Treatment of Psoriatic Arthritis with Clinically Relevant Skin Psoriasis Involvement

When psoriatic arthritis occurs alongside clinically significant skin psoriasis, the extent and impact of skin involvement shapes the treatment approach. This protocol addresses that specific scenario.

Clinical scenario

This protocol applies to patients with psoriatic arthritis who have clinically relevant skin psoriasis involvement — defined as extensive disease (body surface area involvement greater than 10%) or skin involvement that negatively impacts the patient's quality of life, such as face or genital involvement.

      Skin involvement is considered relevant either when it is extensive in area or when it is important to the patient — including sites such as the face or genitals — regardless of total body surface area.
    

Treatment approach (partial overview)

Initial management includes agents directed at musculoskeletal signs and symptoms, with adjunctive local therapy considered where appropriate. The complete structured regimen — including therapy selection informed by the extent of skin involvement — is detailed in the full protocol.

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References

DOI: 10.1136/ard-2024-225531

With clinically relevant skin involvement, preference should be given to an IL-17A or IL-17A/F or IL-23 or IL-12/23 inhibitor.
Relevant skin involvement is defined as either extensive (body surface area involvement >10%), or as important to the patient, that is, impacting negatively their quality of life (such as is the case with face or genital involvement).
Non-steroidal anti-inflammatory drugs may be used to relieve musculoskeletal signs and symptoms; local injections of glucocorticoids may be considered as adjunctive therapy.

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