Table 3.

Principles

A. Goals of therapy   The ultimate goals of therapy for all patients with PsA are as follows: 1) To achieve the lowest possible level of disease activity in all domains of disease; as definitions of remission and low or minimal disease activity become accepted, these will be included in the goal. 2) To optimize functional status, improve quality of life and well-being, and prevent structural damage to the greatest extent possible. 3) To avoid or minimize complications, both from untreated active disease and from therapy (GRAPPA principle 1).

B. Assessment of domains   Assessment of patients with PsA requires consideration of all major disease domains, including peripheral arthritis, axial disease, enthesitis, dactylitis, psoriasis, and nail disease. The impact of disease on pain, function, quality of life, and structural damage should be examined. In addition, activity in other potential related conditions should be considered, included cardiovascular disease, uveitis and, bowel disease. Multidisciplinary and multispecialty assessment and management will be most beneficial for individual patients. (GRAPPA principle 2)   PsA is a heterogeneous and potentially severe disease, which may require multidisciplinary treatment (EULAR principle A)

C. Assessment of relevant comorbidities   A comprehensive assessment of relevant comorbidities (including but not restricted to obesity, metabolic syndrome, gout, diabetes, cardiovascular disease, liver disease, depression, and anxiety) should be undertaken and documented. (GRAPPA principle 4)   When managing patients with PsA, extra-articular manifestations, metabolic syndrome, cardiovascular disease and other comorbidities should be taken into account. (EULAR principle E)

D. Safety of pharmacotherapy and shared decision making   Therapeutic decisions need to be individualized, and are made jointly by the patient and his or her doctor. Treatment should reflect patient preferences, with the patients provided with the best information and relevant options provided to them. Treatment choices may be affected by various factors, including disease activity, structural damage, comorbid conditions, and previous therapies. (GRAPPA principle 5)   Treatment of patients with PsA should aim at the best care and must be based on a shared decision between the patient and the rheumatologist, considering efficacy, safety and costs. (EULAR principle B)

E. Frequency of follow-up   Ideally, patients should be reviewed promptly, offered regular evaluation by appropriate specialists, and have treatment adjusted as needed in order to achieve the goals of therapy. Early diagnosis and treatment is likely to be of benefit.(GRAPPA principle 6)