EULAR points to consider and consensus definitions for difficult-to-manage and treatment-refractory psoriatic arthritis
Annals of the Rheumatic Diseases, vol. 85, pp. 61–74
Abstract
OBJECTIVES: This study aimed to develop evidence-based points to consider (PtC) and consensus definitions of difficult-to-manage (D2M) and treatment-refractory (TR) psoriatic arthritis (PsA). METHODS: A multidisciplinary international European Alliance of Associations for Rheumatology (EULAR) task force (TF) of 27 members, including rheumatologists, dermatologists, health practitioners, and patient partners, was established, and the EULAR standardised operating procedures, including a systematic literature review and a consensus process, were followed. RESULTS: The TF formulated 4 overarching principles addressing the proportion of patients with PsA with an unsatisfactory treatment response despite the best standard of care, and for which the causes are likely multifactorial. Six PtC highlight criterion relevant for subsequent definitions including failure to achieve or maintain response to ≥2 biological/targeted synthetic disease-modifying antirheumatic drugs with ≥2 different mechanisms of action; management of signs and symptoms perceived as problematic by the rheumatologist and/or the patient, and evidence of persistent disease activity in the presence of extramusculoskeletal manifestations and/or comorbidities and/or objective evidence of inflammatory activity. Finally, the following 2 definitions were developed: (1) D2M PsA, an umbrella term including drivers such as inflammation, comorbidities, psychosocial or other factors, incorporating (2) TR PsA, defined by persistent disease activity and objective evidence of active inflammation. CONCLUSIONS: EULAR proposes 2 consensus definitions to identify a D2M PsA population, including a TR subgroup. These definitions should now be tested in research studies to understand disease pathogenesis and improve care for people living with PsA.
Authors 26
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Helena Marzo‐Ortega corresponding
University of Leeds · Leeds Teaching Hospitals NHS Trust
Affiliation as printed
NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. Electronic address: h.marzo-ortega@leeds.ac.uk
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University of Leeds · Leeds Teaching Hospitals NHS Trust
Affiliation as printed
NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institutes of Data Analytics, University of Leeds, Leeds, UK
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Affiliation as printed
Joint Academic Rheumatology Program, First Department of Propaedeutic and Internal Medicine, Athens, Greece
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Vall d'Hebron Hospital Universitari
Affiliation as printed
Rheumatology Unit, Digitalization for the Sustainability of the Healthcare System (DS3) and Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Hospital Universitario Ramón y Cajal
Affiliation as printed
Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
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University of Ottawa · Ottawa Hospital Research Institute
Affiliation as printed
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Carol Davila University of Medicine and Pharmacy
Affiliation as printed
Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Sf. Maria Hospital, Bucharest, Romania
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Affiliation as printed
Patient Research Partner, Oslo, Norway
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Affiliation as printed
School of Health Sciences, Cardiff University, Cardiff, UK
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University of Rome Tor Vergata
Affiliation as printed
Rheumatology, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy
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Affiliation as printed
Department of Medicine, Section of Dermatology and Venereology, University of Verona, Rome, Italy
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University of Copenhagen · Copenhagen University Hospital · Rigshospitalet
Affiliation as printed
Copenhagen Center for Arthritis Research and the DANBIO Registry, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup, Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Inserm · Sorbonne Université · Assistance Publique – Hôpitaux de Paris · Pitié-Salpêtrière Hospital · Institut Pierre Louis d‘Épidémiologie et de Santé Publique
Affiliation as printed
Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Team Pepites, and AP-HP, Pitié-Salpêtrière hospital, Rheumatology Department, Paris, France
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Affiliation as printed
Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey
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Affiliation as printed
Academic Rheumatology Unit, University of Molise, Campobasso, Italy
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Affiliation as printed
Department of Rheumatology and Immunology, Heart and Vascular Center, Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
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Affiliation as printed
Patient Research Partner, Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Universitat Autònoma de Barcelona · Hospital de Sant Pau
Affiliation as printed
Dermatology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
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Universidad de Oviedo · Hospital Universitario Central de Asturias
Affiliation as printed
Rheumatology Division, Hospital Universitario Central de Asturias, Department of Medicine, Oviedo University, Oviedo, Spain
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Memorial University of Newfoundland
Affiliation as printed
Division of Rheumatology, Memorial University, St. John's, Newfoundland, Canada
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Affiliation as printed
Department of Rheumatology, Clinic of Rheumatology, University Hospital "St. Anna", Medical University-Sofia, Sofia, Bulgaria
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Hospital Italiano de Buenos Aires · Universidad Hospital Italiano
Affiliation as printed
Rheumatology Section, Internal Medicine Service Hospital Italiano de Buenos Aires, and University Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Ghent University Hospital · Ghent University · VIB-UGent Center for Inflammation Research
Affiliation as printed
VIB-UGent Center for Inflammation Research, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
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Alexandre Rocha Sepriano Aachen
Leiden University · Leiden University Medical Center · Universidade Nova de Lisboa
Affiliation as printed
NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal; Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
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Northwick Park Hospital · National Institute for Health and Care Research · UCL Biomedical Research Centre · UCL Queen Square Institute of Neurology · University College London
Affiliation as printed
Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, Department of Rheumatology, Northwick Park Hospital, London Northwest University Healthcare NHS Trust, London, UK
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Affiliation as printed
School of Infection and Immunity, University of Glasgow, Glasgow, UK
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