Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis
Special Article: 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis
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DOI：
10.1002/art.40726
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发表时间：
2019-01-01
影响因子：
13.3
通讯作者：
Reston, James
中科院分区：
文献类型：
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作者：
Singh, Jasvinder A.;Guyatt, Gordon;Reston, James
目的 美国风湿病学会 (ACR) 和国家银屑病基金会 (NPF) 合作，制定银屑病关节炎 (PsA) 药物和非药物治疗的循证指南。方法 我们确定了 PsA 和临床相关 PICO（人群/干预/比较/结果）问题中的关键结果。文献综述小组进行了系统的文献综述，总结了支持现有药物和非药物疗法治疗银屑病关节炎的益处和危害的证据。 GRADE（建议评估、制定和评估分级）方法用于评估证据的质量。由风湿病学家、皮肤科医生、其他卫生专业人员和患者组成的投票小组就建议的方向和强度达成了共识。结果 该指南涵盖了未接受治疗的患者和尽管治疗后仍患有活动性银屑病患者的活动性银屑病关节炎的管理，并讨论了口服小分子、肿瘤坏死因子抑制剂、白细胞介素-12/23抑制剂（IL-12/23i）、IL-17抑制剂、CTLA4-Ig（阿巴西普）和JAK抑制剂（托法替尼）的使用。我们还针对银屑病脊柱炎、主要附着点炎以及伴有炎症性肠病、糖尿病或严重感染的情况提出了治疗建议。我们制定了针对目标治疗策略、疫苗接种和非药物治疗的建议。 6% 的建议是强烈的，94% 的建议是有条件的，这表明医疗保健提供者和患者之间积极讨论以选择最佳治疗的重要性。结论 2018 年 ACR/NPF PsA 指南可作为医疗保健提供者和患者在常见临床情况下选择适当治疗方法的工具。最佳治疗决策应考虑每个患者的具体情况。该指南并不具有禁止性，也不应用于限制银屑病关节炎患者的治疗选择。
Objective To develop an evidence-based guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF). Methods We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved consensus on the direction and the strength of the recommendations. Results The guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment. Conclusion The 2018 ACR/NPF PsA guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.