EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

Laure Gossec, Xenofon Baraliakos, Andreas Kerschbaumer, Maarten de Wit, Iain McInnes, Maxime Dougados, Jette Primdahl, Dennis G. McGonagle, Daniel Aletaha, Andra Balanescu, Peter V. Balint, Heidi Bertheussen, Wolf Henning Boehncke, Gerd R. Burmester, Juan D. Canete, Nemanja S. Damjanov, Tue Wenzel Kragstrup, Tore K. Kvien, Robert B.M. Landewé, Rik Jozef Urbain LoriesHelena Marzo-Ortega, Denis Poddubnyy, Santiago Andres Rodrigues Manica, Georg Schett, Douglas J. Veale, Filip E. Van den Bosch, Désirée van der Heijde, Josef S. Smolen

Research output: Contribution to journalArticlepeer-review

334 Citations (Scopus)


OBJECTIVE: To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA). METHODS: According to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined. RESULTS: The updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed. CONCLUSION: These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.

Original languageEnglish
Pages (from-to)700-712
Number of pages13
JournalAnnals of the rheumatic diseases
Issue number6
Publication statusPublished - 1 Jun 2020


  • DMARDs (biologic)
  • psoriatic arthritis
  • treatment


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