This protocol applies to patients with psoriatic arthritis and clinically relevant skin psoriasis involvement who did not achieve the required treatment targets on a conventional synthetic DMARD (csDMARD) regimen.
Clinically relevant skin psoriasis involvement is defined as body surface area (BSA) involvement greater than 10%, or skin involvement that negatively impacts the patient's quality of life — including face or genital involvement regardless of BSA extent.
The preceding treatment line used a csDMARD — methotrexate preferred for clinically relevant skin involvement, or alternatively leflunomide or sulfasalazine. Escalation to this protocol is triggered when that regimen failed to achieve at least 50% reduction in disease activity within 3 months, or failed to reach remission or low disease activity by 6 months.
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).
The choice of the mode of action should reflect non-musculoskeletal manifestations related to psoriatic arthritis; 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.
There are strong data, including head-to-head trials, in the field of skin psoriasis showing that drugs targeting the IL-23 and IL-17 pathways are superior to TNFis and to JAKis for skin psoriasis.
Treatment should be aimed at reaching the target of remission or, alternatively, low disease activity, by regular disease activity assessment and appropriate adjustment of therapy.
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