GRAPPA Psoriatic Arthritis App brought to you free of charge courtesy of Guideline Central. Enjoy!
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11 Table 9. Treatment Recommendations for Psoriasis GRADE Topical therapies are recommended as the basic approach to treat any psoriasis. It is recommended as the sole therapy for mild disease and can be combined with systemic therapies in more active disease. Note: e combination of calcipotriol and betamethasone is considered the gold standard for plaque psoriasis, with exceptions for specific anatomical sites—e.g., face, genitals. S Conventional DMARDs (methotrexate, leflunomide, cyclosporin) are recommended as first line therapy for psoriasis. S TNF inhibitors should be used to treat psoriasis in people who are DMARD naïve or DMARD failures. S IL12/23 inhibitors should be used to treat psoriasis in people who are DMARD naïve or DMARD failures. S IL17 inhibitors (brodalumab, ixekizumab, secukinumab) should be used to treat psoriasis in people who are DMARD naïve or DMARD failures. S Apremilast should be used to treat psoriasis in people who are DMARD naïve or DMARD failures. S Concomitant topical therapy can usually be limited to emollients and pharmacotherapy of single lesions or sites in limited psoriasis since many systemic treatments for PsA will have a beneficial effect on the skin. S In patients with markedly active psoriasis, the following therapies for PsA should be used in preference: methotrexate, cyclosporin, TNFi, IL12/23i, IL17i, apremilast. S Table 10. Treatment Recommendations for Nail Psoriasis GRADE Topical therapies (calcipotriol, tacrolimus, and tazarotene) can be considered for symptom improvement in nail psoriasis. C Procedural therapies (including pulsed dye laser and intralesional corticosteroids) can be considered for symptom improvement in nail psoriasis. C cDMARDs (cyclosporine, leflunomide, acitretin and methotrexate) can be considered for the treatment of nail psoriasis. C TNF alpha inhibitors are recommended as initial or second line therapy in the treatment of refractory or moderate to severe active nail psoriasis. S Ustekinumab is recommended as a second line therapy in the treatment of refractory or moderate to severe active nail psoriasis. S IL17 inhibitors can be considered as a second line therapy in the treatment of refractory or moderate to severe active nail psoriasis. C Apremilast can be considered for the treatment of nail psoriasis. C Recommendations for the treatment of nail disease in PsA rely on data from studies in skin psoriasis.