<\/strong><\/span><\/h4>\n<\/strong><\/span><\/h4>\n<\/strong><\/span><\/h4>\nAncu\u021ba Codrina MD, PhD<\/strong><\/span>
University of Medicine and Pharmacy “Grigore T. Popa” Iasi<\/strong><\/span>
Clinical Recovery Hospital, Rheumatology 2<\/strong><\/span><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.3.4″ hover_enabled=”0″]<\/p>\n
Challenges in the management of psoriasic arthritis. EULAR recommendations \u2013 2019 update<\/span>
Author: Ancu\u021ba Codrina<\/span><\/p>\nObjectives. Defined as an immune-mediated rheumatic disorder developed in patients who have manifest or latent psoriasis, psoriatic arthritis (PsA) is considered a complex multifaceted condition characterized by chronic local and systemic inflammation and a broad spectrum of musculoskeletal as well as mon-musculoskeletal manifestations with significant burden.
\nMethods. Understanding the complex PsA pathobiology allowed the development of a multivalent therapeutic arsenal and a well-defined strategy focused on dual, rheumatologic and dermatologic management.
\nResults. Raising the standard of care for patients with PsA, recent European League Against Rheumatism (EULAR) recommendations not only focus on treat-to-target strategy (remission or, alternatively, low disease activity) and a gradual approach using different drug categories, but also provide a standardized algorithm covering the broad spectrum of disease phenotypes, indicating that a comprehensive therapeutic decision should also consider non-musculoskeletal manifestations, comorbidities and safety. Thus, non-steroidal anti-inflammatory drugs and local injections of glucocorticoids may be considered as first-line medication, irrespective of the musculoskeletal pattern. In patients with peripheral arthritis, a conventional synthetic disease-modifying antirheumatic drug (csDMARD) should be early initiated, with methotrexate preferred if relevant skin involvement, while biological drugs (bDMARD) (TNF, IL-17A or IL-12\/23 inhibitors) are recommended in active PsA with inadequate response to at least one csDMARD. Conversely, a TNF or IL-17A inhibitor represents the treatment of choice if axial PsA. JAK inhibitors are classically indicated after bDMARD failure, while phosphodiesterase-4 inhibitors in the context of mild disease.
\nThe challenges of switching in patients with drug failure as well as tapering in those targeting sustained remission are also addressed.
\nConclusion. 2019 updated EULAR recommendations remain a benchmark in the standardized therapeutic approach of PsA, providing a personalized, gradual process based on clinical phenotype and severity.<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_tablet=”” top_divider_height_phone=”77px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_tablet=”” bottom_divider_height_phone=”54px” bottom_divider_height_last_edited=”on|desktop” global_module=”516″ saved_tabs=”all”][et_pb_row column_structure=”3_5,2_5″ _builder_version=”3.25″ custom_padding=”61px|0px|69px|0px|false|false”][et_pb_column type=”3_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.3.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark” text_line_height_tablet=”” text_line_height_phone=”1.2em” text_line_height_last_edited=”on|desktop”]<\/p>\n
Contact PDI 2020’s PCO<\/p>\n
[\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro” submit_button_text=”Send” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Name” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”E-mail address” field_type=”email” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Message” field_type=”text” fullwidth_field=”on” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.3.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n
PCO of PDI 2020<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”4.3.4″ text_font=”||||||||”]<\/p>\n
![\"\"](\"https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/eventer_logo_150px.png\")
<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAddress: A. Panu St. no. 13, Iasi<\/span>
Tel.: +40 332.40.88.05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
[et_pb_section fb_built=”1″ fullwidth=”on” _builder_version=”3.22″ custom_margin=”||” custom_padding=”15px||29px” top_divider_style=”waves2″ top_divider_color=”#f0622a” top_divider_flip=”horizontal|vertical” bottom_divider_style=”waves2″ bottom_divider_color=”#fcdedb” bottom_divider_height=”105px” bottom_divider_flip=”vertical” collapsed=”off”][et_pb_fullwidth_header title=”@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF90aXRsZSIsInNldHRpbmdzIjp7ImJlZm9yZSI6IiIsImFmdGVyIjoiIn19@” text_orientation=”right” header_image_url=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2020\/03\/pdi2020_new.png” disabled_on=”on|on|off” _builder_version=”4.3.4″ _dynamic_attributes=”title” title_font=”Kaushan Script||||||||” title_text_align=”right” title_text_color=”#f0622a” title_font_size=”50px” content_font=”|600||on|||||” content_text_align=”center” content_text_color=”#686766″ content_font_size=”15px” subhead_font=”||||||||” background_color=”rgba(239,145,107,0.54)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back.jpg” background_layout=”light” custom_margin=”0px||8px” custom_padding=”40px||40px||true” hover_enabled=”0″ content_font_size_tablet=”” content_font_size_phone=”15px” content_font_size_last_edited=”on|desktop”][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.22″][et_pb_row column_structure=”2_5,3_5″ _builder_version=”3.25″][et_pb_column type=”2_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/03\/AncutaCodrina.jpg” align=”center” align_tablet=”center” align_phone=”” align_last_edited=”on|desktop” _builder_version=”3.23″ max_width=”35%” border_radii=”on|100px|100px|100px|100px”][\/et_pb_image][\/et_pb_column][et_pb_column […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5410"}],"collection":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/comments?post=5410"}],"version-history":[{"count":5,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5410\/revisions"}],"predecessor-version":[{"id":8123,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5410\/revisions\/8123"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/media?parent=5410"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
<\/strong><\/span><\/h4>\nAncu\u021ba Codrina MD, PhD<\/strong><\/span>
University of Medicine and Pharmacy “Grigore T. Popa” Iasi<\/strong><\/span>
Clinical Recovery Hospital, Rheumatology 2<\/strong><\/span><\/h4>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.3.4″ hover_enabled=”0″]<\/p>\n
Challenges in the management of psoriasic arthritis. EULAR recommendations \u2013 2019 update<\/span>
Author: Ancu\u021ba Codrina<\/span><\/p>\nObjectives. Defined as an immune-mediated rheumatic disorder developed in patients who have manifest or latent psoriasis, psoriatic arthritis (PsA) is considered a complex multifaceted condition characterized by chronic local and systemic inflammation and a broad spectrum of musculoskeletal as well as mon-musculoskeletal manifestations with significant burden.
\nMethods. Understanding the complex PsA pathobiology allowed the development of a multivalent therapeutic arsenal and a well-defined strategy focused on dual, rheumatologic and dermatologic management.
\nResults. Raising the standard of care for patients with PsA, recent European League Against Rheumatism (EULAR) recommendations not only focus on treat-to-target strategy (remission or, alternatively, low disease activity) and a gradual approach using different drug categories, but also provide a standardized algorithm covering the broad spectrum of disease phenotypes, indicating that a comprehensive therapeutic decision should also consider non-musculoskeletal manifestations, comorbidities and safety. Thus, non-steroidal anti-inflammatory drugs and local injections of glucocorticoids may be considered as first-line medication, irrespective of the musculoskeletal pattern. In patients with peripheral arthritis, a conventional synthetic disease-modifying antirheumatic drug (csDMARD) should be early initiated, with methotrexate preferred if relevant skin involvement, while biological drugs (bDMARD) (TNF, IL-17A or IL-12\/23 inhibitors) are recommended in active PsA with inadequate response to at least one csDMARD. Conversely, a TNF or IL-17A inhibitor represents the treatment of choice if axial PsA. JAK inhibitors are classically indicated after bDMARD failure, while phosphodiesterase-4 inhibitors in the context of mild disease.
\nThe challenges of switching in patients with drug failure as well as tapering in those targeting sustained remission are also addressed.
\nConclusion. 2019 updated EULAR recommendations remain a benchmark in the standardized therapeutic approach of PsA, providing a personalized, gradual process based on clinical phenotype and severity.<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.19.4″ background_color=”rgba(117,194,33,0.23)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back_justflowers_overlay1.png” background_blend=”luminosity” custom_padding=”54px|0px|0|0px|false|false” top_divider_style=”waves2″ top_divider_color=”#ffffff” top_divider_height=”155px” top_divider_height_tablet=”” top_divider_height_phone=”77px” top_divider_height_last_edited=”on|desktop” bottom_divider_style=”waves2″ bottom_divider_color=”#75c221″ bottom_divider_flip=”vertical” bottom_divider_height_tablet=”” bottom_divider_height_phone=”54px” bottom_divider_height_last_edited=”on|desktop” global_module=”516″ saved_tabs=”all”][et_pb_row column_structure=”3_5,2_5″ _builder_version=”3.25″ custom_padding=”61px|0px|69px|0px|false|false”][et_pb_column type=”3_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.3.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark” text_line_height_tablet=”” text_line_height_phone=”1.2em” text_line_height_last_edited=”on|desktop”]<\/p>\n
Contact PDI 2020’s PCO<\/p>\n
[\/et_pb_text][et_pb_contact_form email=”contact@primaderma.ro” submit_button_text=”Send” _builder_version=”3.19.4″ title_font=”||||||||”][et_pb_contact_field field_id=”Name” field_title=”Name” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Email” field_title=”E-mail address” field_type=”email” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][et_pb_contact_field field_id=”Message” field_title=”Message” field_type=”text” fullwidth_field=”on” _builder_version=”3.19.4″ button_text_size__hover_enabled=”off” button_one_text_size__hover_enabled=”off” button_two_text_size__hover_enabled=”off” button_text_color__hover_enabled=”off” button_one_text_color__hover_enabled=”off” button_two_text_color__hover_enabled=”off” button_border_width__hover_enabled=”off” button_one_border_width__hover_enabled=”off” button_two_border_width__hover_enabled=”off” button_border_color__hover_enabled=”off” button_one_border_color__hover_enabled=”off” button_two_border_color__hover_enabled=”off” button_border_radius__hover_enabled=”off” button_one_border_radius__hover_enabled=”off” button_two_border_radius__hover_enabled=”off” button_letter_spacing__hover_enabled=”off” button_one_letter_spacing__hover_enabled=”off” button_two_letter_spacing__hover_enabled=”off” button_bg_color__hover_enabled=”off” button_one_bg_color__hover_enabled=”off” button_two_bg_color__hover_enabled=”off”][\/et_pb_contact_field][\/et_pb_contact_form][\/et_pb_column][et_pb_column type=”2_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.3.4″ text_font=”Kaushan Script||||||||” text_text_color=”#f0622a” text_font_size=”30px” header_font=”||||||||” background_layout=”dark”]<\/p>\n
PCO of PDI 2020<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”4.3.4″ text_font=”||||||||”]<\/p>\n
<\/span><\/p>\n<\/span><\/p>\n<\/span><\/p>\nAddress: A. Panu St. no. 13, Iasi<\/span>
Tel.: +40 332.40.88.05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
<\/span>Website:\u00a0<\/span>www.eventernet.ro<\/a><\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
[et_pb_section fb_built=”1″ fullwidth=”on” _builder_version=”3.22″ custom_margin=”||” custom_padding=”15px||29px” top_divider_style=”waves2″ top_divider_color=”#f0622a” top_divider_flip=”horizontal|vertical” bottom_divider_style=”waves2″ bottom_divider_color=”#fcdedb” bottom_divider_height=”105px” bottom_divider_flip=”vertical” collapsed=”off”][et_pb_fullwidth_header title=”@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF90aXRsZSIsInNldHRpbmdzIjp7ImJlZm9yZSI6IiIsImFmdGVyIjoiIn19@” text_orientation=”right” header_image_url=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2020\/03\/pdi2020_new.png” disabled_on=”on|on|off” _builder_version=”4.3.4″ _dynamic_attributes=”title” title_font=”Kaushan Script||||||||” title_text_align=”right” title_text_color=”#f0622a” title_font_size=”50px” content_font=”|600||on|||||” content_text_align=”center” content_text_color=”#686766″ content_font_size=”15px” subhead_font=”||||||||” background_color=”rgba(239,145,107,0.54)” background_image=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/01\/back.jpg” background_layout=”light” custom_margin=”0px||8px” custom_padding=”40px||40px||true” hover_enabled=”0″ content_font_size_tablet=”” content_font_size_phone=”15px” content_font_size_last_edited=”on|desktop”][\/et_pb_fullwidth_header][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”3.22″][et_pb_row column_structure=”2_5,3_5″ _builder_version=”3.25″][et_pb_column type=”2_5″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/primaderma.ro\/en\/wp-content\/uploads\/2019\/03\/AncutaCodrina.jpg” align=”center” align_tablet=”center” align_phone=”” align_last_edited=”on|desktop” _builder_version=”3.23″ max_width=”35%” border_radii=”on|100px|100px|100px|100px”][\/et_pb_image][\/et_pb_column][et_pb_column […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"_links":{"self":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5410"}],"collection":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/comments?post=5410"}],"version-history":[{"count":5,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5410\/revisions"}],"predecessor-version":[{"id":8123,"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/pages\/5410\/revisions\/8123"}],"wp:attachment":[{"href":"https:\/\/pdi.ro\/en\/wp-json\/wp\/v2\/media?parent=5410"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
University of Medicine and Pharmacy “Grigore T. Popa” Iasi<\/strong><\/span>
Clinical Recovery Hospital, Rheumatology 2<\/strong><\/span><\/h4>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”3.25″][et_pb_column type=”4_4″ _builder_version=”3.25″ custom_padding=”|||” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.3.4″ hover_enabled=”0″]<\/p>\n
Challenges in the management of psoriasic arthritis. EULAR recommendations \u2013 2019 update<\/span> Objectives. Defined as an immune-mediated rheumatic disorder developed in patients who have manifest or latent psoriasis, psoriatic arthritis (PsA) is considered a complex multifaceted condition characterized by chronic local and systemic inflammation and a broad spectrum of musculoskeletal as well as mon-musculoskeletal manifestations with significant burden. 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Author: Ancu\u021ba Codrina<\/span><\/p>\n
\nMethods. Understanding the complex PsA pathobiology allowed the development of a multivalent therapeutic arsenal and a well-defined strategy focused on dual, rheumatologic and dermatologic management.
\nResults. Raising the standard of care for patients with PsA, recent European League Against Rheumatism (EULAR) recommendations not only focus on treat-to-target strategy (remission or, alternatively, low disease activity) and a gradual approach using different drug categories, but also provide a standardized algorithm covering the broad spectrum of disease phenotypes, indicating that a comprehensive therapeutic decision should also consider non-musculoskeletal manifestations, comorbidities and safety. Thus, non-steroidal anti-inflammatory drugs and local injections of glucocorticoids may be considered as first-line medication, irrespective of the musculoskeletal pattern. In patients with peripheral arthritis, a conventional synthetic disease-modifying antirheumatic drug (csDMARD) should be early initiated, with methotrexate preferred if relevant skin involvement, while biological drugs (bDMARD) (TNF, IL-17A or IL-12\/23 inhibitors) are recommended in active PsA with inadequate response to at least one csDMARD. Conversely, a TNF or IL-17A inhibitor represents the treatment of choice if axial PsA. JAK inhibitors are classically indicated after bDMARD failure, while phosphodiesterase-4 inhibitors in the context of mild disease.
\nThe challenges of switching in patients with drug failure as well as tapering in those targeting sustained remission are also addressed.
\nConclusion. 2019 updated EULAR recommendations remain a benchmark in the standardized therapeutic approach of PsA, providing a personalized, gradual process based on clinical phenotype and severity.<\/p>\n<\/span><\/p>\n
Tel.: +40 332.40.88.05<\/span>
E-mail: inscrieri@primaderma.ro<\/a>
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