Key Stakeholders Target Co-Morbidities in Psoriatic Arthritis Patients

Recommendations for co-morbidities identified as an important step for the optimal care of patients.

In an effort to raise awareness for the health dangers attached to psoriatic arthritis, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is preparing the first guidelines drafted for the treatment of co-morbidities associated with the disease.

The guidelines were drafted by GRAPPA and the Spondyloarthritis Research and Treatment Network (SPARTAN) at their recent joint meeting.

"I am really excited that we are taking the initiative to treat and manage the psoriatic arthritis [PsA] patient as a whole," said Dr. Elaine Husni, director of the Arthritis and Musculoskeletal Center at the Cleveland Clinic, in a press release.

A GRAPPA and SPARTAN consensus group fielded questions about key recommendations, which will then proceed through a discussion and review process prior to being formally adopted. The group strongly recommended that patients be evaluated for cardiovascular disease due to mounting evidence PsA patients carry an increased risk, but still conferred it with grade D evidence.

"The grade D was based on the fact that there are no outcomes data specifically in patients with psoriatic arthritis," said Dr. Alexis R. Ogdie-Beatty, director of the Penn Psoriatic Arthritis Clinic at the University of Pennsylvania, in a press release.

Additional strong recommendations with grade D evidence were issued for ophthalmic complications and inflammatory bowel disease screening, in which there is solid evidence for PsA association, but limited proof that the screening can improve outcomes, according to the release. Obesity received a B rating from the groups for evidence that shows a benefit from diagnosis and treatment.

Diabetes screening, however, was given a weak rating with grade D supporting evidence. Other recommendations included screening for hepatitis C, HIV, and tuberculosis before immunosuppressant therapies, particularly biologics, are initiated. Those recommendations were all labeled as strong with ratings between B and C grades.

Despite the consensus including strong screening recommendations, the guidelines are not expected to specifically address the management of co-morbidities due to concern for applicability across various care settings. For example, treatment of cardiovascular disease risks could be managed by rheumatologists in some areas of the world and by specialists in other regions, according to GRAPPA.

The conference identified clear co-morbidity recommendations as an important step in outlining the optimal care for PsA patients, in addition to raising awareness for co-morbidities without any specific valid approach.

The groups are also interested in creating a usage table for specific PsA medications for treatment in the context of co-morbidities. Examples include caution in the use of NSAIDs in patients with cardiovascular disease, monitoring the use of cyclosporine in patients with chronic kidney disease, and a preference for the use of etanercept over other tumor necrosis factor inhibitors for the treatment of hepatitis C infections.