4
Treatment
Figure 1. GRAPPA Treatment Schema for Active PsA
Which domains
Peripheral arthritis
DMARDs
(MTX, SSZ,
LEF), TNFi or
PDE4i
Biologics
(TNFi,
IL12/23i,
IL17i ) or
PDE4i
Switch biologic
(TNFi,
IL12/23i or
IL17i )
NSAIDS
and
IAI
corticosteroids
as
indicated
Axial Disease
NSAIDs only
TNFi, IL17i
or
*IL12/23i
Switch biologic
(TNFi, IL17i
or *IL12/23i )
Physiotherapy
and
NSAIDs
Enthesitis
NSAIDs
Biologics
(TNFi,
IL12/23i,
IL17i ) or
PDE4i
Switch biologic
(TNFi,
IL12/23i,
IL17i ) or
PDE4i
Physiotherapy
*No direct evidence for
therapies in axial PsA.
Recommendations based on
axial SpA literature.
CS injections: Consider on
an individual basis due to
potential for serious side
effects. No clear evidence
for efficacy.
Consider previous therapy, patient choice, other disease involvement and
comorbidities. Choice of therapy should address as many domains as possible.
KEY
Standard Therapeutic Route
Expedited Therapeutic Route
