This protocol addresses psoriatic arthritis patients with peripheral polyarthritis involving five or more swollen joints — or those with monoarthritis/oligoarthritis who carry poor prognostic factors — in whom conventional synthetic DMARD therapy has not achieved adequate disease control.
Peripheral arthritis with polyarthritis (≥5 swollen joints), or monoarthritis/oligoarthritis accompanied by poor prognostic factors: structural damage, elevated acute phase reactants, dactylitis, or nail involvement.
The prior line used a conventional synthetic DMARD — methotrexate, leflunomide, or sulfasalazine. The targets set for that line were at least a 50% reduction in disease activity by 3 months and remission or low disease activity by 6 months. When those goals are not reached, this protocol is the recommended next step.
After an inadequate response to a csDMARD, the protocol directs initiation of a biological DMARD (bDMARD). Multiple agents spanning different mechanistic targets are included; no order of preference among them is specified for joint involvement.
Improvement at 3 months; remission or low disease activity at 6 months, guided by regular disease activity assessment and therapy adjustment as needed.