"We thought that there was not enough data to limit [TNF inhibitor treatment] to patients with a specific number of affected joints," Dr. Gossec said.
"We thought that there were not enough data to limit [TNF inhibitor treatment] to patients with a specific number of affected joints," Dr. Gossec said.
The 10 recommendations are as follows:
1. NSAIDs may be used to relieve musculoskeletal signs and symptoms.
2. Treatment with a DMARD such as methotrexate, sulfasalazine, or leflunomide should be considered at an early stage of active disease, especially when it involves many swollen joints, structural damage in the presence of inflammation, high erythrocyte sedimentation rate or C-reactive protein, or clinically relevant extra-articular manifestations.
3. Consider use of methotrexate or another DMARD that also improves psoriasis in patients with active PsA that involves clinically relevant psoriasis.
4. Local injections of corticosteroids should be considered as adjunctive therapy. Systemic steroids at the lowest effective dose may be used with caution.
5. Therapy with a TNF inhibitor should be initiated in patients with active arthritis that responds inadequately to at least one synthetic DMARD, such as methotrexate.
6. Patients with active enthesitis, dactylitis, or both and insufficient response to NSAIDs or local steroid injections should be considered for anti-TNF therapy.
7. Consider anti-TNF therapy in cases of active, predominantly axial disease that has not responded sufficiently to NSAIDs.
8. In exceptional cases, a patient with very active disease who had not yet been treated with a synthetic DMARD may be considered for treatment with an anti TNF agent, especially when the patient has many swollen joints; structural damage in the presence of inflammation; or clinically relevant extra-articular manifestations, especially extensive skin involvement.
9. Consider switching to a different anti-TNF agent if the patient fails to respond adequately to the first drug from this class.
10. When adjusting treatment, take into account factors beyond disease activity, including comorbidities and safety issues.
Dr. Gossec, Dr. Ritchlin, and Dr. Gladman said that they had no relevant disclosures. Dr. Leonardi has been a consultant to, speaker for, and has received research support from Abbott Laboratories, Amgen Inc., and Genentech Inc. He has been a consultant to and received research support from Genentech. He has been a speaker for Warner Chilcott. He has received research support from Allergan Inc., Altana AG, Alza Corp., Astellis Pharma US Inc., Bristol-Myers Squibb, Celgene Corp., CombinatoRx, Eli Lilly & Co., Galderma Laboratories, Genzyme Corp., Incyte Corp., Israel Pharmaceutical, Novartis AG, Perrigo Co., Pfizer Inc., RTL Group, Schering-Plough Corp., 3M, Vitae Pharmaceuticals Inc., and Wyeth.