The APLAR Recommendations for the Management of Psoriatic Arthritis

OBJECTIVES: Under the auspices of the Asia-Pacific League of Associations for Rheumatology (APLAR), we aimed to develop broad, evidence- and consensus-based guidelines to aid health professionals managing patients with psoriatic arthritis (PsA) in the region. METHODS: A working group of 35 members comprising rheumatologists, dermatologists, and patient research partners from 18 APLAR countries was convened. The working group conducted systematic literature reviews to derive the quality of evidence via GRADE methods in supporting the efficacy and safety of classes of therapeutic agents for the management of active PsA, its comorbidities, and screening for specific infection concerns in the region. Recommendation statements on the principles of management and the best use of therapeutic drugs were developed. Consensus within the working group was achieved. An external voting panel, five from each of the 18 APLAR countries, was convened to confirm further agreement on the recommendation statements. RESULTS: The main literature review included 178 articles from clinical trials for PsA. Additional articles on the evidence for managing comorbidities, uveitis, inflammatory bowel disease, and screening for chronic hepatitis B and latent tuberculosis were reviewed. The working group discussed and reached consensus on eight management principles and 16 recommendation statements for managing PsA. Endorsement from an external voting panel (n = 90, response rate 80%) was achieved. CONCLUSION: These first recommendations for the management of PsA patients in the APLAR regions were developed based on the best available evidence and region-specific considerations through discussion among rheumatologists, dermatologists, and patients, with strong agreement from an external expert panel.