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07-04-2017 | Psoriatic arthritis | Review | Article

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

Journal:
Rheumatology International

Authors: Juan Carlos Torre-Alonso, Loreto Carmona, Mireia Moreno, Eva Galíndez, Jesús Babío, Pedro Zarco, Luis Linares, Eduardo Collantes-Estevez, Manuel Fernández Barrial, Juan Carlos Hermosa, Pablo Coto, Carmen Suárez, Raquel Almodóvar, Jesús Luelmo, Santos Castañeda, Jordi Gratacós

Publisher: Springer Berlin Heidelberg

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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