Executive summary: The 2022 British Society for Rheumatology guideline for the treatment of psoriatic arthritis with biologic and targeted synthetic DMARDs

Need for guideline

PsA is a chronic, inflammatory, musculoskeletal disease affecting approximately one quarter of people with the skin condition psoriasis. PsA is a highly heterogeneous disease, encompassing diverse musculoskeletal manifestations or ‘domains’ resulting from disease activity in different tissues. These include peripheral arthritis, spondylitis (axial inflammation), dactylitis (inflammation of the whole digit) and enthesitis (inflammation where a tendon, ligament or joint capsule insert to the bone). Unlike RA there is a significant variability in clinical presentation of PsA. Individuals with PsA may have different domains involved and drugs have different levels of effectiveness on each domain. The most recent British Society for Rheumatology (BSR) guidelines for the treatment of PsA were published in 2012 [1] and focused specifically on TNF inhibitors as they were the only biologic DMARDs (bDMARDs) available. Since that time, there have been significant advances in therapeutic options available for PsA and drugs with different modes of action are now available, including IL IL17, IL12/23, IL23 p19, cytotoxic T-lymphocyte-associated antigen 4 (CTLA4), phosphodiesterase-4 (PDE4) and Janus kinase (JAK) inhibition.