Enhancing current guidance for psoriatic arthritis and its comorbidities: recommendations from an expert consensus panel

Objectives: The existing guidelines for PsA cover many aspects of management. Some gaps remain relating to routine practice application. An expert group aimed to enhance the current guidance and develop recommendations for clinical practice that are complementary to the existing guidelines. Methods: A steering committee comprising experienced, research-active clinicians in rheumatology, dermatology and primary care agreed on themes and relevant questions. A targeted literature review of PubMed and Embase following a PICO framework was conducted. At a second meeting, recommendations were drafted, and subsequently an extended faculty comprising rheumatologists, dermatologists, primary care clinicians, specialist nurses, allied health professionals, non-clinical academic participants and members of the Brit-PACT patient group, was recruited. Consensus was achieved via an online voting platform at which 75% of respondents agreed in the range of 7-9 on a 9-point scale. Results: The guidance comprised 34 statements covering four PsA themes. Diagnosis focused on strategies for identifying PsA early and referring appropriately, assessment of diagnostic indicators, use of screening tools and use of imaging. Disease assessment centred on holistic consideration of disease activity, physical functioning and impact from a patient perspective, and on how to implement shared decision-making. For comorbidities, recommendations included specific guidance on high-impact conditions such as depression and obesity. Management statements (which excluded extant guidance on pharmacological therapies) recommended multidisciplinary team working, implementation of lifestyle modifications and treat-to-target strategies. Minimizing CS use was recommended where feasible. Conclusion: The consensus group have made evidence-based best-practice recommendations for the management of PsA to enhance the existing guidelines.