GRAPPA Recommendations for Treating Enthesitis in Psoriatic Arthritis Save

GRAPPA has provided new, evidence based updates to the management of enthesitis in patients with psoriatic arthritis (PsA), affecting at least 30% of PsA patients and is associated with more severe disease, x-ray damage, and poorer outcomes. 

Enthesitis scoring systems have been used in clinical trials and also inform clinicians of spectrum of enthesiopathic sites of involvement and their impact. Enthesitis assessments are typically secondary outcome, either assessed by clinical scoring (manual pressure on select entheses) or imaging by ultrasound or magnetic resonance imaging (MRI).  GRAPPA recommendations are informed by a systematic literature review of 41 randomized clinical trials that were graded and scored by PsA experts.

GRAPPA treatment recommendations for enthesitis were presented by drug classes and their grading.

Treatments with a strong recommendation included: TNFi, IL-17i, IL-12/23i, IL-23p19i, PDE4i, and JAKi.

Treatments with a conditional recommendation included: MTX, nonsteroidal antiinflammatory drugs (NSAIDs), CTLA4-Ig, local corticosteroid injection (with extreme caution) and physiotherapy.

Other conventional synthetic DMARDs were not recommended because of a lack of evidence.