10
Treatment
Table 7. Treatment Recommendations for Enthesitis
GRADE
NSAIDs can be considered as an initial therapy for enthesitis with careful
monitoring for side effects.
• Based on expert opinion.
C
Physical therapy can be considered to improve symptoms and functional
deficits associated with enthesitis.
C
Local corticosteroid injections can be considered with caution for enthesitis. C
cDMARDs are NOT recommended for the treatment of enthesitis.
• No published data support efficacy of other DMARDs in placebo-controlled
studies.
S
NOT
TNF alpha inhibitors as a class are recommended as initial or second line
therapy in the treatment of refractory or moderate to severe enthesitis.
S
Ustekinumab is recommended as initial or second line therapy in the treatment
of refractory or moderate to severe enthesitis.
S
Apremilast is recommended as initial or second line therapy in the treatment
of refractory or moderate to severe enthesitis.
• Conditional recommendation as data only currently available in abstract form.
C
IL17 inhibitors can be considered as an initial or second line therapy in the
treatment of refractory or moderate to severe enthesitis.
• Conditional recommendation as data only currently available in abstract form.
C
Table 8. Treatment Recommendations for Dactylitis
GRADE
Local corticosteroid injections can be considered for symptom improvement
in dactylitis.
C
cDMARDs (methotrexate, leflunomide, sulfasalazine) can be considered for
the treatment of dactylitis.
• In contrast to enthesitis, DMARDs are recommended as a first step in dactylitis
based on limited studies for this indication.
C
TNF alpha inhibitors (adalimumab, certolizumab, golimumab and infliximab)
are recommended as initial or second line therapy in the treatment of
refractory or moderate to severe dactylitis.
S
Ustekinumab can be considered as an initial targeted biological therapy or second
line therapy in the treatment of refractory or moderate to severe dactylitis.
C
Apremilast can be considered as a second line therapy in the treatment of
refractory or moderate to severe dactylitis.
C
IL17 inhibitors can be considered as second line therapy in the treatment of
refractory or moderate to severe dactylitis.
C
