3
Treatment
Overarching Principles
➤ These recommendations, which include the most current data
concerning the optimal therapeutic approaches to PsA, present
contextual considerations to empower shared decision-making.
➤ The ultimate goals of therapy for all patients with PsA are:
• To achieve the lowest possible level of disease activity in all domains
of disease. As definitions of remission and low or minimal disease
activity become accepted, these will be included in the goal
• To optimize functional status, improve quality of life and wellbeing,
and prevent structural damage to the greatest extent possible
• To avoid or minimize complications, both from untreated active
disease and from therapy
➤ Assessment of patients with PsA requires consideration of all disease
domains, including peripheral arthritis, axial disease, enthesitis,
dactylitis, skin psoriasis, psoriatic nail disease, uveitis and IBD. The
impact of disease on pain, function, quality of life and structural
damage should be examined.
➤ Clinical assessment ideally includes patient-reported measures with a
comprehensive history and physical examination, often supplemented
by laboratory tests and imaging techniques (for example, X-ray,
ultrasound or MRI). The most widely accepted metrics that have been
validated for PsA should be utilized whenever possible.
➤ Comorbidities and related conditions should be considered and their
impact on the approach to the condition and its treatment addressed
appropriately. Such conditions include obesity, metabolic syndrome,
cardiovascular disease, depression and anxiety, liver disease (for
example, non-alcoholic fatty liver disease), chronic infections,
malignancy, bone health (for example, osteoporosis), central
sensitization (for example, fibromyalgia) and reproductive health.
Multidisciplinary and multispeciality assessment and management
may be most beneficial for individual patients.
➤ Therapeutic decisions need to be individualized and are made jointly
by the patient and their clinician. Treatment should reflect patient
preferences, with patients being provided with the best information
concerning relevant options. Treatment choices may be affected
by various factors, including disease activity, previous therapies,
prognostic factors such as structural damage, comorbid conditions
and patient factors such as cost, convenience and choice.
➤ Ideally, patients should be reviewed promptly, offered regular
evaluation by appropriate specialists, and have treatment adjusted as
needed in order to achieve the goals of therapy. Early diagnosis and
treatment is likely to be of benefit.
