Psoriatic Arthritis Recommendations - GRAPPA

10 Treatment Table 7. Treatment Recommendations for Enthesitis GRADE NSAIDs can be considered as an initial therapy for enthesitis with careful monitoring for side effects. • Based on expert opinion. C Physical therapy can be considered to improve symptoms and functional deficits associated with enthesitis. C Local corticosteroid injections can be considered with caution for enthesitis. C cDMARDs are NOT recommended for the treatment of enthesitis. • No published data support efficacy of other DMARDs in placebo-controlled studies. S NOT TNF alpha inhibitors as a class are recommended as initial or second line therapy in the treatment of refractory or moderate to severe enthesitis. S Ustekinumab is recommended as initial or second line therapy in the treatment of refractory or moderate to severe enthesitis. S Apremilast is recommended as initial or second line therapy in the treatment of refractory or moderate to severe enthesitis. • Conditional recommendation as data only currently available in abstract form. C IL17 inhibitors can be considered as an initial or second line therapy in the treatment of refractory or moderate to severe enthesitis. • Conditional recommendation as data only currently available in abstract form. C Table 8. Treatment Recommendations for Dactylitis GRADE Local corticosteroid injections can be considered for symptom improvement in dactylitis. C cDMARDs (methotrexate, leflunomide, sulfasalazine) can be considered for the treatment of dactylitis. • In contrast to enthesitis, DMARDs are recommended as a first step in dactylitis based on limited studies for this indication. C TNF alpha inhibitors (adalimumab, certolizumab, golimumab and infliximab) are recommended as initial or second line therapy in the treatment of refractory or moderate to severe dactylitis. S Ustekinumab can be considered as an initial targeted biological therapy or second line therapy in the treatment of refractory or moderate to severe dactylitis. C Apremilast can be considered as a second line therapy in the treatment of refractory or moderate to severe dactylitis. C IL17 inhibitors can be considered as second line therapy in the treatment of refractory or moderate to severe dactylitis. C

• Cover
• Key Points
• Overarching Principles
• Strength of Recommendations in GRADE
• GRAPPA Treatment Schema for Active PsA
• Summary of Recommendations by Domain
• Treatment Recommendations
• Comorbidities
• Abbreviations and Sources