2019 EULAR recommendations for the pharmacological management of psoriatic arthritis, with levels of evidence, grade of recommendations and level of agreement.
https://pubmed.ncbi.nlm.nih.gov/32434812/
Overarching principles Level of agreement, mean (SD)
A Psoriatic arthritis is a heterogeneous and potentially severe disease, which may require multidisciplinary treatment.PsAは不均一な疾患であり、場合によっては重症になり、え多面的な治療を要するかもしれない。 LoA 9.9 (0.4)
B Treatment of psoriatic arthritis patients 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.PsAの治療はベストなケアを目標とすべきであり、患者とリウマトロジストの共有された意思決定に基づくべきである。効果、安全性、費用を考慮したうえで。 LoA 9.8 (0.5)
C Rheumatologists are the specialists who should primarily care for the musculoskeletal manifestations of patients with psoriatic arthritis; in the presence of clinically significant skin involvement, a rheumatologist and a dermatologist should collaborate in diagnosis and management.リウマトロジストはＰｓＡ患者の筋骨格の症状のprimary careを行うべきスペシャリストである。臨床的に重大な皮膚病変がある場合リウマトロジストは皮膚科医と診断と管理について協力すべきである。 LoA 9.8 (0.7)
D The primary goal of treating patients with psoriatic arthritis is to maximise health-related quality of life, through control of symptoms, prevention of structural damage, normalisation of function and social participation; abrogation of inflammation is an important component to achieve these goals.PsAの患者を治療する基本的なゴールは症状のcontrol、構造は下位の予防、機能の正常化と社会参加を通して、健康関連ＱＯＬを最大限にすることである。これらのgoalを達成するために炎症の排除は重要な要素となる。 LoA 9.9 (0.4)
E In managing patients with psoriatic arthritis, consideration should be given to each musculoskeletal manifestation and treatment decisions made accordingly.PsA患者の管理では筋骨格症状の各を考慮すべきであり、治療決定もそれに応じて決められるべき。 LoA 9.9 (0.3)
F When managing patients with psoriatic arthritis, non-musculoskeletal manifestations (skin, eye and gastrointestinal tract) should be taken into account; comorbidities such as metabolic syndrome, cardiovascular disease or depression should also be considered.PsA患者を管理する際、非筋骨格（皮膚、目、GI）も考慮に入れられるべき。代謝性疾患、心血管系疾患やうつ症状も考慮されるべき。 LoA 9.8 (0.6)
Recommendations
Lebel of evidence (LoE), Grade of recommendtion (GoR), Level of agreement (LoA), mean (SD)
- Treatment should be aimed at reaching the target of remission or, alternatively, low disease activity, by regular disease activity assessment and appropriate adjustment of therapy.治療は寛解、代替的にLDAをターゲットとすべきである。治療は定期的な疾患活動性の評価と適切な治療の調整によってなされるべき。
LoE 1b, GoR A, LoA 9.4 (1.0)
- Non-steroidal anti-inflammatory drugs may be used to relieve musculoskeletal signs and symptoms. NSAIDsは筋骨格のサインと症状を緩和させるために用いられてよい。
LoE 1b, GoR A, LoA 9.6 (0.8)
- Local injections of glucocorticoids should be considered as adjunctive therapy in psoriatic arthritis*; systemic glucocorticoids may be used with caution at the lowest effective dose†.局所のステロイド注射はPsA患者の付加的な治療として考慮されるべき。全身性ステロイドは有効な最小量で注意深く用いてもよい。
LoE 3b* 4†, GoR C, LoA 9.5 (1.1)
- In patients with polyarthritis, a csDMARD should be initiated* rapidly†, with methotrexate preferred in those with relevant skin involvement*. 多関節炎の患者ではcsDMARDは速やかに開始されるべき。皮膚病変がしっかりある患者においてはMTXが好まれる。
LoE 1b*, 5†, GoR B, LoA 9.5 (0.8)
- In patients with monoarthritis or oligoarthritis, particularly with poor prognostic factors such as structural damage, high erythrocyte sedimentation rate/C reactive protein, dactylitis or nail involvement, a csDMARD should be considered. 単関節炎や少数関節炎の患者では特に構造的破壊やESR･CRP上昇、指趾炎、爪病変のような予後不良因子を有する場合、csDMARDを考慮すべき。
LoE 4, GoR C, LoA 9.3 (1.0)
- In patients with peripheral arthritis and an inadequate response to at least one csDMARD, therapy with a bDMARD should be commenced; when there is relevant skin involvement, an IL-17 inhibitor or IL-12/23 inhibitor may be preferred. 末梢性関節炎を有する患者で少なくとも一つのcsDMARDで改善が得られない場合、bDMARDを開始すべき。有意な皮膚病変がある場合はIL17阻害かIL12/23阻害が好まれるかもしれない。
LoE 1b, GoR B, LoA 9.4 (1.1)
- In patients with peripheral arthritis and an inadequate response to at least one csDMARD and at least one bDMARD, or when a bDMARD is not appropriate, a JAK inhibitor may be considered. 末梢性関節炎の患者で少なくとも一つのcsDMARDと少なくともbDMARDで改善が十分でない場合、またはbDMARDの使用が適切でない場合、JAK阻害薬が考慮されてよい。
LoE 1b, GoR B, LoA 9.2 (1.3)
- In patients with mild disease* and an inadequate response to at least one csDMARD†, in whom neither a bDMARD nor a JAK inhibitor is appropriate*, a PDE4 inhibitor may be considered. 軽症*で、かつ少なくとも一つのcsDMARD†で効果不十分の患者ではbDMARDやJAK阻害薬が適切でない場合*に限りPDE4阻害薬を考慮してもよい。
LoE 5* 1b†, GoR B, LoA 8.5 (1.9)
- In patients with unequivocal enthesitis and insufficient response to NSAIDs or local glucocorticoid injections, therapy with a bDMARD should be considered.明白な付着部炎を有する患者でNSAIDや局所ステロイド治療が効かない患者ではbDMARDを考慮すべき。
LoE 1b, GoR B, LoA 9.3 (0.9)
- In patients with predominantly axial disease which is active and has insufficient response to NSAIDs, therapy with a bDMARD should be considered, which according to current practice is a TNF inhibitor; when there is relevant skin involvement, IL-17 inhibitor may be preferred. 脊椎を主に侵す患者で、NSAIDで効果不十分な場合はbDMARD、現在のプラクティスではTNF阻害薬を考慮すべき。有意な皮疹があればIL17阻害薬が好まれるかもしれない。
LoE 1b, GoR B, LoA 9.7 (0.6)
- In patients who fail to respond adequately to, or are intolerant of a bDMARD, switching to another bDMARD or tsDMARD should be considered*, including one switch within a class†. bDMARDに十分に反応しない患者や耐用できない患者ではその他のbDMARDやtsDMARDへの変更を考慮すべき*。クラス内スイッチでもよい†。
LoE 1b*, 4†, GoR C, LoA 9.5 (1.2)
- In patients in sustained remission, cautious tapering of DMARDs may be considered. 持続寛解の患者では慎重なDMARDの減量を考慮してもよい。
LoE 4, GoR C, LoA 9.5 (0.9)
