Psoriatic arthritis Management Goals of treatment EULAR Q Does the patient have a clinical diagnosis of active psoriatic arthritis? No Consider alternative diagnoses. Yes Initiate treatment aiming to achieve remission or low disease activity or, alternatively, low disease activity, by regular disease activity assessment and appropriate adjustment of therapy. B Nonsteroidal anti-inflammatory drugs Consider prescribing NSAIDs for the relief of musculoskeletal signs and symptoms in patients with PsA. B Disease-modifying antirheumatic drugs EULAR Q Does the patient have significant peripheral arthritis? Yes Initiate a conventional synthetic DMARD (methotrexate preferred in the presence of relevant skin involvement) in patients with polyarthritis. B No Consider initiating a conventional synthetic DMARD in patients with monoarthritis or oligoarthritis, particularly with poor prognostic factors, such as structural damage, high ESR/CRP, dactylitis, or nail involvement. C Consider initiating a PDE4 inhibitor in patients with mild disease C and an inadequate response to at least one conventional synthetic DMARD C , if neither biologic DMARDs nor JAK inhibitors are appropriate. C Systemic corticosteroids Consider initiating systemic corticosteroids, if indicated, with caution and at the lowest effective dose. C Biologic agents Patients with peripheral arthritis Q Does the patient have active peripheral arthritis? Q Does the patient display an inadequate response to one or more conventional synthetic DMARD? Yes to all Initiate a biologic DMARD in patients with peripheral arthritis and an inadequate response to at least one conventional synthetic DMARD. Consider preferring IL-17 or IL-12/23 inhibitors in the presence of relevant skin involvement. B Consider initiating a Januke kinase inhibitor may be considered in patients with peripheral arthritis and an inadequate response to at least one conventional synthetic DMARD and at least one biologic DMARD, or when a biologic DMARD is not appropriate. C No to any Management of inadequate response to biologic agents EULAR Q Does the patient display an adequate response to biologic agents? Yes Continue management as clinically appropriate. No Consider switching to another biologic DMARD or targeted synthetic DMARD, including switching within a class, C in patients failing to respond adequately to or intolerant of a biologic DMARD. C