TY - JOUR T1 - Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.220312 SP - jrheum.220312 AU - Lihi Eder AU - Ashish J. Mathew AU - Philippe Carron AU - Heidi Bertheussen AU - Juan D. CaƱete AU - May Azem AU - Andrea Delle Sedie AU - Carlo Salvarani AU - Roberto Ranza AU - Ashley Elliott AU - Anthony Turkiewicz AU - Ricardo Acayaba de Toledo AU - Hulya Bukulmez AU - Maria S. Stoenoiu AU - Arthur M. Mandelin II AU - Michaela Koehm AU - Chris Lindsay AU - Evan Siegel AU - Philip J. Mease Y1 - 2022/11/01 UR - http://www.jrheum.org/content/early/2022/10/26/jrheum.220312.abstract N2 - Objective Enthesitis is a key pathological and clinical feature of psoriatic arthritis (PsA) in children and adults. Enthesitis is typically assessed clinically using several validated enthesitis scoring systems that have been used in clinical trials. Enthesitis treatment response has been reported as change in the total enthesitis score or the proportion of patients who achieved complete resolution. The majority of trials in PsA did not require patients to have enthesitis at study entry since enthesitis was evaluated only as a secondary outcome. Despite the inherent limitations of the clinical assessment of enthesitis, imaging of the entheses using ultrasound or magnetic resonance imaging has rarely been used in clinical trials to assess response to treatment of enthesitis. This systematic review summarizes existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA to facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA. Methods We performed a systematic literature review to identify 41 randomized clinical trials that reported enthesitis treatment response in patients with PsA. For each intervention, the response effect size was summarized and the quality of evidence was graded. Recommendations were then formulated for the various pharmacological and nonpharmacological therapies. Results We included 41 randomized clinical trials in our review and graded each intervention. Conclusion Several classes of systemic conventional and advanced therapies and local measures were recommended for active enthesitis in patients with PsA. ER -