OriginalDocumento SER de consenso sobre el uso de terapias biológicas en la artritis psoriásicaConsensus statement of the Spanish Society of Rheumatology on the management of biologic therapies in psoriatic arthritis
Section snippets
Introducción
La artritis psoriásica (APs) es una enfermedad inflamatoria musculoesquelética crónica, habitualmente seronegativa, asociada a la presencia de psoriasis cutánea1. La APs ya establecida se clasifica de acuerdo a los criterios CASPAR2 (tabla 1), aunque todavía está por confirmar la utilidad de estos criterios en la APs de inicio3.
Desde el punto de vista clínico, existen cinco grandes áreas de manifestaciones características de la APs: la artritis periférica, vertebral, dactilitis, entesitis y las
Métodos
Para realizar este consenso, se utilizó una modificación de la metodología de RAND/UCLA28. Este documento se basa en las revisiones y recomendaciones de la ESPOGUIA27 junto con una revisión crítica del consenso previo29. Se formó un panel de 19 expertos reumatólogos que pertenecieran al Grupo de Espondiloartritis de la Sociedad Española de Reumatología (SER) (GRESSER) o que hubieran participado en la confección de la ESPOGUIA27 o del consenso de espondiloartritis (EspA) previo29. A estos se les
Objetivo terapéutico
El objetivo del tratamiento de la APs es la remisión de la enfermedad o, en su defecto, reducir al mínimo la actividad inflamatoria (MAE) para alcanzar una mejoría significativa de los síntomas y signos, preservar la capacidad funcional, mantener una buena calidad de vida y controlar el daño estructural (NE 5; GR D; GA 100%).
Para alcanzar una MAE, los pacientes con APs periférica deben reunir al menos 5 de los siguientes 7 criterios:
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NAD ≤ 1.
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NAT ≤ 1.
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PASI ≤ 1 o área de superficie corporal ≤ 3%.
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Discusión
Este documento forma parte de la segunda actualización del consenso de la SER sobre el uso de TB en las EspA. Se basa en las revisiones y recomendaciones de la ESPOGUIA27 junto con una revisión crítica del consenso previo29, siguiendo una metodología científica mediante encuesta Delphi. En relación con los anteriores consensos, la APs aparece como entidad individual para la que se ha realizado un consenso específico. Esta decisión la ha tomado el panel de expertos a partir de que las
Financiación
El presente documento ha sido financiado por la SER y parcialmente con el Subprograma RETICS, RD08/0075 (RIER) del Instituto de Salud Carlos III (ISCIII), dentro del VI PN de I + D + i 2008-2011 (FEDER).
Conflicto de intereses
Los doctores: Estíbaliz Loza y Enrique Batlle declaran no tener conflicto de intereses. La Dra. Rosario García de Vicuña recibe becas de investigación de Roche, BMS y Schering Plough, así como honorarios o pagos por consultoría por parte de la Fundación Abbott. El Dr. Juan Cañete recibe becas de investigación de Abbott.
Agradecimientos
El panel desea agradecer a todos aquellos que participaron en la ESPOGUIA.
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Cited by (33)
Expert recommendations on treating psoriasis in special circumstances
2015, Actas Dermo-SifiliograficasEtanercept in the treatment of psoriatic arthritis
2015, Actas Dermo-SifiliograficasRecommendations for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists: A Delphi study
2014, Actas Dermo-SifiliograficasCitation Excerpt :If the response is acceptable (in polyarticular PsA, DAS28 between 2.6 and 3.2 and/or a decrease of 1.2 points compared to the previous value), treatment should be continued with the possible addition of a DMARD. If the treatment goal has been achieved, treatment should be continued and response assessed in 3 to 4 months.29 There is currently insufficient evidence in patients with PsA receiving biologic therapy whose condition is in remission to support a recommendation for reducing the dose or prolonging the interval between doses, although a reduction in treatment intensity can be considered on a case-by-case basis.29
Pharmacologic treatment of psoriatic arthritis and axial spondyloarthritis with traditional biologic and non-biologic DMARDs
2014, Best Practice and Research: Clinical Rheumatology