This protocol addresses psoriatic arthritis presenting with unequivocal enthesitis as the predominant manifestation — that is, definite entheseal inflammation confirmed clinically or with additional diagnostic imaging.
The requirement for unequivocal enthesitis is deliberate: it is intended to avoid overtreatment of entheseal pain that is not attributable to psoriatic arthritis.
Management begins with anti-inflammatory medication to relieve musculoskeletal symptoms, with a local injection option available as adjunctive therapy where appropriate. The full protocol specifies when and how each option is applied, and what step follows if initial relief is insufficient.
DOI: 10.1136/ard-2024-225531
Non-steroidal anti-inflammatory drugs may be used to relieve musculoskeletal signs and symptoms; local injections of glucocorticoids may be considered as adjunctive therapy.
The use of symptomatic treatments alone should usually be short term, for example, limited to 4 weeks or so.
Unequivocal enthesitis refers (as in 2019) to definite entheseal inflammation (which might need additional diagnostic imaging) to avoid overtreatment of entheseal pain not related to PsA.
In patients with unequivocal enthesitis and an insufficient response to NSAIDs or local glucocorticoid injections, therapy with a bDMARD should be considered.
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