Psoriatic Arthritis in Inflammatory Bowel Disease: Treatment Approach
When psoriatic arthritis occurs alongside inflammatory bowel disease (IBD), treatment selection must account for both conditions simultaneously. Not all agents used in psoriatic arthritis are safe or appropriate in the presence of active IBD.
Clinical scenario
Psoriatic arthritis with concurrent inflammatory bowel disease. The coexisting IBD is a decisive factor in determining which therapies are suitable — certain biologic classes routinely considered for psoriatic arthritis carry a recognised risk of provoking IBD flares and are not recommended in this population.
Treatment approach (partial overview)
The structured regimen for this scenario draws on biologic and targeted therapies that have authorisation in both psoriatic arthritis and IBD — broadly, anti-TNF monoclonal antibodies, IL-12/23 or IL-23 inhibitors, or JAK inhibitors are the relevant classes. An entire category of agents commonly used in psoriatic arthritis is explicitly excluded here due to the IBD risk profile. The complete agent selection, preferred sequence, and decision criteria are available in the full protocol.
Clinical targets
Improvement at 3 months
Remission or low disease activity at 6 months
References
DOI: 10.1136/ard-2024-225531
- The choice of the mode of action should reflect non-musculoskeletal manifestations related to psoriatic arthritis; and with IBD to an anti-TNF monoclonal antibody or an IL-23 inhibitor or IL-12/23 inhibitor or a JAKi.
- IL-17is (both A and A/F) are not recommended in case of active IBD, given indications of a heightened risk of flares.
- For informative purposes, as of mid-2023, drugs authorised for IBD include anti-TNF monoclonal antibodies (ie, adalimumab and infliximab), the IL-12/23i ustekinumab, the IL-23i risankizumab (for Crohn's disease) and two JAKis (one of which, tofacitinib, only for Crohn's disease).
- With IBD to an anti-TNF monoclonal antibody or an IL-23 inhibitor or IL-12/23 inhibitor or a JAKi.
- 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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