GRAPPA Psoriatic Arthritis App brought to you free of charge courtesy of Guideline Central. Enjoy!
Issue link: https://eguideline.guidelinecentral.com/i/662287
Treatment 8 Table 5. Treatment Recommendations for Peripheral Arthritis GRADE NSAIDs can be considered to relieve symptoms of peripheral PsA, at a standard or lower dose and with careful monitoring for side effects if used in a sustained manner. C Chronic systemic corticosteroids are not recommended in the treatment of psoriatic arthritis and are only advisable in discrete circumstances for short- term disease control and not for chronic use. C Intra-articular corticosteroids are recommended for symptom alleviation in the treatment of psoriatic mono-, oligo- and polyarthritis. C In DMARD-naïve patients, both DMARDs (methotrexate, leflunomide, sulfasalazine) and TNFi are strongly recommended for treatment. • DMARDs are commonly used first line due to their low costs and universal access. • Cyclosporine is not recommended due to small evidence of its efficacy and its toxicity profile. S TNF inhibitors should be used to treat symptoms and disease progression of peripheral PsA in people who are DMARD naïve. • DMARDs may be used first, but consideration should be given to early escalation of therapy particularly in patients with poor prognostic factors (e.g., raised inflammatory markers, high active joint counts). S IL12/23 inhibitors are NOT recommended to treat symptoms of peripheral PsA in people who are DMARD naïve. C NOT IL17 inhibitors should NOT be used to treat symptoms of peripheral PsA in people who are DMARD naïve. C NOT Apremilast can be considered to treat symptoms of peripheral PsA in people who are DMARD naïve. • Conditional recommendation as data only currently available in abstract form. • No data available assessing the impact of PDE4i on radiographic damage. C TNF inhibitors should be used to treat symptoms and disease progression of peripheral PsA in people who have failed conventional DMARDs. S IL12/23 inhibitors should be used to treat symptoms and disease progression of peripheral PsA in people who have failed conventional DMARDs. S IL17 inhibitors should be used to treat symptoms and disease progression of peripheral PsA in people who have failed conventional DMARDs. • Conditional recommendation as data only currently available in abstract form. C Apremilast should be used to treat symptoms of peripheral PsA in people who have failed conventional DMARDs. S Switching TNF inhibitors or to an alternate targeted biological agent for inadequate response or adverse effects can be considered to treat symptoms of peripheral PsA in people with PsA that are not responding to a previous targeted biological agent. C