Treatment for psoriatic arthritis or other peripheral spondyloarthritides depends on the extent and nature of the disease. It can include local corticosteroid injections as monotherapy or trying a standard DMARD for three months. Both cDMARDs and biologics can be augmented with NSAIDs, but if this is insufficient for pain, then a local injected or short-course oral glucocorticoid may be necessary.9
Etanercept, infliximab and adalimumab should be reserved for use in people with peripheral arthritis with three or more tender joints and three or more swollen joints, and which has not responded to adequate trials of at least two standard DMARDs, administered either individually or in combination. This should be assessed after 12 weeks and the DMARD discontinued if the response is not adequate.
NICE says golimumab can be used for active and progressive psoriatic arthritis along the same lines as etanercept, infliximab and adalimumab, but use depends on the cost.
Ustekinumab can be used alone or in combination with methotrexate for active psoriatic arthritis where treatment with TNF€‘α inhibitors is contraindicated or the person has had treatment with at least one TNF€‘α inhibitors. Use should be reviewed after 24 weeks.