. Effectiveness and retention rates of methotrexate in psoriatic arthritis in comparison with methotrexate-treated patients with rheumatoid arthritis. Ann. Rheum. Dis. 69, 671–676 (2010).
Coates, L. C. & Helliwell, P. S. Methotrexate efficacy in the Tight Control in Psoriatic Arthritis study. J. Rheumatol. 43, 356–361 (2016).
Acosta Felquer, M. L. et al. Drug therapies for peripheral joint disease in psoriatic arthritis: a systematic review. J. Rheumatol. 41, 2277–2285 (2014).
Baranauskaite, A. et al. Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the RESPOND study. Ann. Rheum. Dis. 71, 541–548 (2012).
Ramiro, S. et al. Pharmacological treatment of psoriatic arthritis: a systematic literature review for the 2015 update of the EULAR recommendations for the management of psoriatic arthritis. Ann. Rheum. Dis. 75, 490–498 (2016).
McInnes, I. B. et al. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 382, 780–789 (2013).
Ritchlin, C. et al. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial. Ann. Rheum. Dis. 73, 990–999 (2014).
Mease, P. J. et al. Secukinumab inhibition of interleukin-17A in patients with psoriatic arthritis. N. Engl. J. Med. 373, 1329–1339 (2015).
McInnes, I. B. et al. Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 386, 1137–1146 (2015).
Griffiths, C. E. et al. Comparison of ixekizumab with etanercept or placebo in moderate-to-severe psoriasis (UNCOVER-2 and UNCOVER-3): results from two phase 3 randomised trials. Lancet. 386, 541–551 (2015).
Langley, R. G. et al. Secukinumab in plaque psoriasis — results of two phase 3 trials. N. Engl. J. Med. 371, 326–338 (2014).
Schett, G. et al. Oral apremilast in the treatment of active psoriatic arthritis: results of a multicenter, randomized, double-blind, placebo-controlled study. Arthritis Rheum. 64, 3156–3167 (2012).
Kavanaugh, A. et al. Treatment of psoriatic arthritis in a phase 3 randomised, placebo-controlled trial with apremilast, an oral phosphodiesterase 4 inhibitor. Ann. Rheum. Dis. 73, 1020–1026 (2014).
Edwards, C. J. et al. Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with psoriatic arthritis and current skin involvement: a phase III, randomised, controlled trial (PALACE 3). Ann. Rheum. Dis. 75, 1065–1073 (2016).
Wells, A. et al. SAT0382 Palace 4, a phase 3, randomized, controlled trial of apremilast, an oral phosphodiesterase 4 inhibitor, for treatment of psoriatic arthritis: long-term (52-week) improvements in physical function. Ann. Rheum. Dis. 73 (Suppl. 2), 732 (2014).
Celgene. Celgene Reports Fourth Quarter and Full Year 2015 Operating and Financial Results. Celgene http://ir.celgene.com/releasedetail.cfm?ReleaseID=952157 (2016).
U.S. Food & Drug Administration. Information on biosimilars. FDA http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/ApprovalApplications/TherapeuticBiologicApplications/Biosimilars/default.htm (2016).
Dörner, T. & Kay, J. Biosimilars in rheumatology: current perspectives and lessons learnt. Nat. Rev. Rheumatol. 11, 713–724 (2015).
Putrik, P. et al. Inequities in access to biologic and synthetic DMARDs across 46 European countries. Ann. Rheum. Dis. 73, 198–206 (2014).
Ogdie, A. et al. Comprehensive treatment of psoriatic arthritis: managing comorbidities and extra-articular manifestations. J. Rheumatol. 41, 2315–2322 (2014).
World Health Organization. WHO handbook for guideline development [online], (2012).
Author information
Authors and Affiliations
Contributions
L.G., L.C.C., A.F.K., S.R., P.J.M., C.T.R., D.v.d.H. and J.S.S. researched data for the article. All authors made a substantial contribution to the discussion of content, wrote the article, and reviewed or edited the manuscript before submission. L.G. and L.C.C. contributed equally.
Corresponding author
Ethics declarations
Competing interests
The authors declare a potential conflict of interest having received grant support and/or honoraria for consultations and/or for presentations as indicated: L.G. Abbvie, BMS, Celgene, Chugai, Janssen, MSD, Novartis, Pfizer, Roche, UCB. L.C.C. Abbvie, Amgen, Boehringer Ingelheim, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, UCB. M.d.W. BMS, Celgene, Novartis, Roche. A.K. AbbVie, Amgen, Celgene, Janssen, Novartis, UCB. S.R. no competing interests. P.M. Abbvie, Amgen, Celgene, BMS, Boehringer Ingelheim, Janssen, Lilly, Merck, Novartis, Pfizer, UCB. C.R. Abbvie, Amgen, Boehringer Ingelheim, Janssen, Lilly, Novartis, Pfizer, UCB. D.v.d.H. AbbVie, Amgen, Astellas, AstraZeneca, Augurex, BMS, Boehringer Ingelheim, Celgene, Centocor, Chugai, Covagen, Daiichi, Eli-Lilly, Galapagos, GSK, Janssen Biologics, Merck, Novartis, Novo-Nordisk, Otsuka, Pfizer, Roche, Sanofi-Aventis, UCB, Vertex. Director of Imaging Rheumatology bv. J.S.S. Abbvie, Amgen, Astra-Zeneca, Astro, BMS, Celgene, Glaxo, ILTOO, Janssen, Merck-Serono, MSD, Novartis-Sandoz, Pfizer, Roche-Chugai, Samsung, UCB.
Related links
FURTHER INFORMATION
Rights and permissions
About this article
Cite this article
Gossec, L., Coates, L., de Wit, M. et al. Management of psoriatic arthritis in 2016: a comparison of EULAR and GRAPPA recommendations. Nat Rev Rheumatol 12, 743–750 (2016). https://doi.org/10.1038/nrrheum.2016.183
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrrheum.2016.183
This article is cited by
-
PsABIOnd Study and eDaily Substudy Design: Long-Term Effectiveness and Safety of Guselkumab and IL-17 Inhibitors in Routine Clinical Practice in Patients with Psoriatic Arthritis
Rheumatology and Therapy (2023)
-
Real-World Efficacy and Safety of Apremilast in Belgian Patients with Psoriatic Arthritis: Results from the Prospective Observational APOLO Study
Advances in Therapy (2022)
-
Epidemiology and Treatment of Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Psoriasis in Germany: A Real-World Evidence Study
Advances in Therapy (2021)
-
Doppler enthesitis: a potential useful outcome in the assessment of axial spondyloarthritis and psoriatic arthritis
Clinical Rheumatology (2021)
-
Differentiating rheumatoid and psoriatic arthritis: a systematic analysis of high-resolution magnetic resonance imaging features—preliminary findings
Skeletal Radiology (2021)