Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain

Abstract

The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.

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“…Furthermore, the oral small molecule JAK inhibitors tofacitinib and filgotinib appear promising in clinical trials and may soon be approved for AS. 163,164 Several guidelines for the management of AS have been issued by expert panels in France, 165 Spain, 166 Tukey, 167 Canada, 168,169 the United Kingdom, 170 the United States 171 and Europe, 172 which are all based on systematic literature reviews. As shown in Fig.…”

Consensus on the management of patients with psoriatic arthritis in a dermatology setting

“…As an example, in the presence of clinically significant skin involvement rheumatologist and dermatologist should collaborate in the choice of treatment. Moreover, a comprehensive assessment of comorbidities including obesity, gout, diabetes, cardiovascular disorders, liver disease, depression and anxiety should be undertaken because they could influence the therapeutic decision . The primary goal of treating patients with PsA is to optimize the controls of symptoms, prevent structural damage and disability and improve the quality of life .…”

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“…Notably, the comorbidities of patients with chronic inflammatory diseases need to be considered in treatment decisionmaking. Expert recommendations for the detection and monitoring of comorbidities in the treatment of psoriasis, PsA, and RA patients were developed to provide further guidance on achieving improved disease outcomes [58,59].…”