2021 Clinical Practice Guidelines for the Diagnosis, Treatment, and Follow-up of Patients with Peripheral Spondyloarthritis. Colombian Association of Rheumatology; [Guía de práctica clínica 2021 para el diagnóstico, el tratamiento y el seguimiento de pacientes con espondiloartritis periférica. Asociación Colombiana de Reumatología]

Autores organización

• Wilson Armando Bautista Molano

  Autor

• Maria Consuelo Romero Sanchez

  Autor

Autores

• Saldarriaga-Rivera L.M.
• Junca-Ramírez A.
• Fernández-Aldana A.R.
• Fernández-Ávila D.G.
• Jaimes D.A.
• Jáuregui E.A.
• Segura-Charry J.S.
• Felipe-Diaz O.J.

Unidades de investigación

• Grupo de Inmunología celular y molecular Universidad El Bosque (InmuBo)

  Investigador

  Maria Consuelo Romero Sanchez

• Grupo de Investigación Básica y Traslacional (GIBAT)

  Investigador

  Rafael Antonio Guerrero Rojas

Resumen

Background: Peripheral spondyloarthritis is a chronic inflammatory disease whose clinical presentation is related to the presence of arthritis, enthesitis and/or dactylitis. This term is used interchangeably with some of its subtypes such as psoriatic arthritis, reactive arthritis, and undifferentiated spondyloarthritis. Objective: To develop and formulate a set of specific recommendations based on the best available evidence for the diagnosis, treatment, and monitoring of adult patients with peripheral spondyloarthritis. Methods: A working group was established, clinical questions were formulated, outcomes were graded, and a systematic search for evidence was conducted. The guideline panel was multidisciplinary (including patient representatives) and balanced. Following the formal expert consensus method, the GRADE methodology “Grading of Recommendations Assessment, Development and Evaluation” was used to assess the quality of the evidence and generate the recommendations. The clinical practice guideline includes ten recommendations related to monitoring of disease activity (n=1) and treatment (n=9). Results: In patients with peripheral spondyloarthritis, the use of methotrexate or sulfasalazine as the first line of treatment is suggested, and local injections of glucocorticoids are conditionally recommended. In patients with failure to cDMARDs, an anti TNFa or an anti IL17A is recommended. In case of failure to bDMARDs, it is suggested to use another bDMARD or JAK inhibitor. In patients with peripheral spondyloarthritis associated with inflammatory bowel disease, it is recommended to start treatment with cDMARDs; in the absence of response, the use of an anti TNFa over an anti-IL-17 or an anti-IL-12-23 is recommended as a second line of treatment. In patients with psoriatic arthritis, the combined use of methotrexate with a bDMARD is conditionally recommended for optimization of dosing. To assess disease activity in Psoriatic Arthritis, the use of DAPSA or MDA is suggested for patient monitoring. Conclusions: This set of recommendations provides an updated guideline on the diagnosis and treatment of peripheral spondyloarthritis. © 2021 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología

Keywords

• Clinical practice guideline; Monitoring; Spondyloarthritis; Treatment;Arthritis, Psoriatic; Colombia; Follow-Up Studies; Humans; Rheumatology; Spondylarthritis; disease modifying antirheumatic drug; glucocorticoid; interleukin 12; interleukin 17; interleukin 23; methotrexate; salazosulfapyridine; Article; chronic arthritis; clinical outcome; consensus; disease activity; disease association; evidence based practice; follow up; human; inflammatory bowel disease; multidisciplinary team; patient monitoring; peripheral spondyloarthritis; practice guideline; process optimization; psoriatic arthritis; quality control; rheumatology; treatment failure; Colombia; follow up; psoriatic arthritis; rheumatology; spondylarthritis