Guidelines of care for the management of psoriasis and psoriatic arthritis : Section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: Case-based presentations and evidence-based conclusions - 28/07/11

Doi : 10.1016/j.jaad.2010.11.055

Alan Menter, MD ^a : Chair, Neil J. Korman, MD, PhD ^b, Craig A. Elmets, MD ^c, Steven R. Feldman, MD, PhD ^d, Joel M. Gelfand, MD, MSCE ^e,^l, Kenneth B. Gordon, MD ^f, Alice Gottlieb, MD, PhD ^g, John Y.M. Koo, MD ^h, Mark Lebwohl, MD ⁱ, Craig L. Leonardi, MD ^j, Henry W. Lim, MD ^k, Abby S. Van Voorhees, MD ^l, Karl R. Beutner, MD, PhD ^h,^m, Caitriona Ryan, MB, BCh, BAO ^a, Reva Bhushan, PhD ^n,^⁎
^a Psoriasis Research Center, Baylor University Medical Center, Dallas, Texas
^b Department of Dermatology at Murdough Family Center for Psoriasis and University Hospitals Case Medical Center, Cleveland, Ohio
^c Department of Dermatology, University of Alabama at Birmingham, Birmingham, Alabama
^d Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
^e Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
^l Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
^f Division of Dermatology, Evanston Northwestern Healthcare, and Department of Dermatology, Northwestern University, Fienberg School of Medicine, Chicago, Illinois
^g Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
^h Department of Dermatology, University of California–San Francisco, San Francisco, California
ⁱ Department of Dermatology, Mount Sinai School of Medicine, New York, New York
^j Saint Louis University, St Louis, Missouri
^k Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
^m Anacor Pharmaceuticals Inc, Palo Alto, CA
ⁿ American Academy of Dermatology, Schaumburg, Illinois

Reprint requests: Reva Bhushan, PhD, 930 E Woodfield Rd, Schaumburg, IL 60173.

Abstract

Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In the first 5 parts of the AmericanAcademy of Dermatology Psoriasis Guidelines of Care, we have presented evidence supporting the use of topical treatments, phototherapy, traditional systemic agents, and biological therapies for patients with psoriasis and psoriatic arthritis. In this sixth and final section of the Psoriasis Guidelines of Care, we will present cases to illustrate how to practically use these guidelines in specific clinical scenarios. We will describe the approach to treating patients with psoriasis across the entire spectrum of this fascinating disease from mild to moderate to severe, with and without psoriatic arthritis, based on the 5 prior published guidelines. Although specific therapeutic recommendations are given for each of the cases presented, it is important that treatment be tailored to meet individual patients’ needs. In addition, we will update the prior 5 guidelines and address gaps in research and care that currently exist, while making suggestions for further studies that could be performed to help address these limitations in our knowledge base.

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Key words : adalimumab, alefacept, biologics, case studies, clinical guidelines for psoriasis, combination therapy, comorbidities, dermatology, etanercept, gaps in knowledge, gaps in research, golimumab, guidelines, inflammation, infliximab, methotrexate, narrowband, phototherapy, psoralen plus ultraviolet A, psoriasis, psoriatic arthritis, skin disease, systemic therapy, therapeutic recommendations, topical treatments, traditional systemic therapy, tumor necrosis factor-alfa, ustekinumab

Abbreviations used : AAD, BB, BSA, FDA, IL, LFT, MTX, NB, NSAIDs, PASI, PASI-75, PsA, PUVA, SCC, TNF, UV