BACKGROUND: Since the publication of the European League Against Rheumatism recommendations for the pharmacological treatment of psoriatic arthritis (PsA) in 2012, new evidence and new therapeutic agents have emerged. The objective was to update these recommendations. METHODS: A systematic literature review was performed regarding pharmacological treatment in PsA. Subsequently, recommendations were formulated based on the evidence and the expert opinion of the 34 Task Force members. Levels of evidence and strengths of recommendations were allocated. RESULTS: The updated recommendations comprise 5 overarching principles and 10 recommendations, covering pharmacological therapies for PsA from non-steroidal anti-inflammatory drugs (NSAIDs), to conventional synthetic (csDMARD) and biological (bDMARD) disease-modifying antirheumatic drugs, whatever their mode of action, taking articular and extra-articular manifestations of PsA into account, but focusing on musculoskeletal involvement. The overarching principles address the need for shared decision-making and treatment objectives. The recommendations address csDMARDs as an initial therapy after failure of NSAIDs and local therapy for active disease, followed, if necessary, by a bDMARD or a targeted synthetic DMARD (tsDMARD). The first bDMARD would usually be a tumour necrosis factor (TNF) inhibitor. bDMARDs targeting interleukin (IL)12/23 (ustekinumab) or IL-17 pathways (secukinumab) may be used in patients for whom TNF inhibitors are inappropriate and a tsDMARD such as a phosphodiesterase 4-inhibitor (apremilast) if bDMARDs are inappropriate. If the first bDMARD strategy fails, any other bDMARD or tsDMARD may be used. CONCLUSIONS: These recommendations provide stakeholders with an updated consensus on the pharmacological treatment of PsA and strategies to reach optimal outcomes in PsA, based on a combination of evidence and expert opinion.

A DI PSO Rome Italy

Arthritis Unit Department of Rheumatology Hospital Clínic and IDIBAPS Barcelona Spain

Belgrade University School of Medicine Belgrade Serbia

Centre for Arthritis and Rheumatic Disease Dublin Academic Medical Centre St Vincent's University Hospital Dublin Ireland

Department of Clinical Immunology and Rheumatology Amsterdam Rheumatology Center Amsterdam The Netherlands Atrium Medical Center Heerlen The Netherlands

Department of Dermatology University Hospital Münster Münster Germany

Department of Internal Medicine 3 University of Erlangen Nuremberg Erlangen Germany

Department of Rheumatology and Clinical Immunology Charité University Medicine Berlin Germany

Department of Rheumatology and Clinical Immunology German Rheumatism Research Centre Berlin Charité University Medicine Berlin Germany

Department of Rheumatology Campus Benjamin Franklin Charité Berlin Germany

Department of Rheumatology Diakonhjemmet Hospital Oslo Norway

Department of Rheumatology Leiden University Medical Centre Leiden The Netherlands

Department of Rheumatology St Vincent's University Hospital and Conway Institute University College Dublin Dublin Ireland

Division of Rheumatology Department of Medicine 3 Medical University of Vienna Vienna Austria

Division of Rheumatology Department of Medicine 3 Medical University of Vienna Vienna Austria 2nd Department of Medicine Hietzing Hospital Vienna Austria

EULAR representing People with Arthritis Rheumatism in Europe London UK

Ghent University Hospital Ghent Belgium

Institute and Clinic of Rheumatology Charles University Prague Czech Republic

Institute of Infection Immunity and Inflammation University of Glasgow Glasgow UK

Laboratory of Tissue Homeostasis and Disease Skeletal Biology and Engineering Research Center KU Leuven Belgium Division of Rheumatology University Hospitals Leuven Leuven Belgium

Leeds NIHR Musculoskeletal Biomedical Research Unit LTHT Leeds UK Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Leeds UK

Medicine Faculty Paris Descartes University Paris France Rheumatology B Department APHP Cochin Hospital Paris France

North Devon UK

Research Laboratory and Clinical Division of Rheumatology Department of Internal Medicine University of Genova Viale Benedetto Italy

Rheumatology Department of Lucania San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera Potenza Italy

Rheumazentrum Ruhrgebiet Herne and Ruhr Universität Bochum Herne Germany

Schoen Klinik Hamburg Rheumatology and Clinical Immunology Hamburg Germany

Section of Musculoskeletal Disease Leeds Institute of Molecular Medicine University of Leeds Leeds UK

Section of Rheumatology Department of Clinical Sciences Lund University Lund Sweden Sweden and School of Business Engineering and Science Halmstad University Halmstad Sweden

Sorbonne Universités UPMC Univ Paris 06 Institut Pierre Louis d'Epidémiologie et de Santé Publique GRC UPMC 08 Paris France Department of rheumatology AP HP Pitié Salpêtrière Hospital Paris France

References provided by Crossref.org

Efficacy and Safety of Ixekizumab in Patients with Psoriatic Arthritis and Inadequate Response to TNF Inhibitors: 3-Year Follow-Up (SPIRIT-P2)

Impact of tapering targeted therapies (bDMARDs or JAKis) on the risk of serious infections and adverse events of special interest in patients with rheumatoid arthritis or spondyloarthritis: a systematic analysis of the literature and meta-analysis

Efficacy and Safety of Subcutaneous Secukinumab 150 mg with or Without Loading Regimen in Psoriatic Arthritis: Results from the FUTURE 4 Study

Mapping Quality of Life (EQ-5D) from DAPsA, Clinical DAPsA and HAQ in Psoriatic Arthritis

Efficacy and safety of secukinumab administration by autoinjector in patients with psoriatic arthritis: results from a randomized, placebo-controlled trial (FUTURE 3)

Comparing biosimilar SB2 with reference infliximab after 54 weeks of a double-blind trial: clinical, structural and safety results