EULAR points to consider and consensus definitions for difficult-to-manage and treatment-refractory psoriatic arthritis
Por:
Marzo-Ortega, H, Harrison, SR, Fragoulis, GE, Michelena, X, Macía-Villa, C, Aydin, SZ, Balanescu, A, Bertheussen, H, Bundy, C, Chimenti, MS, Gisondi, P, Glintborg, B, Gossec, L, Kalyoncu, U, Lubrano, E, Nagy, G, Wagenaar, W, Puig, L, Queiro, R, Rahman, P, Shumnalieva, R, Soriano, ER, van den Bosch, F, Sande, MMGHV, Sepriano, A, Machado, PM, Siebert, S
Publicada:
1 ene 2026
Ahead of Print:
1 ene 2026
Resumen:
Objectives: This study aimed to develop evidence-based points to consider (PtC) and consensus definitions of difficult-to-manage (D2M) and treatment-refractory (TR) psoriatic arthritis (PsA). Methods: A multidisciplinary international European Alliance of Associations for Rheumatology (EULAR) task force (TF) of 27 members, including rheumatologists, dermatologists, health practitioners, and patient partners, was established, and the EULAR standardised operating procedures, including a systematic literature review and a consensus process, were followed. Results: The TF formulated 4 overarching principles addressing the proportion of patients with PsA with an unsatisfactory treatment response despite the best standard of care, and for which the causes are likely multifactorial. Six PtC highlight criterion relevant for subsequent definitions including failure to achieve or maintain response to >= 2 biological/targeted synthetic disease-modifying antirheumatic drugs with >= 2 different mechanisms of action; management of signs and symptoms perceived as problematic by the rheumatologist and/or the patient, and evidence of persistent disease activity in the presence of extramusculoskeletal manifestations and/ or comorbidities and/or objective evidence of inflammatory activity. Finally, the following 2 definitions were developed: (1) D2M PsA, an umbrella term including drivers such as inflammation, comorbidities, psychosocial or other factors, incorporating (2) TR PsA, defined by persistent disease activity and objective evidence of active inflammation. Conclusions: EULAR proposes 2 consensus definitions to identify a D2M PsA population, including a TR subgroup. These definitions should now be tested in research studies to understand disease pathogenesis and improve care for people living with PsA.
Filiaciones:
Marzo-Ortega, H:
Univ Leeds, Leeds Teaching Hosp NHS Trust, NIHR Leeds Biomed Res Ctr, Leeds, England
Univ Leeds, Leeds Inst Rheumat & Musculoskeletal Med, Leeds, England
Harrison, SR:
Univ Leeds, Leeds Teaching Hosp NHS Trust, NIHR Leeds Biomed Res Ctr, Leeds, England
Univ Leeds, Leeds Inst Rheumat & Musculoskeletal Med, Leeds, England
Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds, England
Univ Leeds, Leeds Inst Data Analyt, Leeds, England
Fragoulis, GE:
First Dept Propedeut & Internal Med, Joint Acad Rheumatol Program, Athens, Greece
Michelena, X:
Hosp Univ Vall dHebron, Digest Syst Res Unit, Vall dHebron Barcelona Hosp Campus, Barcelona, Spain
Macía-Villa, C:
Ramon & Cajal Univ Hosp, Rheumatol Dept, Madrid, Spain
Aydin, SZ:
Univ Ottawa, Ottawa Hosp, Res Inst, Ottawa, ON, Canada
Balanescu, A:
Carol Davila Univ Med & Pharm, Sf Maria Hosp, Dept Internal Med & Rheumatol, Bucharest, Romania
Bertheussen, H:
Patient Res Partner, Oslo, Norway
Bundy, C:
Cardiff Univ, Sch Hlth Sci, Cardiff CF24 OAB, Wales
Chimenti, MS:
Univ Roma Tor Vergata, Rheumatol Allergol & Clin Immunol, Rome, Italy
Gossec, L:
Sorbonne Univ, Pitie Salpetriere Hosp, AP HP, INSERM 1136 UMRS PEP Team,Dept Rheumatol, Paris, France
Kalyoncu, U:
Hacettepe Univ, Fac Med, Dept Internal Med, Div Rheumatol, Ankara, Turkiye
Lubrano, E:
Univ Molise, Acad Rheumatol Unit, Campobasso, Italy
Nagy, G:
Semmelweis Univ, Heart & Vasc Ctr, Dept Rheumatol & Immunol, Dept Genet Cell & Immunobiol, Budapest, Hungary
Wagenaar, W:
Tilburg Univ, Tilburg Sch Social & Behav Sci, Tranzo, Tilburg, Netherlands
Puig, L:
Autonomous Univ Barcelona, Hosp Santa Creu & St Pau, Dermatol Dept, Barcelona, Spain
Queiro, R:
Oviedo Univ, Hosp Univ Cent Asturias, Dept Med, Rheumatol Div, Oviedo, Spain
Rahman, P:
Mem Univ, Div Rheumatol, St John, NF, Canada
Shumnalieva, R:
Med Univ Sofia, Univ Hosp St Ivan Rilski, Dept Rheumatol, Clin Rheumatol, Sofia 1612, Bulgaria
Soriano, ER:
Univ Hosp Italiano Buenos Aires, Hosp Italiano Buenos Aires, Internal Med Serv, Rheumatol Sect, Buenos Aires, Argentina
van den Bosch, F:
Univ Ghent, VIB UGent Ctr Inflammat Res, Dept Internal Med & Pediat, Ghent, Belgium
Ghent Univ Hosp, Dept Rheumatol, Ghent, Belgium
Sande, MMGHV:
Univ Amsterdam, Dept Rheumatol & Clin Immunol, Amsterdam UMC, Locat AMC, Amsterdam, Netherlands
Amsterdam Rheumatol & Immunol Ctr ARC, Amsterdam, Netherlands
Amsterdam Inst Immunol & Infect Dis, Amsterdam, Netherlands
Sepriano, A:
Univ NOVA Lisboa, NOVA Med Sch, Lisbon, Portugal
Leiden Univ, Med Ctr, Dept Rheumatol, Leiden, Netherlands
Machado, PM:
Univ Coll London UCL, UCL Queen Sq Inst Neurol, Dept Neuromuscular Dis, London WC1N 3BG, England
Univ Coll London Hosp NHS Fdn Trust, Natl Inst Hlth Res NIHR, Univ Coll London Hosp, Biomed Res Ctr, London, England
Siebert, S:
Univ Glasgow, Sch Infect & Immun, Glasgow, Scotland
Green Submitted, Green Published, hybrid
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