Group for Research and Assessment of Psoriasis and Psoriatic Arthritis

Overview

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published updated recommendations for therapy of PsA in 2021 (Figure 6-11). Although he current recommendations continue to be organized by PsA domain, GRAPPA recognizes that most patients present with PsA in multiple domains, and the choice of therapy should address as many domains as possible while taking into account patient preferences and prior and concomitant therapies.

For the treatment of peripheral PsA, the guidelines offer different recommendations based on prior therapy. For disease-modifying antirheumatic drugs (DMARD)-naïve patients, a csDMARD (with the exception of cyclosporine), a tumor necrosis factor inhibitor (TNFi), an inhibitor of IL-12/23, IL-17, or IL-23, a JAKi, or a PDE4i is strongly recommended. For patients with an inadequate response to prior DMARD therapy, a TNFi, an IL-12/23, -17, or -23 inhibitor, a JAKi, or a PDE4i are preferred. Finally, for patients with prior biologic DMARD experience, the preferred agent is a TNFi, IL-17i, IL-23i, or a JAKi.

For patients with axial disease, NSAIDs, physiotherapy, and simple analgesia are strongly recommended, as are a JAKi, TNFi, or IL-17i. For PsA enthesitis, strongly recommended options include a TNFi, an IL-12/23, -17, or -23 inhibitor, a JAKi, or a PDE4i. Finally, for patients with dactylitis, GRAPPA strongly recommends a TNFi, an IL-12/23, -17, or -23 inhibitor, a JAKi, or a PDE4i.

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