Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Ying Ying Leung*, Tatiana V. Korotaeva, Liliana Candia, Wilson Bautista Molano, Eric M. Ruderman, Rodolfo Perez-Alamino, Wendy Olsder, Burkhard Möller, Simeon Grazio, Tania Gudu, Girish M. Mody, Carlos Pineda, Helena Raffayova, Sherry Rohekar, Claudia Goldenstein-Schainberg, Sergio R. Gutierrez Urena, Julio César Casasola Vargas, Bhowmik Meghnathi, Roopa Prasad, Pascal RichetteJose Roberto S. Miranda, Nikolas Malliotis, Ulla Lindqvist, David Simon, Amara Ezeonyeji, Enrique R. Soriano, Oliver FitzGerald

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

8 Citations (Scopus)


OBJECTIVE: We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. METHODS: A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings. RESULTS: The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain. CONCLUSION: Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations.

Original languageEnglish
Pages (from-to)119-130
Number of pages12
JournalThe Journal of rheumatology
Issue number1
Publication statusPublished - 1 Jan 2023
Externally publishedYes

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Publisher Copyright:
Copyright © 2023 by the Journal of Rheumatology.

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© 2023 Journal of Rheumatology. All rights reserved.


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