Clinical Scenario

This protocol addresses psoriatic arthritis where skin psoriasis is clinically significant — defined as body surface area involvement greater than 10%, or involvement that negatively impacts the patient's quality of life, such as facial or genital involvement.

Treatment is targeted at measurable improvement by 3 months, and remission or low disease activity by 6 months, assessed through regular disease activity monitoring.

Prior Line — Inadequate Response

This protocol is reached after failure of a biologic DMARD (bDMARD) that targets the IL-17A, IL-17A/F, IL-23, or IL-12/23 pathway — specifically ixekizumab, secukinumab, bimekizumab, guselkumab, risankizumab, or ustekinumab — where treatment did not achieve improvement at 3 months or remission/low disease activity at 6 months.

Next Treatment Step

Following inadequate response to a bDMARD in this setting, a JAK inhibitor approach may be considered, with the appropriate agent determined by individual safety considerations. The complete evidence-based regimen — including agent selection and monitoring framework — is available in the full protocol.

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).

In patients with peripheral arthritis and an inadequate response to at least one bDMARD, or when a bDMARD is not appropriate, a JAKi may be considered, taking safety considerations into account.

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.

View source ↗

Psoriatic Arthritis with Clinically Relevant Skin Involvement After bDMARD Failure

References