Fast Five Quiz: Can You Identify Psoriatic Arthritis and Initiate the Best Treatment Practices?

Herbert S Diamond, MD; Anwar Al Hammadi, MD; Eric M. Ruderman, MD; Marina Magrey, MD


January 25, 2023

Treatment with tumor necrosis factor (TNF)–inhibitor therapy should be considered at an early stage for patients with active PsA. According to ACR/NPF guidelines, TNF-inhibitor therapy is recommended over methotrexate or other nonbiologic disease-modifying agents. On the basis of low-quality evidence, TNF inhibitor therapy is preferred to interleukin-17–inhibitor therapy for initial treatment. Disease-modifying therapy may be considered in patients with contraindications to TNF-inhibitor treatment and in patients who do not have severe psoriasis, prefer oral therapy, or are concerned about starting a TNF inhibitor as initial therapy. According to recent Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) guidelines, TNF inhibitors, IL-17A inhibitors, or IL-23 inhibitors are recommended as first-line therapy in PsA.

Antimalarials, particularly hydroxychloroquine, are usually avoided in patients with psoriasis for fear of precipitating exfoliative dermatitis or exacerbating psoriasis. Systemic corticosteroids are usually avoided as well because of possible rebound of the skin disease upon withdrawal and should not be used as initial therapy.

Learn more about the treatment of PsA.


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