The 2012 BSR and BHPR guideline for the treatment of psoriatic arthritis with biologics
Laura C. Coates1, William Tillett2, David Chandler3, Philip S. Helliwell1,Eleanor Korendowych2, Stuart Kyle4, Iain B. McInnes5, Susan Oliver6, Anthony Ormerod7, Catherine Smith8, Deborah Symmons9, Nicola Waldron2 and Neil J. McHugh2,10 on behalf of BSR Clinical Affairs Committee & Standards, Audit and Guidelines Working Group and the BHPR
Key words: psoriatic arthritis, biologics, treatment, management, guidelines, recommendations, anti-TNF therapies, psoriasis, enthesitis, dactylitis.
PsA is a chronic inflammatory arthropathy affecting up to 40%of patients with skin or nail psoriasis. It is considered a type of seronegative SpA and can cause arthritis, enthesitis, dactylitis and axial inflammation. The use of anti-TNF therapy for the treatment of inflammatory arthritis, including PsA, has revolutionized therapeutic options in rheumatology.
The last British Society of Rheumatology (BSR) guidelines for the treatment of PsA were published in 2005 when anti-TNF therapy was not widely available. At that time, only one of the anti-TNF therapies was licensed for the treatment of PsA. Since then, use in PsA has become more widespread, with multiple anti-TNF drugs licensed for the treatment of PsA and approved for therapy by the National Institute for Health and Clinical Excellence (NICE).
However, despite these advances, there are still patients who do not respond to treatment with anti-TNF therapies and there are difficult clinical situations where the risks of such drugs may outweigh the benefits of therapy. For this reason, it was felt that further guidance was required.
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