Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force

Background: Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Objective: To define the treatment target for SpA including ankylosing spondylitis and psoriatic arthritis (PsA) and develop recommendations for achieving the target, including a treat-to-target management strategy. Methods: Based on results of a systematic literature review and expert opinion, a task force of expert physicians and patients developed recommendations which were broadly discussed and voted upon in a Delphi-like process. Level of evidence, grade and strength of the recommendations were derived by respective means. The commonalities between axial SpA, peripheral SpA and PsA were discussed in detail. Results: Although the literature review did not reveal trials comparing a treat-to-target approach with another or no strategy, it provided indirect evidence regarding an optimised approach to therapy that facilitated the development of recommendations. The group agreed on 5 overarching principles and 11 recommendations; 9 of these recommendations related commonly to the whole spectrum of SpA and PsA, and only 2 were designed separately for axial SpA, peripheral SpA and PsA. The main treatment target, which should be based on a shared decision with the patient, was defined as remission, with the alternative target of low disease activity. Follow-up examinations at regular intervals that depend on the patient's status should safeguard the evolution of disease activity towards the targeted goal. Additional recommendations relate to extra-articular and extramusculoskeletal aspects and other important factors, such as comorbidity. While the level of evidence was generally quite low, the mean strength of recommendation was 9-10 (10: maximum agreement) for all recommendations. A research agenda was formulated. Conclusions: The task force defined the treatment target as remission or, alternatively, low disease activity, being aware that the evidence base is not strong and needs to be expanded by future research. These recommendations can inform the various stakeholders about expert opinion that aims for reaching optimal outcomes of SpA

Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force

Therapeutic targets have been defined for axial and peripheral spondyloarthritis (SpA) in 2012, but the evidence for these recommendations was only of indirect nature. These recommendations were re-evaluated in light of new insights. Based on the results of a systematic literature review and expert opinion, a task force of rheumatologists, dermatologists, patients and a health professional developed an update of the 2012 recommendations. These underwent intensive discussions, on site voting and subsequent anonymous electronic voting on levels of agreement with each item. A set of 5 overarching principles and 11 recommendations were developed and voted on. Some items were present in the previous recommendations, while others were significantly changed or newly formulated. The 2017 task force arrived at a single set of recommendations for axial and peripheral SpA, including psoriatic arthritis (PsA). The most exhaustive discussions related to whether PsA should be assessed using unidimensional composite scores for its different domains or multidimensional scores that comprise multiple domains. This question was not resolved and constitutes an important research agenda. There was broad agreement, now better supported by data than in 2012, that remission/inactive disease and, alternatively, low/minimal disease activity are the principal targets for the treatment of PsA. As instruments to assess the patients on the path to the target, the Ankylosing Spondylitis Disease Activity Score (ASDAS) for axial SpA and the Disease Activity index for PSoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA) for PsA were recommended, although not supported by all. Shared decision-making between the clinician and the patient was seen as pivotal to the process. The task force defined the treatment target for SpA as remission or low disease activity and developed a large research agenda to further advance the field

Recommendations for the use of biologics and other novel drugs in the treatment of psoriatic arthritis: 2017 update from the Italian Society of Rheumatology

To update the 2011 Italian Society of Rheumatology (SIR) recommendations for the use of biologics and other novel agents in the treatment of psoriatic arthritis (PsA)

Recommendations for the use of biologics and other novel drugs in the treatment of psoriatic arthritis: 2017 update from the Italian Society of Rheumatology

Objective To update the 2011 Italian Society of Rheumatology (SIR) recommendations for the use of biologics and other novel agents in the treatment of psoriatic arthritis (PsA). Methods To create this new set of recommendations, the SIR "Spondyloartritis and Psoriatic Arthritis study group - A. Spadaro" went through the following steps: literature search, identification of the items of interests for each of the four previously identified clinical domains of PsA and the different treatment phases, achievement of the consensus on all topics, and generation of the recommendations. Results An update on the available evidence on all of the biologics and new small molecules tested in PsA is reported, comprising the data for each of the individual articular manifestation. Indications for therapy inclusion criteria, choice of the drug, disease assessment, response definition, therapy failure management, and disease remission management for PsA peripheral joint arthritis, enthesitis, dactylitis, and spondylitis are provided. Suggestions for the treatment of patients with PsA and concomitant extra-articular manifestations are also given. Conclusion These evidence-based recommendations may be used for guidance in the complex and fast-evolving field of the treatment of PsA

Recommendations for the use of biologics and other novel drugs in the treatment of psoriatic arthritis: 2017 update from the Italian Society of Rheumatology

Objective To update the 2011 Italian Society of Rheumatology (SIR) recommendations for the use of biologics and other novel agents in the treatment of psoriatic arthritis (PsA). Methods To create this new set of recommendations, the SIR "Spondyloartritis and Psoriatic Arthritis study group - A. Spadaro" went through the following steps: literature search, identification of the items of interests for each of the four previously identified clinical domains of PsA and the different treatment phases, achievement of the consensus on all topics, and generation of the recommendations. Results An update on the available evidence on all of the biologics and new small molecules tested in PsA is reported, comprising the data for each of the individual articular manifestation. Indications for therapy inclusion criteria, choice of the drug, disease assessment, response definition, therapy failure management, and disease remission management for PsA peripheral joint arthritis, enthesitis, dactylitis, and spondylitis are provided. Suggestions for the treatment of patients with PsA and concomitant extra-articular manifestations are also given. Conclusion These evidence-based recommendations may be used for guidance in the complex and fast-evolving field of the treatment of PsA

Recommendations for the use of biologics and other novel drugs in the treatment of psoriatic arthritis: 2017 update from the Italian Society of Rheumatology

To update the 2011 Italian Society of Rheumatology (SIR) recommendations for the use of biologics and other novel agents in the treatment of psoriatic arthritis (PsA)

La fatigue dans le rhumatisme psoriasique. Étude transversale portant sur 246 patients de 13 pays

International audienceObjectifs: dans le rhumatisme psoriasique (RPso), la fatigue est un aspect important pour les patients. L’objectif était d’évaluer l’ampleur de la fatigue chez les patients souffrant de RPso et les facteurs susceptibles d’expliquer une fatigue intense.Méthodes: il s’agissait d’une analyse ancillaire d’une étude transversale menée dans 13 pays sur des patients non sélectionnés atteints de RPso qui remplissaient les critères CASPAR. L’importance de la fatigue pour les patients a été évaluée par un exercice de hiérarchisation au moyen d’une échelle numérique (EN) (plage 0-10). Les facteurs pouvant être associés à une intensité de fatigue > 5/10, à savoir des variables démographiques (âge, sexe, durée de la maladie, niveau d’éducation) et des caractéristiques de la maladie (nombre d’articulations touchées, protéine réactive C, psoriasis cutané, atteinte axiale, enthésite, dactylite, dommages structuraux) ont été évalués par une analyse logistique univariée et multivariée et une analyse par régression linéaire multiple.Résultats: au total, 246 patients ont été analysés : âge moyen ± écart-type 51,2 ± 13,0 ans ; durée moyenne de la maladie 9,9 ± 10,1 ans ; score DAS 28 moyen 3,5 ± 1,3. La fatigue a été classée en deuxième position d’importance pour les patients après la douleur. Son intensité était élevée : fatigue moyenne 5,0 ± 3,0. L’intensité de fatigue > 5/10 a été bien expliquée (variance expliquée 73 %) par le psoriasis cutané (Odds Ratio 4,67 [intervalle de confiance 95 % 1,05 ; 20,72]), les articulations douloureuses (1,30 [1,01 ; 1,68]) et un faible niveau d’éducation (1,09 [1,02 ; 1,23]). Dans le modèle de régression linéaire multiple, la fatigue a été expliquée par le psoriasis cutané, les articulations douloureuses, l’enthésite, le sexe féminin et le niveau d’éducation.Conclusions: la fatigue est un problème prioritaire chez les patients atteints de RPso. La fatigue mesurée est intense chez ces patients. Les cas d’intensité > 5/10 étaient majoritairement associés à des facteurs liés à la maladie mais aussi à des variables caractéristiques des patients. La fatigue, dans le RPso, indique une étiologie multifactorielle