Group for Research and Assessment of Psoriasis and Psoriatic Arthritis

Reviewed on July 30, 2024

Overview

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published updated recommendations for therapy of PsA in 2021 (Figure 6-11). Although he current recommendations continue to be organized by PsA domain, GRAPPA recognizes that most patients present with PsA in multiple domains, and the choice of therapy should address as many domains as possible while taking into account patient preferences and prior and concomitant therapies.

For the treatment of peripheral PsA, the guidelines offer different recommendations based on prior therapy. For disease-modifying antirheumatic drugs (DMARD)-naïve patients, a csDMARD (with the exception of cyclosporine), a tumor necrosis factor inhibitor (TNFi), an inhibitor of IL-12/23, IL-17, or IL-23, a JAKi, or a PDE4i is strongly recommended. For patients with an inadequate response to prior DMARD therapy, a TNFi, an IL-12/23, -17, or -23 inhibitor, a JAKi, or a PDE4i are preferred. Finally, for patients with prior…

Overview

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published updated recommendations for therapy of PsA in 2021 (Figure 6-11). Although he current recommendations continue to be organized by PsA domain, GRAPPA recognizes that most patients present with PsA in multiple domains, and the choice of therapy should address as many domains as possible while taking into account patient preferences and prior and concomitant therapies.

For the treatment of peripheral PsA, the guidelines offer different recommendations based on prior therapy. For disease-modifying antirheumatic drugs (DMARD)-naïve patients, a csDMARD (with the exception of cyclosporine), a tumor necrosis factor inhibitor (TNFi), an inhibitor of IL-12/23, IL-17, or IL-23, a JAKi, or a PDE4i is strongly recommended. For patients with an inadequate response to prior DMARD therapy, a TNFi, an IL-12/23, -17, or -23 inhibitor, a JAKi, or a PDE4i are preferred. Finally, for patients with prior biologic DMARD experience, the preferred agent is a TNFi, IL-17i, IL-23i, or a JAKi.

For patients with axial disease, NSAIDs, physiotherapy, and simple analgesia are strongly recommended, as are a JAKi, TNFi, or IL-17i. For PsA enthesitis, strongly recommended options include a TNFi, an IL-12/23, -17, or -23 inhibitor, a JAKi, or a PDE4i. Finally, for patients with dactylitis, GRAPPA strongly recommends a TNFi, an IL-12/23, -17, or -23 inhibitor, a JAKi, or a PDE4i.

Enlarge  Figure 6-11: GRAPPA Treatment Schema for Active PsA.  Key: bDMARD, biologic DMARD; CTLA4- Ig, CTLA4–immunoglobulin fusion protein; csDMARD, conventional synthetic DMARD; ETN, etanercept; GC, glucocorticoid; IBD, inflammatory bowel disease; JAKi, Janus kinase inhibitor; MTX, methotrexate; PDE4i, phosphodiesterase 4 inhibitor; TNFi, TNF inhibitor. The order of the products in the boxes is sorted by mechanism of action and does not reflect guidance on relative efficacy or suggested usage. Bold text indicates a strong recommendation, standard text a conditional recommendation. The asterisks indicate a conditional recommendation based on data from abstracts only. Source:  Coates LC, et al. Nat Rev Rheumatol. 2022;18(8):465-479.
Figure 6-11: GRAPPA Treatment Schema for Active PsA. Key: bDMARD, biologic DMARD; CTLA4- Ig, CTLA4–immunoglobulin fusion protein; csDMARD, conventional synthetic DMARD; ETN, etanercept; GC, glucocorticoid; IBD, inflammatory bowel disease; JAKi, Janus kinase inhibitor; MTX, methotrexate; PDE4i, phosphodiesterase 4 inhibitor; TNFi, TNF inhibitor. The order of the products in the boxes is sorted by mechanism of action and does not reflect guidance on relative efficacy or suggested usage. Bold text indicates a strong recommendation, standard text a conditional recommendation. The asterisks indicate a conditional recommendation based on data from abstracts only. Source: Coates LC, et al. Nat Rev Rheumatol. 2022;18(8):465-479.

References

  • Ruderman EM, Gordon KB. Clinical Management of Psoriatic Arthritis and Psoriasis. 4th ed. Professional Communications Inc. 2022
  • Coates LC, Soriano ER, Corp N, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol. 2022;18(8):465-479