SAT0376 MAKING THE NEXT STEPS IN PSORIATIC ARTHRITIS MANAGEMENT: DOMAIN DRIVEN, TREAT-TO-TARGET, TAILORED MANAGEMENT APPROACH
Authors: Yasser El Miedany, Mohammed Hassan Abu-Zaid, Waleed Hassan, Mohammed A. Mortada, Dalia Mekkawy, Samah Ismail Nasef, Nadia El Aroussy, Mervat Eissa, Yossra Atef, Eiman Dessouki, Maha El Gaafary
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The diverse clinical picture of psoriatic arthritis (PsA) suggests the need to identify suitable therapies to address the different combinations of clinical manifestations and comorbidities. The current treatment paradigms recommend early diagnosis and treatment, and a strategic, target orientated approach, aiming at a low disease activity status. The introduction of new treatment modalities highlighted the need for guidelines to prioritize these options for doctors and patients <h3>Objectives</h3> To develop an evidence-based recommendation for the management and treatment of PsA. The management paradigm should cover all domains of psoriatic disease and provide a stepwise tailored treatment options giving clear advice on treatment from the initial diagnosis, including inclusion/exclusion criteria for treatment, monitoring requirements and how to quantify response to treatment. <h3>Methods</h3> A Steering Committee formulated a set of overarching principles for the management of PsA based on evidence derived from a systematic literature review. These were subsequently discussed, amended and voted on by a Task Force of 20 rheumatologists, dermatologists and patient research partners. Using the nominal group technique and Delphi method, 7domains were identified (peripheral arthritis, axial disease, enthesitis, dactylitis, skin and nails as well as comorbidities including uveitis). A multidisciplinary, evidence- and consensus-based treatment recommendations for PsA were developed for each of the domains based on three consensus discussions. A set of recommendations for a sequential DMARD/biologic treatment algorithm for patients with PsA was also set. <h3>Results</h3> literature review provided evidence regarding an optimised domain specific, treat-to- target approach to management. The guidelines addressed both drug and non-drug interventions. 20-statements regarding diagnosis, disease activity scoring, US/MRI scanning, and drug therapy were generated. Percentage of positive votes ranged between 86-100%; whereas mean±SD level of agreement was 9.6+0.3. The main treatment outcome is to achieve remission status or at least low disease activity state, which should be based on a shared decision with parents/patients. Treatment should be adapted according to disease activity. Treatment should be also adapted if the remission state got lost. <h3>Conclusion</h3> Although no clear correlation exists between joint inflammation and the skin in every patient, the skin and joint aspects of the disease often must be treated simultaneously. Treatment recommendations for the cardinal physical manifestations of PsA were developed based on a literature review and consensus between rheumatologists, dermatologists and patients. It is anticipated that periodic updates will take place using this framework as new data become available. <h3>Disclosure of Interests</h3> None declared