Treatment
Overarching Principles
1. Goals of therapy:
a. To achieve the lowest possible level of disease activity in all domains of disease.
b. To optimize functional status, improve quality of life and wellbeing, and
minimize structural damage to the greatest extent possible.
c. To avoid or minimize complications, both from untreated active disease and from
therapy.
2. Assessment should include:
a. All major disease domains, including peripheral arthritis, axial disease, enthesitis,
dactylitis, psoriasis, and nail disease.
b. Other potential related conditions and comorbidities, including, but not
restricted to, obesity, metabolic syndrome, gout, diabetes, cardiovascular disease,
liver disease, uveitis, inflammatory bowel disease, depression and anxiety.
c. A comprehensive history and physical examination, often supplemented by
laboratory tests and imaging techniques—e.g., x-ray, ultrasound, MRI.
d. Patient-reported measures evaluating the impact of disease on pain, function and
quality of life.
e. Multidisciplinary and multispecialty assessment and management as indicated.
Note: The most widely accepted metrics that have been validated for PsA should be
utilized whenever possible.
3. Therapy:
a. Therapeutic decisions need to be individualized, and are made jointly by patient
and doctor.
b. Patients should be provided with the best information and relevant options
available.
c. Treatment should reflect patient preferences.
Note: Treatment choices may be affected by various factors, including disease
activity, structural damage, comorbid conditions and previous therapies.
d. Patients should be evaluated promptly, offered regular re-evaluation by
appropriate specialists, and have treatment adjusted as needed in order to achieve
therapeutic goals.
e. Early diagnosis and treatment is likely to be of benefit.
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