Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Ying-Ying Leung; Tatiana V Korotaeva; Liliana Candia; Susanne Juhl Pedersen; Wilson Bautista Molano; Eric M Ruderman; Radjesh Bisoendial; Rodolfo Perez-Alamino; Wendy Olsder; Burkhard Möller; Simeon Grazio; Tania Gudu; Girish M Mody; Carlos Pineda; Helena Raffayova; Sherry Rohekar; Claudia Goldenstein-Schainberg; Sergio R Gutierrez Urena; Julio César Casasola Vargas; Bhowmik Meghnathi; Roopa Prasad; Pascal Richette; Jose Roberto S Miranda; Nikolas Malliotis; Ulla Lindqvist; David Simon; Amara Ezeonyeji; Enrique R Soriano; Oliver FitzGerald

doi:10.3899/jrheum.220315

Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

J Rheumatol. 2023 Jan;50(1):119-130. doi: 10.3899/jrheum.220315. Epub 2022 Oct 15.

Authors

Ying-Ying Leung¹, Tatiana V Korotaeva², Liliana Candia³, Susanne Juhl Pedersen⁴, Wilson Bautista Molano⁵, Eric M Ruderman⁶, Radjesh Bisoendial⁷, Rodolfo Perez-Alamino⁸, Wendy Olsder⁹, Burkhard Möller¹⁰, Simeon Grazio¹¹, Tania Gudu¹², Girish M Mody¹³, Carlos Pineda¹⁴, Helena Raffayova¹⁵, Sherry Rohekar¹⁶, Claudia Goldenstein-Schainberg¹⁷, Sergio R Gutierrez Urena¹⁸, Julio César Casasola Vargas¹⁹, Bhowmik Meghnathi²⁰, Roopa Prasad²¹, Pascal Richette²², Jose Roberto S Miranda²³, Nikolas Malliotis²⁴, Ulla Lindqvist²⁵, David Simon²⁶, Amara Ezeonyeji²⁷, Enrique R Soriano²⁸, Oliver FitzGerald²⁹

Affiliations

¹ Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, Duke-NUS Medical School, Singapore; katyccc@hotmail.com.
² T.V. Korotaeva, PhD, MD, V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia.
³ L. Candia, MD, Universidad Juárez del Estado de Durango, Durango, Mexico.
⁴ S.J. Pedersen, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.
⁵ W.B. Molano, MD, PhD, University Hospital Fundación Santa Fe de Bogotá, Universidad el Bosque, Bogotá, Colombia.
⁶ E.M. Ruderman, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁷ R. Bisoendial, MD, PhD, Maasstad Hospital, Rotterdam, the Netherlands.
⁸ R. Perez-Alamino, MD, Rheumatology Section, Hospital Avellaneda, Tucumán, Argentina.
⁹ W. Olsder, MSc, Eindhoven University of Technology, School of Industrial Engineering, Eindhoven, the Netherlands.
¹⁰ B. Möller, MD, Department of Rheumatology & Immunology, Inselspital University Hospital Bern, Bern, Switzerland.
¹¹ S. Grazio, MD, PhD, SFEBPRM, Department for Rheumatology, Physical and Rehabilitation Medicine, University Clinical Center Sestre Milosrdnice, Zagreb, Croatia.
¹² T. Gudu, Rheumatology Department, Cambridge University Hospitals NHS FT, Cambridge, UK.
¹³ G.M. Mody, MD, MACR, Department of Rheumatology, University of KwaZulu-Natal, Durban, South Africa.
¹⁴ C. Pineda, PhD, MD, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
¹⁵ H. Raffayova, MD, PhD, National Institute of Rheumatic Diseases, Piešťany, Slovakia.
¹⁶ S. Rohekar, MD, Western University, London, Ontario, Canada.
¹⁷ C. Goldenstein-Schainberg, MD, PhD, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade Sao Paulo, Sao Paulo, Brazil.
¹⁸ S.R. Gutierrez Urena, MD, MSc, Hospital Civil de Guadalajara FAA Universidad de Guadalajara, Guadalajara, Mexico.
¹⁹ J.C.C. Vargas, MD, Hospital General de Mexico, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico.
²⁰ B. Meghnathi, DNB-SS, MD, Department of Rheumatology & Clinical Immunology, CIMS Hospital, Ahmedabad, India.
²¹ R. Prasad, MB BCh, University Hospital of Wales, Cardiff, UK.
²² P. Richette, MD, PhD, Rheumatology Department, Hopital Lariboisière, Université de Paris, INSERM U1132, Paris, France.
²³ J.R.S. Miranda, MD, Private practice, Sao Paulo, Brazil.
²⁴ N. Malliotis, MD, Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden.
²⁵ U. Lindqvist, MD, PhD, Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
²⁶ D. Simon, MD, Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
²⁷ A. Ezeonyeji, MBBS, MRCP, MDRes, St George's University Hospital NHS Foundation Trust, London, UK.
²⁸ E.R. Soriano, MD, MSc, Rheumatology Unit, and University Institute, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
²⁹ O. FitzGerald, MD, FRCP, Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland.

PMID: 36243409
DOI: 10.3899/jrheum.220315

Abstract

Objective: We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations.

Methods: A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings.

Results: The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain.

Conclusion: Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations.

Keywords: GRAPPA; peripheral arthritis; practice guideline; psoriasis; psoriatic arthritis; systematic literature review.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / therapeutic use
Arthritis, Psoriatic* / drug therapy
Humans
Interleukin-12
Janus Kinase Inhibitors* / therapeutic use
Methotrexate / therapeutic use
Psoriasis* / drug therapy

Substances

Antirheumatic Agents
Methotrexate
Interleukin-12
Janus Kinase Inhibitors