Current treatment of psoriatic arthritis: update based on a systematic literature review to establish French Society for Rheumatology (SFR) recommendations for managing spondyloarthritis.

OBJECTIVE

The latest recommendations on managing psoriatic arthritis (PsA) were issued in 2007 by the French Society for Rheumatology (SFR) and in 2012 by the European League against Rheumatism (EULAR). A panel of spondyloarthritis experts developed new recommendations on the management of spondyloarthritides, including PsA, based on a literature review and expert opinion.

METHODS

The relevant literature published between December 1, 2009 and March 31, 2013 was reviewed by searching Medline; Embase; the Cochrane database; abstracts from meetings held by the SFR, EULAR, and American College of Rheumatology (ACR) between 2010 and 2012; and the therapeutic trials registered on http://www.clinicaltrials.gov.

RESULTS

No studies assessed nonsteroidal anti-inflammatory drugs or glucocorticoids (given systemically or intraarticularly) in PsA. The efficacy of methotrexate was evaluated versus a placebo in the randomized MIPA trial. TNFα antagonists (the soluble receptor etanercept, chimeric monoclonal antibody [mAb] infliximab, humanized mAbs adalimumab and golimumab, and PEGylated mAb certolizumab) are the reference-standard biotherapies in PsA. The treat-to-target approach should be used, with the target being a remission or minimal disease activity. Registry data leave room for controversy about the potential benefits of combining methotrexate and a TNFα antagonist. Switching to an alternative TNFα antagonist when the first drug fails is effective, although the initial response and drug continuation rate may be decreased. New drugs such as apremilast and ustekinumab are being developed.

CONCLUSION

This systematic literature review allowed the development of new SFR recommendations on the treatment of PsA.