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by MedMaven M.D. updated 09/2021

The American College of Rheumatology (ACR) and National Psoriasis Foundation (NPF) have updated their recommendations on caring for individuals with active psoriatic arthrits (PsA) and patients who continue to have active PsA despite treatment.

Key recommendations from the guideline include:

  • Emphasis on treat-to-target approach for all patients with active PsA;
  • Consider use of tumor necrosis factor inhibitor (TNFi) biologics as a first-line therapy option in patients with active PsA
  • A strong recommendation for smoking avoidance/cessation.

According to Dr. Jasvinder Singh, MD, MPH, a rheumatologist at the University of Alabama at Birmingham who served as principal investigator for the guideline project “Treat-to-target is key, because it encompasses all clinical scenarios, rather than one particular clinical situation, the available evidence suggests the irreversible joint damage, associated functional limitations, joint deformities and disability associated with PsA could possibly be avoided/delayed with optimal disease management using a targeted approach. A targeted approach can also improve pain, function and quality of life and social participation.”

“The available evidence suggested that in the absence of certain conditions, many treatment-naïve patients would benefit from trying a TNFi biologic first,” said Dafna Gladman, MD, a rheumatology professor of medicine at the University of Toronto

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The strong recommendation for smoking cessation was based on evidence linking smoking to a reduced efficacy of biologics; the benefits of smoking cessation; and the well-established link of smoking with mortality, cancers and heart and lung diseases in the general population.


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