A NEW comparative analysis of international guidelines for psoriatic arthritis (PsA) management reveals key divergences in treatment strategies across leading rheumatology societies, underscoring ongoing challenges in global consensus despite shared therapeutic goals.
Psoriatic arthritis is a heterogeneous, immune-mediated disease marked by musculoskeletal inflammation and systemic involvement. As treatment options have expanded, guideline updates have aimed to integrate evolving evidence into clinical pathways. In this review, guidelines from five major organizations, the American College of Rheumatology (ACR), European Alliance of Associations for Rheumatology (EULAR), British Society of Rheumatology (BSR), Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), and Pan American League of Associations for Rheumatology (PANLAR), were assessed to identify alignment and divergence in clinical recommendations.
All guidelines emphasize a treat-to-target strategy that prioritizes the control of active PsA, reflecting a unified commitment to proactive disease management. However, notable differences emerged in treatment sequencing, particularly regarding the initiation and selection of biologic versus targeted synthetic DMARDs. These distinctions appear influenced by variations in healthcare infrastructure, regulatory environments, and regional therapeutic access.
Further discrepancies were observed in the approaches to treating specific PsA domains such as enthesitis and dactylitis. While some guidelines provided distinct treatment pathways for these features, others offered broader strategies with less domain-specific detail. The analysis also highlighted a common emphasis on the role of comorbidities, such as cardiovascular and metabolic conditions, in determining therapeutic choices and improving long-term outcomes.
In addition to mapping current practice, the review identifies promising new therapeutic targets that are likely to influence future updates across international guidelines. These may help align strategies and personalize care more effectively across disease phenotypes.
This analysis offers a valuable reference point for U.S. clinicians treating PsA, especially those engaging in shared decision-making with patients navigating increasingly complex therapeutic landscapes shaped by global evidence and local practice patterns.
Reference:
Singla S et al. Global Guidelines for Psoriatic Arthritis Management: A Comparative Analysis. J Clin Rheumatol. 2025. doi: 10.1097/RHU.0000000000002254.
