This protocol applies to patients with peripheral psoriatic arthritis — either with five or more swollen joints, or with monoarthritis/oligoarthritis and poor prognostic features — whose previous biologic DMARD did not achieve the expected treatment targets.
Peripheral arthritis with polyarthritis (≥5 swollen joints), or monoarthritis/oligoarthritis in the presence of poor prognostic factors — including structural damage, elevated acute phase reactants, dactylitis, or nail involvement.
The preceding line used a bDMARD — adalimumab, certolizumab, etanercept, infliximab, golimumab, ustekinumab, ixekizumab, secukinumab, bimekizumab, guselkumab, or risankizumab. Escalation to this protocol is indicated when that bDMARD did not achieve improvement at 3 months, or remission or low disease activity at 6 months.
DOI: 10.1136/ard-2024-225531
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.
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.
For JAKis, caution is needed for patients aged 65 years or above, those who are current or past long-time smokers, with a history of atherosclerotic cardiovascular disease or other cardiovascular risk factors or with other malignancy risk factors, and with known risk factors for venous thromboembolism.
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 ↗