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Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain

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Abstract

The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.

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Acknowledgements

The panel appreciated the critical revision of the recommendations and thoughtful suggestions made by Dr Silvia Rodríguez Sopena, Hospital manager at Ferrol Hospital and Miguel Martínez Villafranca, informatics engineer with PsA. We also want to acknowledge the invaluable help of Teresa Otón with the translation and checklist preparation.

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Authors and Affiliations

  1. Hospital Monte Naranco and Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain

    Juan Carlos Torre-Alonso

  2. Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain

    Loreto Carmona

  3. Hospital Universitari Parc Taulí, Sabadell, Spain

    Mireia Moreno, Jesús Luelmo & Jordi Gratacós

  4. Hospital Universitario de Basurto, Bilbao, Spain

    Eva Galíndez

  5. Hospital Universitario de Cabueñes, Gijón, Spain

    Jesús Babío

  6. Hospital Universitario Fundación Alcorcón, Madrid, Spain

    Pedro Zarco & Raquel Almodóvar

  7. Hospital Complejo Universitario Virgen de la Arrixaca, Murcia, Spain

    Luis Linares

  8. Servicio de Reumatologia, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain

    Eduardo Collantes-Estevez

  9. Centro de Salud de Sotondrio, Langreo, Spain

    Manuel Fernández Barrial

  10. Centro de Salud “Ciudades”, Getafe, Spain

    Juan Carlos Hermosa

  11. Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Coto

  12. Servicios de Medicina Interna y Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain

    Carmen Suárez & Santos Castañeda

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  1. Juan Carlos Torre-Alonso
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  2. Loreto Carmona
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Correspondence to Juan Carlos Torre-Alonso.

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This study is based on the review of the literature and on the opinion of the authors and collaborators. No human subject was recruited for research. Due to the nature of the study, an Ethical Review Board was not consulted.

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The authors declare no conflicts of interest in relation to the contents of this consensus.

Funding

This Project was funded by a non-restricted grant by Merck Sharp & Dohme of Spain. Merck Sharp & Dohme did not influence the conduct of the project nor the final content of the manuscript.

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Torre-Alonso, J.C., Carmona, L., Moreno, M. et al. Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain. Rheumatol Int 37, 1239–1248 (2017). https://doi.org/10.1007/s00296-017-3702-9

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