This protocol addresses psoriatic arthritis in which unequivocal enthesitis is the predominant manifestation, and an initial biologic DMARD has not achieved the expected treatment targets — whether due to inadequate response or intolerance.
Unequivocal enthesitis denotes definite entheseal inflammation, which may require additional diagnostic imaging to confirm, distinguishing it from entheseal pain not attributable to PsA.
A first biologic DMARD was used. Approved options for predominant enthesitis include:
Targets not met on that therapy:
When a biologic DMARD has been inadequately effective or is not tolerated, switching to a different biologic DMARD or a JAK inhibitor is considered — the full protocol specifies which options apply and how to approach the transition.
Targets are assessed by regular disease activity monitoring, with therapy adjusted accordingly.
DOI: 10.1136/ard-2024-225531
In patients with unequivocal enthesitis and an insufficient response to NSAIDs or local glucocorticoid injections, therapy with a bDMARD should be considered.
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 an inadequate response or intolerance to a bDMARD or a JAKi, switching to another bDMARD or JAKi should be considered, including one switch within a class.
Although tsDMARDs are not mentioned specifically in the bullet point, they are an option in some cases of enthesitis (always considering benefit to risk ratios, in particular for JAKis).
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 ↗