Treatment of Psoriatic Arthritis

Publication Date: November 30, 2018
Last Updated: December 15, 2022

Table 1. Recommendations for the Initial Treatment of Patients With Active PsA Who Are OSM- and Other Treatment-Naïve

In OSM- and other treatment–naïve patients with active PsA:

Treat with a TNFi biologic over an OSM (MTX, SSZ, LEF, CSA, or APR)

May consider an OSM if the patient does not have severe PsA, does not have severe psoriasis, prefers oral therapy, has concern over starting a biologic as the first therapy, or has contraindications to TNFi biologics, including congestive heart failure, previous serious infections, recurrent infections, or demyelinating disease. ( Conditional , Low )
607

Treat with a TNFi biologic over an IL-17i biologic

May consider an IL-17i biologic if the patient has severe psoriasis or has contraindications to TNFi biologics, including congestive heart failure, previous serious infections, recurrent infections, or demyelinating disease. ( Conditional , Very Low )
607

Treat with a TNFi biologic over an IL-12/23i biologic

May consider an IL-12/23i biologic if the patient has severe psoriasis, prefers less frequent drug administration, or has contraindications to TNFi biologics, including congestive heart failure, previous serious infections, recurrent infections, or demyelinating disease. ( Conditional , Very Low )
607

Treat with an OSM over an IL-17i biologic

May consider an IL-17i biologic if the patient has severe psoriasis and/or severe PsA. ( Conditional , Very Low )
607

Treat with an OSM over an IL-12/23i biologic

May consider an IL-12/23i biologic if the patient has concomitant IBD and/or severe psoriasis and/or severe PsA or prefers less frequent drug administration. ( Conditional , Very Low )
607

Treat with MTX over NSAIDs

May consider NSAIDs before starting MTX in patients with less active disease, after careful consideration of cardiovascular risks and renal risks of NSAIDs. ( Conditional , Very Low )
607

Treat with an IL-17i biologic over an IL-12/23i biologic

May consider an IL-12/23i biologic if the patient has concomitant IBD or prefers less frequent drug administration. ( Conditional , Very Low )
607

Table 2. Recommendations for Treatment of Patients With Active PsA Despite Treatment With an OSM

In adult patients with active PsA despite treatment with an OSM

Overview

Title

Treatment of Psoriatic Arthritis

Authoring Organizations

American College of Rheumatology

National Psoriasis Foundation