This protocol covers patients with psoriatic arthritis who have significant skin psoriasis involvement and have not achieved an adequate response on a JAK inhibitor.
The patient has clinically relevant skin psoriasis involvement: body surface area affected greater than 10%, or skin disease that negatively impacts quality of life — such as involvement of the face or genitals.
The preceding treatment was a JAK inhibitor (tofacitinib or upadacitinib, selected with safety considerations). The expected goals — improvement at 3 months, and remission or low disease activity at 6 months — were not reached, prompting escalation to this protocol.
Improvement at 3 months; remission or low disease activity at 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).
In patients with an inadequate response or intolerance to a bDMARD or a JAKi, switching to another bDMARD or JAKi should be considered, including one switch within a class.
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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