Latest! 6 general rules , 12 recommendations, psoriasis arthritis diagnosis and treatment guidelines a piece of knowledge.

Don't want to miss Jiemei's push? Poke the blue word "medical rheumatism and nephropathy channel" to pay attention to us and click the "··" menu in the upper right corner and select "set as star" 2019 EULAR psoriasis arthritis diagnosis and treatment guide! Psoriatic arthritis (PSA) can occur at any age, but it usually occurs in 40-50 years old.most patients developed PSA about 10 years after the onset of psoriasis. Although PSA alone without skin lesions is rare, it has also been reported.PSA is a heterogeneous disease, including musculoskeletal and non musculoskeletal manifestations; the latter includes the skin and nails, but can also involve the intestine or eyes (uveitis).chronic active PSA is also associated with cardiovascular, psychological and metabolic comorbidities.it has been 4 years since the 2015 European Union Against Rheumatism (EULAR) guidelines on PSA drug treatment were updated. With more new drugs applied in clinical practice, clinicians need to update relevant knowledge and concepts.therefore, the 2019 EULAR PSA treatment guidelines have been updated, and the full text of the guidelines has been officially published in the journal Annals of the rheumatic diseases."rheumatism and nephropathy channel" specially invited Professor Guo Qiang, Department of Rheumatology and immunology, Renji Hospital, Medical College of Shanghai Jiaotong University, to give us wonderful comments! According to the diagnosis and treatment flow chart, the guidelines recommend the initial use of NSAIDs and local glucocorticoid injection for treatment of PSA.for patients with arthritis with poor prognosis (such as multiple arthritis, single / oligoarthritis with finger / toe inflammation or joint injury, etc.), it is recommended to start using traditional synthetic disease improving antirheumatic drugs (csdmards, such as methotrexate) as soon as possible.if the treatment goal is not achieved after treatment, biological (b) DMARDs (TNF inhibitor, IL-17A inhibitor, IL-12 / 23 inhibitor) are given next, and the related skin lesions are also considered.If axial disease is the main disease, TNF inhibitors should be used as the first-line DMARDs, and IL-17A inhibitors are more suitable for axial PSAs with skin involvement.JAK inhibitors are mainly used in peripheral PSA patients with failure of bdmar treatment.if the patients with PSA have a mild condition and low disease activity, and the above drugs are not suitable, phosphodiesterase-4 (PDE4) inhibitors can be considered.in general, the new guidelines include 6 general principles and 12 recommendations. The recommendations mainly focus on the non local drug treatment of PSA, focusing on musculoskeletal lesions.there is no significant difference between the six general provisions and the 2015 Version (one new article and one revised wording).among the 12 recommendations, there are additions, revisions, and some suggestions remain unchanged.6 general principles 01psa is a heterogeneous disease that can develop into severe disease and may require multidisciplinary treatment.the treatment of 02psa should aim at the best medical care, and must be based on the common decision-making between patients and rheumatologists on efficacy, safety and cost. 03 rheumatologists should be responsible for the treatment of joint problems in patients with PSA; if the patient has severe skin diseases at the same time, they need to cooperate with dermatologists. the main goal of 04psa treatment is to maximize the quality of life by controlling symptoms and preventing structural damage and inflammation. 05 each musculoskeletal manifestation should be considered and the corresponding treatment decision (New) should be made. 06 skin, eye and gastrointestinal symptoms, as well as complications such as metabolic syndrome, cardiovascular disease or depression, should be considered. the 12 recommendations suggested that the therapeutic purpose of 01psa should be to achieve remission or low disease activity through regular disease activity evaluation and appropriate treatment adjustment. 02nsaids can be used to relieve musculoskeletal manifestations and symptoms (modify wording). 03 topical glucocorticoids should be considered as an adjunct therapy for PSA; perhaps systemic administration of glucocorticoids at the minimum dose may be considered (adjustment number). 04 for patients with multiple arthritis, csdmards should be started quickly, and methotrexate (Revised) should be preferred for patients with skin involvement. 05 csdmards (New) should be considered for patients with monoarthritis or oligoarthritis, especially those with poor prognosis factors such as structural damage, rapid erythrocyte sedimentation rate / high C-reactive protein, fingernail (toe) inflammation or nail involvement. 06 patients with peripheral arthritis who have poor response to at least one csdmards should be treated with bdmads; when related skin is involved, IL-17 inhibitors or IL-12 / 23 inhibitors (Revised and combined) may be preferred. 07 JAK inhibitors (New) may be considered for peripheral arthritis patients with poor response to at least one csdmards and at least one bdmads (or when bdmads are not applicable). 08 for patients with mild disease who have poor response to at least one csdmards, PDE4 inhibitors (Revised) can be considered when both bdmads and JAK inhibitors are not applicable. 09 patients with definite adhesitis who did not respond adequately to NSAIDs or local glucocorticoid injection should be considered for bdmads treatment (Revised). 10 patients with active axial arthritis who have a good response to NSAIDs should be considered for treatment with bdmads (TNF inhibitors are preferred according to current clinical practice), and IL-17 inhibitors may be preferred (Revised) when skin involvement is involved. 11 in patients with poor response or intolerance to bdmads, it is necessary to consider switching to another bdmads or tsdmards, including switching to other drugs of the same type (Revised). 12 for patients with persistent remission, the dosage of DMARDs should be carefully reduced (New). Professor Guo Qiang's PSA is an interdisciplinary disease with rich phenotypes. In addition to the familiar rash and arthritis, it often presents tendon, intestinal, eye, and A-like lesions, involving different pathogenesis, and has many treatment options, so that it goes beyond the classification of the representative disease - axial type spa. however, the drug itself can not be automatically converted into the remission rate of PSA. If it is not effectively and reasonably selected, one more drug is only one more choice. therefore, various academic institutions are scrambling to collate evidence-based evidence and prepare treatment guidelines. among them, the most representative is the treatment guidelines written by EULAR, which has recently released the third edition. according to the established guidelines of EULAR, 21 rheumatologists, 2 PSA patients, 1 public health expert and 1 dermatologist from 15 countries participated in the third edition of the guideline working group. 30% of them were new members, taking into account the representativeness and Modernity of PSA treatment field. one of the important updated contents of this edition of guidelines is to sort out and define the clinical manifestations of psoriasis. Musculoskeletal manifestations include tendinitis, tendinitis, tenosynovitis, phalitis, phalitis and axial arthropathy; non musculoskeletal manifestations include psoriasis rash, enteritis, uveitis and nail lesions, so as to clarify the problem of unclear indication of PSA extraarticular manifestations. another important update of this edition of the guidelines is to affirm the therapeutic value of IL-17 and IL-12 / 23 antagonists in the treatment of psoriatic skin rash PSA. It is recommended that both of them should be preferentially selected in peripheral PSA with insufficient csdmard efficacy and rash, and IL-17 antagonist should be preferred in axial PSA with insufficient efficacy of NSAIDs and rash. considering that most PSA patients are accompanied by psoriasis, this is a big update. tsdmard is also included in the PSA treatment guidelines for the first time in this edition of guidelines, which is targeted at peripheral PSA patients with insufficient or inapplicable bdmar response, reflecting the latest research results of JAK inhibitors in the field of arthritis treatment. compared with the previous version of PSA guidelines, the overall design framework of this guide is basically unchanged, which reflects the maturity of EULAR in the development of guidelines methodology. compared with the American Society of Rheumatology (ACR) 2018 PSA guidelines, EULAR still does not adopt the grade evidence evaluation method which is popular in recent years. On the contrary, it believes that the latter will not be able to present empirical and exploratory research from clinicians due to the emphasis on strong evidence, which may cause the application value of csdmard like MTX to be underestimated. in view of the fact that accurate evaluation is the prerequisite for the realization of disease goal-oriented treatment, and PSA needs to integrate several different tools to complete the comprehensive evaluation due to its multiple characteristics, this version of the guidelines lacks additional description. in addition, considering that psoriasis has become a research hotspot in both rheumatism and skin, and new results will continue to emerge, the guidelines are expected to be updated again in 4 years. Prof. Guo Qiang, executive deputy director, Department of Rheumatology and immunology, Renji Hospital Affiliated to Shanghai Jiaotong University Medical College, standing member of the immunosorbent Academic Committee of the Chinese Medical Association, member and Secretary of the rheumatic immune sample bank of the Chinese Medical Biotechnology Association c L, Baraliakos X, Kerschbaumer A, et al, EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update, Annals of the Rheumatic Diseases 2020;79:700-712.