scholarly journals European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies

2011 ◽  
Vol 71 (1) ◽  
pp. 4-12 ◽  
Author(s):  
L Gossec ◽  
J S Smolen ◽  
C Gaujoux-Viala ◽  
Z Ash ◽  
H Marzo-Ortega ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Research Agenda ◽  
Task Force ◽  
Optimal Outcomes ◽  
Eular Recommendations ◽  
Evidence Strength ◽  
European League Against Rheumatism ◽  
Combining Evidence ◽  
Musculoskeletal Manifestations ◽  
European League

BackgroundPsoriatic arthritis (PsA) is a clinically heterogeneous disease. Clear consensual treatment guidance focused on the musculoskeletal manifestations of PsA would be advantageous. The authors present European League Against Rheumatism (EULAR) recommendations for the treatment of PsA with systemic or local (non-topical) symptomatic and disease-modifying antirheumatic drugs (DMARD).MethodsThe recommendations are based on evidence from systematic literature reviews performed for non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, synthetic DMARD and biological DMARD. This evidence was discussed, summarised and recommendations were formulated by a task force comprising 35 representatives, and providing levels of evidence, strength of recommendations and levels of agreement.ResultsTen recommendations were developed for treatment from NSAID through synthetic DMARD to biological agents, accounting for articular and extra-articular manifestations of PsA. Five overarching principles and a research agenda were defined.ConclusionThese recommendations are intended to provide rheumatologists, patients and other stakeholders with a consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes, based on combining evidence and expert opinion. The research agenda informs directions within EULAR and other communities interested in PsA.

scholarly journals European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update

2015 ◽  
Vol 75 (3) ◽  
pp. 499-510 ◽  
Author(s):  
L Gossec ◽  
J S Smolen ◽  
S Ramiro ◽  
M de Wit ◽  
M Cutolo ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Expert Opinion ◽  
Pharmacological Treatment ◽  
Task Force ◽  
Local Therapy ◽  
Initial Therapy ◽  
Tnf Inhibitor ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
European League

BackgroundSince the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations.MethodsA systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated.ResultsThe updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used.ConclusionsThese recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.

Treating to target in psoriatic arthritis: how to implement in clinical practice

2015 ◽  
Vol 75 (4) ◽  
pp. 640-643 ◽  
Author(s):  
Laura C Coates ◽  
Philip S Helliwell
Keyword(s):  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Standard Of Care ◽  
Routine Clinical Practice ◽  
Tight Control ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Medical Specialities ◽  
Optimal Measure ◽  
European League

Treating to target is becoming the standard of care in many medical specialities, including rheumatology. The Tight Control of Psoriatic Arthritis (TICOPA) trial has recently provided evidence of the benefit of treating to target in psoriatic arthritis (PsA), and the revised European League Against Rheumatism (EULAR) recommendations on the management of PsA suggest this approach. However, the question of the optimal measure to use and the practicalities of incorporating this into routine clinical practice remain problematic.

scholarly journals EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis

2011 ◽  
Vol 71 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Yvonne van Eijk-Hustings ◽  
Astrid van Tubergen ◽  
Carina Boström ◽  
Elena Braychenko ◽  
Beate Buss ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Research Agenda ◽  
Psychosocial Support ◽  
Task Force ◽  
Future Research ◽  
Chronic Inflammatory Arthritis ◽  
European League Against Rheumatism ◽  
European League ◽  
Educational Agenda

ObjectivesThe authors aim to develop European League Against Rheumatism recommendations for the role of the nurse in the management of patients with chronic inflammatory arthritis, to identify a research agenda and to determine an educational agenda.MethodsA task force made up of a multidisciplinary expert panel including nurses, rheumatologists, occupational therapist, physiotherapist, psychologist, epidemiologist and patient representatives, representing 14 European countries, carried out the development of the recommendations, following the European League Against Rheumatism standardised operating procedures.The task force met twice. In the first meeting, the aims of the task force were defined, and eight research questions were developed. This was followed by a comprehensive, systematic literature search. In the second meeting, the results from the literature review were presented to the task force that subsequently formulated the recommendations, research agenda and educational agenda.ResultsIn total, 10 recommendations were formulated. Seven recommendations covered the contribution of nurses to care and management: education, satisfaction with care, access to care, disease management, psychosocial support, self-management and efficiency of care. Three recommendations focused on professional support for nurses: availability of guidelines or protocols, access to education and encouragement to undertake extended roles. The strength of the recommendations varied from A to C, dependent on the category of evidence (1A–3), and a high level of agreement was achieved. Additionally, the task force agreed upon 10 topics for future research and an educational agenda.Conclusion10 recommendations for the role of the nurse in the management of chronic inflammatory arthritis were developed using a combination of evidence-based and expert consensus approach.

scholarly journals 2018 Update of the EULAR recommendations for the management of large vessel vasculitis

2019 ◽  
Vol 79 (1) ◽  
pp. 19-30 ◽  
Author(s):  
Bernhard Hellmich ◽  
Ana Agueda ◽  
Sara Monti ◽  
Frank Buttgereit ◽  
Hubert de Boysson ◽  
...  
Keyword(s):  
Task Force ◽  
Scientific Evidence ◽  
Clinical Care ◽  
Large Vessel Vasculitis ◽  
Large Vessel ◽  
High Dose ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Increased Risk ◽  
European League

BackgroundSince the publication of the European League Against Rheumatism (EULAR) recommendations for the management of large vessel vasculitis (LVV) in 2009, several relevant randomised clinical trials and cohort analyses have been published, which have the potential to change clinical care and therefore supporting the need to update the original recommendations.MethodsUsing EULAR standardised operating procedures for EULAR-endorsed recommendations, the EULAR task force undertook a systematic literature review and sought opinion from 20 experts from 13 countries. We modified existing recommendations and created new recommendations.ResultsThree overarching principles and 10 recommendations were formulated. We recommend that a suspected diagnosis of LVV should be confirmed by imaging or histology. High dose glucocorticoid therapy (40–60 mg/day prednisone-equivalent) should be initiated immediately for induction of remission in active giant cell arteritis (GCA) or Takayasu arteritis (TAK). We recommend adjunctive therapy in selected patients with GCA (refractory or relapsing disease, presence of an increased risk for glucocorticoid-related adverse events or complications) using tocilizumab. Methotrexate may be used as an alternative. Non-biological glucocorticoid-sparing agents should be given in combination with glucocorticoids in all patients with TAK and biological agents may be used in refractory or relapsing patients. We no longer recommend the routine use of antiplatelet or anticoagulant therapy for treatment of LVV unless it is indicated for other reasons.ConclusionsWe have updated the recommendations for the management of LVV to facilitate the translation of current scientific evidence and expert opinion into better management and improved outcome of patients in clinical practice.

Patient and rheumatologist perspectives on glucocorticoids: an exercise to improve the implementation of the European League Against Rheumatism (EULAR) recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases

2009 ◽  
Vol 69 (6) ◽  
pp. 1015-1021 ◽  
Author(s):  
M C van der Goes ◽  
J W G Jacobs ◽  
M Boers ◽  
T Andrews ◽  
M A M Blom-Bakkers ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Diseases ◽  
Adverse Events ◽  
Work Experience ◽  
Research Agenda ◽  
International Forum ◽  
Eular Recommendations ◽  
Systemic Glucocorticoid ◽  
European League Against Rheumatism ◽  
European League

ObjectiveTo explore perspectives among patients and rheumatologists on glucocorticoid (GC) therapy and European League Against Rheumatism (EULAR) recommendations on the management of systemic GC therapy in order to enhance implementation of the recommendations.MethodsRheumatologists (from eight countries) and patients (from five countries) acquainted with GCs participated in separate meetings, during which positive and negative aspects of GC therapy were discussed and possible adverse events (AEs) were ranked for importance; in addition participants were asked to evaluate the published EULAR recommendations. The reports from these meetings and themes related to implementation of the recommendations were discussed during an international forum of the experts who had formulated the recommendations and patient participants.ResultsIn all, 140 patients (78% women; mean age 53 years; 61% patients with rheumatoid arthritis) and 110 rheumatologists (mean work experience 15 years) participated in the meetings. Osteoporosis, diabetes and cardiovascular diseases were ranked among the five most worrisome AEs by patients and rheumatologists. In both groups, there was agreement with most of the recommendations; the recommendations on GC information cards and GC use during pregnancy scored lowest. Ideas to improve implementation of the recommendations and a research agenda were generated.ConclusionThe patient and rheumatologist views on GCs corresponded to a large extent, reflected by concerns in both groups about osteoporosis, diabetes and cardiovascular diseases. Specific problems with the EULAR recommendations were identified and addressed to improve their implementation. This exercise shows that patient and rheumatologist perspectives should be included early in the process of formulating recommendations.

Vaccination in immunocompromised adults

2013 ◽  
pp. 717-720
Author(s):  
Sander van Assen ◽  
Marc Bijl
Keyword(s):  
Pneumococcal Infection ◽  
Pneumococcal Vaccination ◽  
Underlying Disease ◽  
Inflammatory Rheumatic Diseases ◽  
Live Vaccines ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Immunosuppressed Patients ◽  
Humoral Responses ◽  
European League

This chapter addresses all important questions regarding vaccination of patients with autoimmune inflammatory rheumatic diseases (AIIRD). First, the incidence of vaccine-preventable infections in these patients is discussed. Pulmonary infections, including influenza and pneumococcal infection, occur more often in AIIRD patients; herpes zoster and human papillomavirus are also more frequent. The efficacy of vaccination for all European registered vaccines is discussed. Treatment with disease-modifying anti-rheumatic drugs (DMARDs) and biologicals (in particular TNFα‎‎-blocking agents) do not hamper, or only slightly hamper, the immune responses to most vaccines. Rituximab is an exception, severely reducing humoral responses following influenza and pneumococcal vaccination, at least during the first 6 months after administration. Safety of vaccination is an important issue in patients with autoimmune diseases, since increased disease activity of the underlying disease as a result of vaccination is theoretically possible. The available evidence is summarized, suggesting that vaccination is safe in AIIRD patients. Live vaccines, however, are contraindicated in immunosuppressed patients with AIIRD. Finally, the European League Against Rheumatism (EULAR) recommendations are highlighted, summarizing the ’do’s’ and ’don’ts’ of vaccination in adults with AIIRD.

Enthesitis

2013 ◽  
pp. 398-403
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents and other biologics have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Enthesitis

2016 ◽  
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritis (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term ’enthesis organ’ has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying antirheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Enthesitis

2013 ◽  
Author(s):  
Martin Rudwaleit
Keyword(s):  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Biomechanical Stress ◽  
Eular Recommendations ◽  
European League Against Rheumatism ◽  
Study Results ◽  
Doppler Signals ◽  
Proven Efficacy ◽  
Inflammatory Drugs ◽  
Chronic Course

Enthesitis is one of the key manifestations of spondyloarthritides (SpA) including ankylosing spondylitis (AS) and psoriatic arthritis. Enthesitis can occur alone or in combination with peripheral arthritis, sacroiliitis, or spondylitis. The inflammatory process is typically located at the insertion of the enthesis or ligament to bone, often resulting in osteitis as well. Because of its anatomical and functional complexity the term 'enthesis organ' has been coined. Biomechanical stress applied to the enthesis seems to play an important role for the occurrence of enthesitis in genetically predisposed individuals. Ultrasound imaging of peripheral entheses reveals enthesis abnormalities including entheseal calcification, bony erosion, or bony proliferation. Power Doppler signals demonstrating increased vascularization of inflamed entheses at the insertional site appear to be the most characteristic finding for enthesitis, yet study results are conflicting. Enthesitis-related osteitis and enthesitis at the spine is best visualized by MRI. Enthesitis may resolve spontaneously or may run a chronic course. Standard treatment includes local steroid injections, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. There is little evidence for the efficacy of disease-modifying anti-rheumatic drugs (DMARDs) in enthesitis. In contrast, anti-TNF agents have proven efficacy, and their use in treatment-resistant enthesitis is recommended in the Assessment of SpondyloArthritis international Society (ASAS)/European League Against Rheumatism (EULAR) recommendations for the management of AS and axial SpA and in the EULAR recommendations for psoriatic arthritis.

Therapiestrategien der Psoriasisarthritis

2020 ◽  
Vol 145 (11) ◽  
pp. 773-780
Author(s):  
Michaela Köhm ◽  
Harald Burkhardt ◽  
Frank Behrens
Keyword(s):  
Psoriatic Arthritis ◽  
Randomisierte Kontrollierte Studien ◽  
Neue Substanzen ◽  
Kontrollierte Studien ◽  
European League Against Rheumatism ◽  
European League

Was ist neu? Bestehende Therapieempfehlungen und deren Limitationen In den letzten Jahren haben sich die Basistherapieoptionen für die Behandlung der Psoriasisarthritis deutlich erweitert. Das Sicherheitsprofil der verfügbaren Therapien ist gut untersucht und für die verschiedenen Präparate bekannt. Verschiedene Empfehlungen zur Auswahl und Steuerung der geeigneten Therapie stehen dem Behandler zur Verfügung. Hierbei finden die Empfehlungen der European League Against Rheumatism (EULAR) und der Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) national und international in der Routine Anwendung. Zugelassene Therapieoptionen zur Behandlung der Psoriasisarthritis csDMARD-Therapien haben im Vergleich zur RA in der PsA-Behandlung eine schlechte Evidenzlage. Für neue Substanzen in den Kategorien tsDMARD und bDMARD liegen höhere Evidenzniveaus vor. Da neue Therapien unterschiedliche Zielstrukturen adressieren, bieten sich zunehmend Chancen der personalisierten und individualisierten Therapieentscheidung. Gerade neue pathophysiologische Erkenntnisse zum Erkrankungsbild und die daraus resultierenden Therapieoptionen, die gezielt spezifische Targets adressieren, bieten Möglichkeiten einer immer differenzierteren und individualisierten medikamentösen Behandlung zur Verbesserung der Versorgung der PsA-Patienten, vor allem mit Fokus auf personalisierte Strategien zur optimalen Behandlung verschiedener Manifestationsformen und -muster. Randomisierte kontrollierte Studien und deren Relevanz für den Versorgungsalltag Studienendpunkte randomisierter kontrollierter Studien, deren Studiendesign oft aus der rheumatoiden Arthritis entliehen ist, dienen auch aufgrund der großen Heterogenität der Erkrankung kaum als Basis für individuelle Therapieentscheidungen. Ein mehrschrittiges Vorgehen bei der Auswahl eines individualisierten Behandlungsregimes ist wichtig unter Berücksichtigung der klinischen Manifestation, potenzieller Begleiterkrankungen, von Langzeitsicherheitsaspekten, Kontraindikationen, Applikationsformen und nicht zuletzt des Patientenwunschs.

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