EULAR points to consider and consensus definitions for difficult-to-manage and treatment-refractory psoriatic arthritis

Marzo-Ortega, Helena, Harrison, Stephanie R., Fragoulis, George E., Michelena, Xabier, Macía-Villa, Cristina, Aydin, Sibel Z., Balanescu, Andra, Bertheussen, Heidi, Bundy, Christine ORCID: https://orcid.org/0000-0002-5981-3984, Chimenti, Maria Sole, Gisondi, Paolo, Glintborg, Bente, Gossec, Laure, Kalyoncu, Umut, Lubrano, Ennio, Nagy, Gyorgy, Wagenaar, Wendy, Puig, Luis, Queiro, Rubén, Rahman, Proton, Shumnalieva, Russka, Soriano, Enrique R., van den Bosch, Filip, van de Sande, Marleen M.G.H., Sepriano, Alexandre, Machado, Pedro M. and Siebert, Stefan 2025. EULAR points to consider and consensus definitions for difficult-to-manage and treatment-refractory psoriatic arthritis. Annals of the Rheumatic Diseases 10.1016/j.ard.2025.10.002

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Abstract

Objectives This study aimed to develop evidence-based points to consider (PtC) and consensus definitions of difficult-to-manage (D2M) and treatment-refractory (TR) psoriatic arthritis (PsA). Methods A multidisciplinary international European Alliance of Associations for Rheumatology (EULAR) task force (TF) of 27 members, including rheumatologists, dermatologists, health practitioners, and patient partners, was established, and the EULAR standardised operating procedures, including a systematic literature review and a consensus process, were followed. Results The TF formulated 4 overarching principles addressing the proportion of patients with PsA with an unsatisfactory treatment response despite the best standard of care, and for which the causes are likely multifactorial. Six PtC highlight criterion relevant for subsequent definitions including failure to achieve or maintain response to ≥2 biological/targeted synthetic disease-modifying antirheumatic drugs with ≥2 different mechanisms of action; management of signs and symptoms perceived as problematic by the rheumatologist and/or the patient, and evidence of persistent disease activity in the presence of extramusculoskeletal manifestations and/or comorbidities and/or objective evidence of inflammatory activity. Finally, the following 2 definitions were developed: (1) D2M PsA, an umbrella term including drivers such as inflammation, comorbidities, psychosocial or other factors, incorporating (2) TR PsA, defined by persistent disease activity and objective evidence of active inflammation. Conclusions EULAR proposes 2 consensus definitions to identify a D2M PsA population, including a TR subgroup. These definitions should now be tested in research studies to understand disease pathogenesis and improve care for people living with PsA.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Healthcare Sciences
Publisher:	Elsevier
ISSN:	0003-4967
Date of First Compliant Deposit:	4 December 2025
Date of Acceptance:	4 October 2025
Last Modified:	04 Dec 2025 16:30
URI:	https://orca.cardiff.ac.uk/id/eprint/182925

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