Table 2. Treatment Recommendations for Comorbidities/
Extraarticular Manifestations
GRADE
Given evidence suggesting that PsA is associated with increased cardiovascular
risk, a cardiovascular risk assessment should be strongly considered for all
patients with PsA.
S
Given the association of diabetes with PsA, fasting glucose or hemoglobin
A1C should be considered in all patients with PsA.
C
Patients should be encouraged to achieve and maintain a healthy body weight. S
Because PsA can be associated with ophthalmic disease and inflammatory
bowel disease, rheumatologists should ask about relevant symptoms and
should consider referral.
S
Consider periodically performing skin examinations for the detection of skin
cancer in patients with PsA utilizing TNF alpha inhibitors.
S
Strongly consider screening for HCV and HBV prior to beginning therapy
with immunosuppressive agents.
S
Screening for HIV should be considered in patients with risk factors prior to
starting immunosuppressive agents.
S
Patients should be screened for latent TB infection prior to starting a biologic
agent.
S
Consider screening for depression in all patients with PsA. S
Table 1. Strength of Recommendations in GRADE
a
GRADE Strength Interpretation
Implications
for clinicians
Implications
for
policymakers
S Strongly in
favor
Almost all informed
patients would choose to
receive the intervention
Should be
accepted by most
patients to whom
it is offered
Should be
adopted as
policy
C Conditionally
in favor
Most informed patients
would choose the
intervention, but a sizable
minority would not
Large role for
education and
shared decision-
making
Requires
stakeholder
engagement
and discussion
C
NOT
Conditionally
against
Most informed patients
would not choose the
intervention, but a small
minority would
Large role for
education and
shared decision-
making
Requires
stakeholder
engagement
and discussion
S
NOT
Strongly
against
Most patients should not
receive the intervention
Should not be
offered to patients
Should be
adopted as policy
a
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