Treatment of Psoriatic Arthritis
Based on guidelines from the American College of Rheumatology.
Initial Treatment
In OSM- and other treatment–naive patients with active PsA, treat with a TNFi biologic over an OSM.
In OSM- and other treatment–naive patients with active PsA, treat with a TNFi biologic over an IL-17i biologic.
In OSM- and other treatment–naive patients with active PsA, treat with a TNFi biologic over an IL-12/23i biologic.
In OSM- and other treatment–naive patients with active PsA, treat with an OSM over an IL-17i biologic.
In OSM- and other treatment–naive patients with active PsA, treat with an OSM over an IL-12/23i biologic.
In OSM- and other treatment–naive patients with active PsA, treat with MTX over NSAIDs.
In OSM- and other treatment–naive patients with active PsA, treat with an IL-17i biologic over an IL-12/23i biologic.
Active PsA
In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over a different OSM.
In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over an IL-17i biologic.
In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over an IL-12/23i biologic.
In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over abatacept.
In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over tofacitinib.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i over a different OSM.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i biologic over an IL-12/23i biologic.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i biologic over abatacept.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i biologic over tofacitinib.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-12/23i biologic over a different OSM.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-12/23i biologic over abatacept.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-12/23i biologic over tofacitinib.
In adult patients with active PsA despite treatment with an OSM, add apremilast to current OSM therapy over switching to apremilast.
In adult patients with active PsA despite treatment with an OSM, switch to another OSM (except apremilast) over adding another OSM (except apremilast) to current treatment.
In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic monotherapy over MTX and a TNFi biologic combination therapy.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i biologic monotherapy over MTX and an IL-17i biologic combination therapy.
In adult patients with active PsA despite treatment with an OSM, switch to an IL-12/23i biologic monotherapy over MTX and an IL-12/23i biologic combination therapy.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic over switching to an IL-17i biologic.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic over switching to an IL-12/23i biologic.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic over switching to abatacept.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic over switching to tofacitinib.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic (with or without MTX) over adding MTX to the same TNFi biologic monotherapy.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-17i biologic over switching to an IL-12/23i biologic.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-17i biologic over abatacept.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-17i biologic over tofacitinib.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-12/23i biologic over abatacept.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-12/23i biologic over tofacitinib.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic monotherapy over switching to a different TNFi biologic and MTX combination therapy.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-17i biologic monotherapy over switching to an IL-17i biologic and MTX combination therapy.
In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-12/23i biologic monotherapy over switching to an IL-12/23i biologic and MTX combination therapy.
In adult patients with active PsA despite treatment with a TNFi biologic and MTX combination therapy, switch to a different TNFi biologic + MTX over switching to a different TNFi biologic monotherapy.
In adult patients with active PsA despite treatment with a TNFi biologic and MTX combination therapy, switch to an IL-17i biologic monotherapy over an IL-17i biologic and MTX combination therapy.
In adult patients with active PsA despite treatment with a TNFi biologic and MTX combination therapy, switch to IL-12/23i biologic monotherapy over IL-12/23i biologic and MTX combination therapy.
In adult patients with active PsA despite treatment with an IL-17i biologic monotherapy, switch to a TNFi biologic over switching to an IL-12/23i biologic.
In adult patients with active PsA despite treatment with an IL-17i biologic monotherapy, switch to a TNFi biologic over switching to a different IL-17i biologic.
In adult patients with active PsA despite treatment with an IL-17i biologic monotherapy, switch to a TNFi biologic over adding MTX to an IL-17i biologic.
In adult patients with active PsA despite treatment with an IL-17i biologic monotherapy, switch to an IL-12/23i biologic over switching to a different IL-17i biologic.
In adult patients with active PsA despite treatment with an IL-17i biologic monotherapy, switch to an IL-12/23i biologic over adding MTX to an IL-17i biologic.
In adult patients with active PsA despite treatment with an IL-12/23i biologic monotherapy, switch to a TNFi biologic over switching to an IL-17i biologic.
In adult patients with active PsA despite treatment with an IL-12/23i biologic monotherapy, switch to a TNFi biologic over adding MTX to an IL-12/23i biologic.
In adult patients with active PsA despite treatment with an IL-12/23i biologic monotherapy, switch to an IL-17i biologic over adding MTX to an IL-12/23i biologic.
In adult patients with active PsA, use a treat-to-target strategy over not following a treat-to-target strategy.
In patients with active PsA with psoriatic spondylitis/axial disease despite treatment with NSAIDs, switch to a TNFi biologic over switching to an IL-17i biologic.
In patients with active PsA with psoriatic spondylitis/axial disease despite treatment with NSAIDs, switch to a TNFi biologic over switching to an IL-17i biologic.
In patients with active PsA with psoriatic spondylitis/axial disease despite treatment with NSAIDs, switch to an IL-17i biologic over switching to an IL-12/23i.
In adult patients with active PsA and predominant enthesitis who are both OSM- and biologic treatment-naive, start oral NSAIDs over an OSM (specifically apremilast).
In adult patients with active PsA and predominant enthesitis who are both OSM- and biologic treatment-naive, start a TNFi biologic over an OSM (specifically apremilast).
In adult patients with active PsA and predominant enthesitis who are both OSM- and biologic treatment-naive, start tofacitinib over an OSM (specifically apremilast).
In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to a TNFi biologic over an IL-17i biologic.
In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to a TNFi biologic over an IL-12/23i biologic.
In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to a TNFi biologic over switching to another OSM.
In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to an IL-17i biologic over an IL-12/23i biologic.
In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to an IL-17i biologic over switching to another OSM.
In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to an IL-12/23i biologic over switching to another OSM.
In adult patients with active PsA and concomitant active IBD who are both OSM- and biologic treatment–naive, start a monoclonal antibody TNFi biologic over an OSM.
In adult patients with active PsA and concomitant active IBD despite treatment with an OSM, switch to a monoclonal antibody TNFi biologic over a TNFi biologic soluble receptor biologic (i.e., etanercept).
In adult patients with active PsA and concomitant active IBD despite treatment with an OSM, switch to a TNFi monoclonal antibody biologic over an IL-17i biologic.
In adult patients with active PsA and concomitant active IBD despite treatment with an OSM, switch to a TNFi biologic monoclonal antibody biologic over an IL-12/23i biologic.
In adult patients with active PsA and concomitant active IBD despite treatment with an OSM, switch to an IL-12/23i biologic over switching to an IL-17i biologic.
Comorbidities, Vaccination, Non-drug Tx
In adult patients with active PsA and diabetes who are both OSM- and biologic treatment–naive, start an OSM other than MTX over a TNFi biologic.
In adult patients with active PsA and frequent serious infections who are both OSM- and biologic treatment–naive, start an OSM over a TNFi biologic.
In adult patients with active PsA and frequent serious infections who are both OSM- and biologic treatment–naive, start an IL-12/23i biologic over a TNFi biologic.
In adult patients with active PsA and frequent serious infections who are both OSM- and biologic treatment–naive, start an IL-17i biologic over a TNFi biologic.
In adult patients with active PsA needing vaccinations, start the biologic and administer inactivated vaccines over delaying the start of biologic to administer inactivated vaccines.