Journal
JOURNAL OF RHEUMATOLOGY
Volume 50, Issue 3, Pages 433-437Publisher
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.220313
Keywords
GRAPPA; psoriatic arthritis; psoriasis
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This article updates the treatment recommendations for nail psoriasis, and suggests that biologic agents are the preferred treatment option.
Objective. Nail psoriasis is common, impairs fine motor finger functioning, affects cosmesis, and is associated with a lower quality of life. This review updates the previous Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for nail psoriasis.Methods. This systematic literature review of the PubMed, MEDLINE, Embase, and Cochrane databases examined the updated evidence since the last GRAPPA nail psoriasis treatment recommendations pub-lished in 2014. Recommendations are based on preformed PICO (Patient/Population -Intervention -Comparison/Comparator -Outcome) questions formulated by an international group of dermatologists, rheumatologists, and patient panel members. Data from this literature review were evaluated in line with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.Results. Overall, there is insufficient evidence to make any recommendation for the use of topical corticoste-roids, topical calcipotriol, topical tazarotene, topical cyclosporine, dimethyl fumarates/fumaric acid esters, phototherapy, and alitretinoin. There is a low strength of evidence to support the use of calcipotriol and corticosteroid preparations, topical tacrolimus, oral cyclosporine, oral methotrexate, intralesional corticoste-roids, pulsed dye laser, acitretin, Janus kinase inhibitors, and apremilast.Conclusion. The highest strength of supporting evidence is for the recommendation of biologic agents including tumor necrosis factor inhibitors, and interleukin 12/23, 17, and 23 inhibitors.
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