Treatment of specific types of active psoriatic arthritis (PSA)

Treatment of specific types of active psoriatic arthritis PsA:

1. Patients with active PsA with spondylitis as the main manifestation: The treatment of axial arthritis PsA should follow the treatment recommendations of the American College of Rheumatology/American Spondyloarthritis Association/Spondyloarthritis Research and Treatment Network for axial spondyloarthritis. Oral small molecule compound drugs are ineffective for spondyloarthritis. For this type of PsA patients, tumor necrosis factor inhibitors are recommended over interleukin-17 inhibitors IL-17i or interleukin-12/23 inhibitors IL-12/23i. IL-17i can be considered for use when the patient has severe psoriasis or contraindications to the tumor necrosis factor inhibitor TNFi. Based on the fact that three IL-12/23i clinical trials conducted in patients with axial spondyloarthritis were terminated without reaching the primary and secondary endpoints, this guideline does not recommend the use of IL-12/23i to treat such patients.

2. Patients with active PsA with enthesitis as the main manifestation: For the treatment of patients with PsA with enthesitis as the main manifestation, non-steroidal anti-inflammatory drugs, tumor necrosis factor inhibitors TNFi or tofacitinib are given priority as initial treatment options, and oral small molecule compounds are placed at a later stage. Oral small molecule compounds can be selected as initial treatment when patients have contraindications to the above drugs or prefer oral medications. For such patients who are already using oral small molecule compounds but still have active disease, switching to TNFi, IL-17i, IL-12/23i may be a better choice than switching to another oral small molecule compound. Similarly, in this type of patients, it is recommended to use TNFi instead of IL-17i or IL-12/23i, and switching to IL-17i is better than switching to IL-12/23i.