The following is a summary of the “Management of Enthesitis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations,” published in the February 2023 issue of Rheumatology by Eder, et al.
Psoriatic arthritis (PsA) in children and adults is characterized by enthesitis, a key pathological and clinical feature of PsA. Several enthesitis scoring systems have undergone clinical trial use and are generally accepted for clinical assessment of enthesitis. Treatment response for enthesitis has been reported as either a change in the overall enthesitis score or a percentage of patients who experienced complete resolution.
Most PsA trials did not require patients to have enthesitis at study entry because enthesitis was evaluated only as a secondary outcome. Ultrasound or magnetic resonance imaging of the entheses has been used rarely in clinical trials to evaluate the efficacy of enthesitis treatments, despite the limitations of the clinical assessment of enthesitis. To facilitate an evidence-based update of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for PsA, this systematic review summarises existing evidence regarding pharmaceutical and nonpharmaceutical interventions for enthesitis in patients with PsA.
Using a systematic literature search, we could locate 41 randomized clinical trials reporting treatment success for enthesitis in patients with psoriatic arthritis. The quality of the evidence and the effect size of the responses to each intervention were summarised. Afterward, suggestions for both drug and nondrug treatments were made. They analyzed 41 randomized clinical trials, giving each intervention a letter grade. Patients with active enthesitis should consider combining systemic conventional and advanced therapies and local treatments.
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