6
Treatment
Table 1. Summary of Recommendations for Treatment of PsA
Indication Strong recommendation for
Conditional
recommendation for
Peripheral arthritis,
DMARD naive
csDMARDs (except CsA), TNFi,
IL-12/23i, IL-17i, IL-23i, JAKi,
PDE4i
NSAIDs, oral GC, IA
GC
Peripheral
arthritis, DMARD
inadequate response
TNFi, IL-12/23i, IL-17i, IL-23i,
JAKi, PDE4i
csDMARDs, NSAIDs,
oral GC, IA GC,
CTLA4-Ig
Peripheral arthritis,
bDMARD
experienced
TNFi, IL-17i, IL-23i, JAKi NSAIDs, oral GC, IA
GC, IL-12/23i, PDE4i,
CTLA4-Ig
Axial disease,
bDMARD naive
NSAIDs, physiotherapy, simple
analgesia, TNFi, IL-17i, JAKi
GC SIJ injections,
bisphosphonates
Enthesitis TNFi, IL-12/23i, IL-17i, IL-23i,
JAKi, PDE4i
NSAIDs, physiotherapy,
MTX, CTLA4-Ig, GC
injections (with extreme
caution)
Dactylitis TNFi, IL-12/23i, IL-17i, IL-23i,
JAKi, PDE4i
NSAIDs, GC injections,
MTX, CTLA4-Ig
Psoriasis (plaque) Topical therapies, phototherapy,
csDMARDs (MTX, fumarate,
fumaric acid esters, CsA), TNFi,
IL-12/23i, IL-17i, IL-23i, PDE4i,
JAKi
Acitretin
Nail psoriasis TNFi, IL-12/23i, IL-17i, IL-23i,
PDE4i
Topical GC, tacrolimus
and calcipotriol
combination or individual
therapies, pulsed dye laser,
csDMARDs (MTX, LEF,
CsA), acitretin, JAKi
IBD: Crohn's
disease
TNFi (not ETN), IL-12/23i IL-23i, JAKi, MTX
IBD: UC TNFi (not ETN), IL-12/23i IL-23i, JAKi, MTX
Uveitis — TNFi (not ETN), CsA,
MTX
bDMARD, biologic DMARD; csDMARD, conventional synthetic DMARD (MTX, SSZ,
LEF, CsA; unless otherwise specified); CsA, ciclosporin; ETN, etanercept; GC, glucocorticoids;
IA, intra-articular; IBD, inflammatory bowel disease; IL-12/23i, IL-12/23 inhibitor; IL-17i,
IL-17 inhibitor; IL-23i, IL-23 inhibitor; JAKi, Janus kinase inhibitor; LEF, leflunomide; MTX,
methotrexate; PDE4i, phosphodiesterase 4 inhibitor (apremilast); PsA, psoriatic arthritis; SIJ,
sacroiliac joint; SSZ, sulfasalazine; TNFi, TNF inhibitor; UC, ulcerative colitis
