ILAR Treatment Recommendations for Psoriatic Arthritis in Resource-Poor Countries Available

New International League of Associations for Rheumatology (ILAR) recommendations are now available for the treatment of patients with psoriatic arthritis (PsA) living in resource-poor regions, including Central and South America and Africa.

The new ILAR recommendations were adapted from existing PsA treatment recommendations developed by the European League Against Rheumatism (EULAR)¹ and the Group for Research and Assessment of Psoriasis and PSA (GRAPPA),² as well as expert opinion from these regions. EULAR and GRAPPA issued their respective recommendations for management of PsA in 2015, but there have been concerns that the guidelines were primarily based on studies conducted in resource-wealthy countries and thus might not be applicable to resource-poor countries. The study, by Musaab Elmamoun, MBBS, MRCPI, and a group of international expert colleagues, was presented at the annual European Congress of Rheumatology, held June 13-16, 2018, in Amsterdam, and hosted by EULAR.

The first part of the collaborative process was undertaken to assess and adapt EULAR and GRAPPA treatment recommendations for PsA to cover patients living in Central and South America and Africa:

• Set-up phase: identifying and seeking agreement from a panel of participants from the relevant countries.
• Adaptation phase: defining health questions using the PIPOH tool, assessing the 2 sources’ recommendations, conducting a systematic literature review to answer health questions not addressed in the 2 sources’ recommendations, assessing quality of source recommendations, assessing applicability of principles contained in the source recommendations, and drafting adapted recommendations.
• Finalization phase: external review, aftercare planning, and final production.

The adaptation process resulted in the creation of 5 principles for the management of PsA that address goals of therapy, assessment of domains, assessment of relevant comorbidities, safety of pharmacotherapy and shared decision-making, and frequency of follow up.

Finally, the collaborative group developed the following 6 recommendations for the management of PsA:

1. Goals of therapy
2. Screening and management of tuberculosis, HIV, hepatitis B infection, hepatitis C infection, Chagas’ disease, leishmaniasis, leprosy, and other concomitant comorbidities
3. Frequency of monitoring in resource-poor countries
4. Safety and efficacy of pharmacotherapy in all domains
5. Efficacy and safety of combination therapy
6. Safety and efficacy of biosimilars and intended copies of biologic treatments

References

1. Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75(3):499-510. doi: 10.1136/annrheumdis-2015-208337.
2. Coates LC, Kavanaugh A, Mease PJ, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol. 2016;68(5):1060-1071. doi: 10.1002/art.39573.