The first set of international treatment guidelines for psoriatic arthritis address the five most significant clinical manifestations of this chronic systemic inflammatory disorder, which afflicts approximately 10%-30% of people with psoriasis.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has introduced 19 treatment recommendations for peripheral arthritis, enthesitis (inflammation of the entheses, where tendons and ligaments attach to bone), axial disease, skin and nail psoriasis, and dactylitis (uniform swelling of a digit) in the setting of psoriatic arthritis.
This international consortium of medical professionals and patient representatives notes that although advances in the treatment of psoriatic arthritis have accelerated rapidly over the past decade, therapeutic decision making is complicated by diverse clinical characteristics, involvement of multiple different tissues, and varying degrees of severity (Ann Rheum Dis. 2009;68:1387-1394). Psoriatic arthritis manifestations can range from mild psoriasis to widespread psoriatic plaques, disfiguring nail disease to disabling joint inflammation and destruction, and increased mortality.
To address these complexities, GRAPPA formulated evidence-based treatment recommendations for the five clinical manifestations based on literature reviews and consensus opinion. In addition, the group created a grid that factors disease severity into each of the manifestations to guide clinicians in determining the best course of care for each patient.