This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis. Thank you for everything you do.

      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Treatment of Psoriatic Arthritis (beta)

    Based on guidelines from the American College of Rheumatology.

    Strength
    Strong recommendation
    Moderate recommendation
    Conditional recommendation
    Weak recommendation
    Evidence
    High quality evidence
    Moderate quality evidence
    Low quality evidence
    Very low quality evidence

    Initial Treatment

    Initial Treatment
    1. In OSM- and other treatment–naive patients with active PsA, treat with a TNFi biologic over an OSM.
    2. In OSM- and other treatment–naive patients with active PsA, treat with a TNFi biologic over an IL-17i biologic.
    3. In OSM- and other treatment–naive patients with active PsA, treat with a TNFi biologic over an IL-12/23i biologic.
    4. In OSM- and other treatment–naive patients with active PsA, treat with an OSM over an IL-17i biologic.
    5. In OSM- and other treatment–naive patients with active PsA, treat with an OSM over an IL-12/23i biologic.
    6. In OSM- and other treatment–naive patients with active PsA, treat with MTX over NSAIDs.
    7. In OSM- and other treatment–naive patients with active PsA, treat with an IL-17i biologic over an IL-12/23i biologic.

    Active PsA

    On OSM
    1. In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over a different OSM.
    2. In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over an IL-17i biologic.
    3. In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over an IL-12/23i biologic.
    4. In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over abatacept.
    5. In adult patients with active PsA despite treatment with an OSM, switch to a TNFi biologic over tofacitinib.
    6. In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i over a different OSM.
    7. In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i biologic over an IL-12/23i biologic.
    8. In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i biologic over abatacept.
    9. In adult patients with active PsA despite treatment with an OSM, switch to an IL-17i biologic over tofacitinib.
    10. In adult patients with active PsA despite treatment with an OSM, switch to an IL-12/23i biologic over a different OSM.
    11. In adult patients with active PsA despite treatment with an OSM, switch to an IL-12/23i biologic over abatacept.
    12. In adult patients with active PsA despite treatment with an OSM, switch to an IL-12/23i biologic over tofacitinib.
    13. In adult patients with active PsA despite treatment with an OSM, add apremilast to current OSM therapy over switching to apremilast.
    14. 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.
    15. 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.
    16. 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.
    17. 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.
    On TNFi +/- MTX
    1. 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.
    2. 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.
    3. In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic over switching to abatacept.
    4. In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to a different TNFi biologic over switching to tofacitinib.
    5. 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.
    6. 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.
    7. In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-17i biologic over abatacept.
    8. In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-17i biologic over tofacitinib.
    9. In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-12/23i biologic over abatacept.
    10. In adult patients with active PsA despite treatment with a TNFi biologic monotherapy, switch to an IL-12/23i biologic over tofacitinib.
    11. 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.
    12. 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.
    13. 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.
    14. 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.
    15. 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.
    16. 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.
    On IL17i or IL-12/23i
    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    Treat-to-Target, Active Axial Disease, etc
    1. In adult patients with active PsA, use a treat-to-target strategy over not following a treat-to-target strategy.
    2. 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.
    3. 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.
    4. 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.
    5. 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).
    6. 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).
    7. In adult patients with active PsA and predominant enthesitis who are both OSM- and biologic treatment-naive, start tofacitinib over an OSM (specifically apremilast).
    8. In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to a TNFi biologic over an IL-17i biologic.
    9. In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to a TNFi biologic over an IL-12/23i biologic.
    10. In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to a TNFi biologic over switching to another OSM.
    11. 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.
    12. In adult patients with active PsA and predominant enthesitis despite treatment with OSM, switch to an IL-17i biologic over switching to another OSM.
    13. 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.
    14. 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.
    15. 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).
    16. 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.
    17. 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.
    18. 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

    Comorbidities
    1. 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.
    2. 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.
    3. 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.
    4. 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.
    Vaccination
    1. 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.
    2. In adult patients with active PsA needing vaccinations, delay the start of biologic to administer live attenuated vaccines over starting the biologic and administering live attenuated vaccines.
    Nonpharmacologic Intervention
    1. In adult patients with active PsA, recommend exercise over no exercise.
    2. In adult patients with active PsA, recommend low-impact exercise (e.g., tai chi, yoga, swimming) over high-impact exercise (e.g., running).
    3. In adult patients with active PsA, recommend physical therapy over no physical therapy.
    4. In adult patients with active PsA, recommend occupational therapy over no occupational therapy.
    5. In adult patients with active PsA, recommend weight loss over no weight loss for patients who are overweight/obese.
    6. In adult patients with active PsA, recommend massage therapy over no massage therapy.
    7. In adult patients with active PsA, recommend acupuncture over no acupuncture.
    8. In adult patients with active PsA, recommend smoking cessation over no smoking cessation.
    What do the icons mean?  
    Research PaperSingh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Rheumatol. 2018.