EULAR points to consider and consensus definitions for difficult-to-manage and treatment-refractory psoriatic arthritis
Helena Marzo‐Ortega, Stephanie R Harrison, G. Fragoulis, Xabier Michelena, Cristina Macía‐Villa, Sibel Zehra Aydın, Andra Bălănescu, Heidi Bertheussen, Christine Bundy, Maria Sole Chimenti, Paolo Gisondi, Bente Glintborg, Laure Gossec, Umut Kalyoncu, Ennio Lubrano, György Nagy, Wendy Wagenaar, L. Puig, Rubén Queiró, Proton Rahman, Russka Shumnalieva, Enrique R. Soriano, Filip Van den Bosch, Marleen M.G.H. van de Sande, Alexandre Sepriano, Pedro Machado, Stefan Siebert
Abstract
OBJECTIVES: This study aimed to develop evidence-based points to consider (PtC) and consensus definitions of difficult-to-manage (D2M) and treatment-refractory (TR) psoriatic arthritis (PsA). METHODS: A multidisciplinary international European Alliance of Associations for Rheumatology (EULAR) task force (TF) of 27 members, including rheumatologists, dermatologists, health practitioners, and patient partners, was established, and the EULAR standardised operating procedures, including a systematic literature review and a consensus process, were followed. RESULTS: The TF formulated 4 overarching principles addressing the proportion of patients with PsA with an unsatisfactory treatment response despite the best standard of care, and for which the causes are likely multifactorial. Six PtC highlight criterion relevant for subsequent definitions including failure to achieve or maintain response to ≥2 biological/targeted synthetic disease-modifying antirheumatic drugs with ≥2 different mechanisms of action; management of signs and symptoms perceived as problematic by the rheumatologist and/or the patient, and evidence of persistent disease activity in the presence of extramusculoskeletal manifestations and/or comorbidities and/or objective evidence of inflammatory activity. Finally, the following 2 definitions were developed: (1) D2M PsA, an umbrella term including drivers such as inflammation, comorbidities, psychosocial or other factors, incorporating (2) TR PsA, defined by persistent disease activity and objective evidence of active inflammation. CONCLUSIONS: EULAR proposes 2 consensus definitions to identify a D2M PsA population, including a TR subgroup. These definitions should now be tested in research studies to understand disease pathogenesis and improve care for people living with PsA.