Objective New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. Methods Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. Results The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. Conclusion These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.

中文翻译：

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EULAR 关于药物治疗银屑病关节炎的建议：2023 年更新

目的 新的作用模式以及有关现有药物在银屑病关节炎 (PsA) 中的疗效和安全性的更多数据要求更新 EULAR 2019 年关于 PsA 药物治疗的建议。方法 遵循 EULAR 标准化操作程序，该过程包括系统的文献综述和 2023 年 4 月 36 位国际专家的共识会议。确定了证据水平和建议等级。结果 更新后的建议包括 7 项总体原则和 11 项建议，并为药物治疗提供了治疗策略。非甾体抗炎药应仅用于轻度 PsA 的短期单药治疗；不建议使用口服糖皮质激素。对于患有外周关节炎的患者，建议快速开始使用常规合成的改善病情的抗风湿药物，并优先使用甲氨蝶呤。如果该策略未达到治疗目标，则应开始使用生物改善病情的抗风湿药物 (bDMARD)，而不优先考虑作用模式。相关皮肤银屑病应以针对白细胞介素 (IL)-23p40、IL-23p19、IL-17A 和 IL-17A/F 抑制剂的 bDMARD 为导向。如果主要为中轴或肌腱疾病，还提出了一种算法。建议在 bDMARD 失败后（考虑到相关风险因素）或在 bDMARD 不是合适选择的情况下主要使用 Janus 激酶抑制剂。如果存在炎症性肠病和葡萄膜炎，应影响药物选择，建议使用单克隆肿瘤坏死因子抑制剂。还讨论了持续缓解中的药物转换和逐渐减少。结论这些更新的建议以实用和渐进的方式整合了所有当前可用的药物，这将有助于 PsA 的药物管理。