Table 2.

Summary of differences in recommendations

	EULAR 2015	GRAPPA 2015	ACR/NPF 2018
Process
Method	OCEBM	Modified GRADE	GRADE
Composition of the committees	Mainly rheumatologists; patients and allied health professionals	Greater dermatologist involvement including leading two working groups; patients involved in each group	Relatively few dermatologists involved; patients in the expert and voting panels and separate patient panel; allied health professionals involved in the expert and voting panels
Structure of recommendations	Flow diagram with caveats	Flow diagrams for each feature with caveats	Only pairwise comparisons; no flow diagram can be created
Psoriasis management	Minimally addressed except to refer to co-management	Skin and nail disease addressed	Addressed in the conditions with regard to severity of psoriasis in particular; refers to co-management and concurrent AAD/NPF guidelines for management of psoriasis
Axial disease management	Addressed	Addressed	Only a few questions addressed but otherwise refers to ACR/SPARTAN guideline
Enthesitis	Addressed	Addressed	Addressed
Drugs
MTX	Recommended as csDMARD of choice	Considered alongside other csDMARDs	Generally considered alongside other OSMs
TNF inhibitors	Recommended after failure of csDMARD for peripheral arthritis Earlier use in predominant axial disease or enthesitis. Or if there were prognostic indicators for severe disease Preference for TNFi as first-line biologic	Recommended after failure of csDMARD for peripheral arthritis though can be used first in severe disease, enthesitis or axial disease No clear preference among biologics	Conditionally recommended first in treatment naïve PsA over OSMs Conditional preference for TNFi over other biologics
Secukinumab	Recommended after failure of csDMARD but TNFi preferred as first line biologic	Recommended alongside other biologics	Conditionally recommended after TNFi but may be used earlier in setting of contraindications to TNFi or patients with severe psoriasis or nail disease
Ixekizumab	Not available	Not available	Conditionally recommended after TNFi but may be used earlier in setting of contraindications to TNFi or patients with severe psoriasis or nail disease.
Ustekinumab	Recommended after failure of csDMARD but TNFi preferred as first line biologic	Recommended alongside other biologics	Conditionally recommended after IL-17 except in IBD and in patients who desire less frequent injections
Apremilast	Recommended for use after MTX if biologics are contraindicated	Recommended for use after failure of csDMARDs or if csDMARDs are contraindicated. Conditionally recommended before csDMARD in some cases	Considered alongside other OSMs
Abatacept	Not available	Not available	Generally conditionally recommended after TNFi
Tofacitinib	Not available	Not available	Generally conditionally recommended after TNFi

This table was adapted from Gossec et al. [16]. csDMARD: conventional synthetic DMARD; GRADE: Grading of Recommendations Assessment, Development and Evaluation; GRAPPA: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; NPF: National Psoriasis Foundation; OCEBM: Oxford Centre for Evidence-Based Medicine; OSM: oral small molecules; SPARTAN: Spondyloarthritis Research and Treatment Network; TNFi: TNF inhibitors.