Table 1.

GRAPPA treatment recommendations’ overarching principles.

  1. Therapy goals for PsA patients

      The ultimate goals of therapy for all patients with PsA are:

        To achieve the lowest possible level of disease activity in all domains of disease. As definitions of remission and low or minimal disease activity become accepted, these will be included in the goal.

        To optimize functional status, improve quality of life and well-being, and prevent structural damage to the greatest extent possible.

        To avoid or minimize complications from both untreated active disease and from therapy.

  2. Assessment of PsA patients

      Assessment of patients with PsA requires consideration of all disease domains, including peripheral arthritis, axial disease, enthesitis, dactylitis, skin psoriasis, psoriatic nail disease, uveitis, and IBD. The effect of disease on pain, function, quality of life, and structural damage should be examined.

  3. Clinical assessment

      Clinical assessment ideally includes patient-reported measures with a comprehensive history and physical examination, often supplemented by laboratory tests and imaging techniques (e.g., radiographs, ultrasound, MRI). The most widely accepted metrics validated for PsA should be used whenever possible.

  4. Comorbidities

      Comorbidities and related conditions should be considered and addressed as soon as possible, including obesity, metabolic syndrome, cardiovascular disease, depression and anxiety, and cardiovascular disease. Multidisciplinary and multispeciality assessment and management will be most beneficial for individual patients.

  5. Therapeutic decisions and treatment

      Therapeutic decisions need to be individualized and should be made jointly by the patient and his or her doctor. Treatment should reflect patient preferences, with patients being provided the best information and relevant options. Treatment choices may be affected by various factors, including disease activity, previous therapies, prognostic factors (such as structural damage and comorbid conditions), and patient factors (such as cost, convenience, and choice).

  6. Treatment

      Ideally, patients should be reviewed promptly and offered regular evaluation by appropriate specialists. Patients should also have their treatment adjusted as needed to achieve the goals of therapy. Early diagnosis and treatment are likely to be of benefit.

  • PsA: psoriatic arthritis; GRAPPA: Group for Research and Assessment of Psoriasis and PsA; IBD: inflammatory bowel disease; MRI: magnetic resonance imaging.