This first-line protocol covers peripheral psoriatic arthritis presenting with a significant active joint burden or clinical features that indicate a higher risk of unfavourable disease course.
The protocol applies to patients with peripheral psoriatic arthritis and polyarthritis involving five or more swollen joints, or those with monoarthritis or oligoarthritis accompanied by one or more of the following poor prognostic factors:
Management targets musculoskeletal symptom relief, with anti-inflammatory therapy forming part of the initial strategy; adjunctive local measures may also be considered.
In patients with polyarthritis, or those with monoarthritis/oligoarthritis and poor prognostic factors (eg, structural damage, elevated acute phase reactants, dactylitis or nail involvement), a csDMARD should be initiated rapidly, with methotrexate preferred in those with clinically relevant skin 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.
DOI: 10.1136/ard-2024-225531 View source ↗