为银屑病关节炎(PsA)的药物和非药物治疗制定循证指南,作为美国风湿病学会(ACR)和国家牛皮癣基金会(NPF)之间的合作。
我们确定了PsA和临床相关PICO(人口/干预/比较/结果)问题的关键结果。文献综述小组进行了系统的文献综述,以总结支持PsA的可用药物和非药物疗法的益处和危害的证据。等级(建议评估的等级,开发和评估)方法用于评估证据质量。一个投票小组,包括风湿病学家,皮肤科医生,其他卫生专业人员,和病人,就建议的方向和力度达成共识。
该指南涵盖了未接受治疗的患者以及尽管接受了治疗仍继续患有活动性PsA的患者的活动性PsA的管理。并解决了口服小分子的使用,肿瘤坏死因子抑制剂,白细胞介素-12/23抑制剂(IL-12/23i),IL-17抑制剂,CTLA4-Ig(abatacept),和JAK抑制剂(托法替尼)。我们还提出了牛皮癣性脊柱炎的建议,占优势的附着性炎,并在并发炎症性肠病的情况下进行治疗,糖尿病,或严重感染。我们为治疗到目标的策略制定了建议,疫苗接种,和非药物疗法。6%的建议是强有力的,94%的建议是有条件的,表明卫生保健提供者和患者之间积极讨论以选择最佳治疗的重要性。
2018年ACR/NPFPsA指南是医疗保健提供者和患者在常见临床场景中选择适当治疗的工具。最佳治疗决定考虑每个患者的情况。该指南并不意味着是程序性的,也不应用于限制PsA患者的治疗选择。
To develop an evidence-based
guideline for the pharmacologic and nonpharmacologic treatment of psoriatic arthritis (PsA), as a collaboration between the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF).
We identified critical outcomes in PsA and clinically relevant PICO (population/intervention/comparator/outcomes) questions. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available pharmacologic and nonpharmacologic therapies for PsA. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of the evidence. A voting panel, including rheumatologists, dermatologists, other health professionals, and patients, achieved
consensus on the direction and the strength of the recommendations.
The
guideline covers the management of active PsA in patients who are treatment-naive and those who continue to have active PsA despite treatment, and addresses the use of oral small molecules, tumor necrosis factor inhibitors, interleukin-12/23 inhibitors (IL-12/23i), IL-17 inhibitors, CTLA4-Ig (abatacept), and a JAK inhibitor (tofacitinib). We also developed recommendations for psoriatic spondylitis, predominant enthesitis, and treatment in the presence of concomitant inflammatory bowel disease, diabetes, or serious infections. We formulated recommendations for a treat-to-target strategy, vaccinations, and nonpharmacologic therapies. Six percent of the recommendations were strong and 94% conditional, indicating the importance of active discussion between the health care provider and the patient to choose the optimal treatment.
The 2018 ACR/NPF PsA
guideline serves as a tool for health care providers and patients in the selection of appropriate therapy in common clinical scenarios. Best treatment decisions consider each individual patient situation. The
guideline is not meant to be proscriptive and should not be used to limit treatment options for patients with PsA.