Servicio de Reumatología, Hospital Universitario La Princesa, IIS-IP, Calle de Diego de León 62, 28006, Madrid, Spain.
Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Rheumatol Int. 2021 Sep;41(9):1549-1565. doi: 10.1007/s00296-021-04877-5. Epub 2021 May 2.
To establish practical recommendations for the management of patients with psoriatic arthritis (PsA) with particular clinical situations that might lead to doubts in the pharmacological decision-making. A group of six expert rheumatologists on PsA identified particular clinical situations in PsA. Then, a systematic literature review (SLR) was performed to analyse the efficacy and safety of csDMARDs, b/tsDMARDs in PsA. In a nominal group meeting, the results of the SLR were discussed and a set of recommendations were proposed for a Delphi process. A total of 65 rheumatologists were invited to participate in the Delphi. Agreement was defined if ≥ 70% of the participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grade of recommendation was established based on the Oxford Evidence-Based Medicine categorisation. Particular clinical situations included monoarthritis, axial disease, or non-musculoskeletal manifestations. The SLR finally comprised 131 articles. A total of 16 recommendations were generated, all but 1 reached consensus. According to them, it is crucial to carefully analyse the impact of individual manifestations on patients (disability, quality of life, etc.), but also to recognise the impact of each drug singularities on selected clinical phenotypes to adopt the most appropriate treatment strategy. Early diagnosis and treatment to target approach, along with a close risk management, is also necessary. These recommendations are intended to complement gaps in national and international guidelines by helping health professionals address and manage particular clinical situations in PsA.
为了针对可能导致药物决策产生疑虑的特定临床情况，为患有银屑病关节炎（PsA）的患者制定切实可行的管理建议。一组 6 名银屑病关节炎专家确定了银屑病关节炎中的特定临床情况。然后，进行了系统文献回顾（SLR），以分析 csDMARDs、b/tsDMARDs 在银屑病关节炎中的疗效和安全性。在名义小组会议上，讨论了 SLR 的结果，并提出了一套建议，供 Delphi 流程使用。共邀请了 65 名风湿病学家参加 Delphi。如果≥70%的参与者投票≥7（从 1 分，完全不同意到 10 分，完全同意），则定义为达成一致。对于每个建议，根据牛津循证医学分类法确定证据水平和推荐等级。特定的临床情况包括单关节炎、轴性疾病或非骨骼肌肉表现。SLR 最终包括 131 篇文章。共提出了 16 项建议，除了 1 项外，其余都达成了共识。根据这些建议，仔细分析个体表现对患者的影响（残疾、生活质量等）至关重要，但也需要认识到每种药物特性对选定临床表型的影响，以采用最合适的治疗策略。早期诊断和靶向治疗，以及密切的风险管理也是必要的。这些建议旨在通过帮助卫生专业人员解决和管理银屑病关节炎中的特定临床情况，补充国家和国际指南中的空白。
