Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Leung YY, Korotaeva TV, Candia L, Pedersen SJ, Molano WB, Ruderman EM, Bisoendial R, Perez-Alamino R, Olsder W, Möller B, Grazio S, Gudu T, Mody GM, Pineda C, Raffayova H, Rohekar S, Goldenstein-Schainberg C, Gutierrez Urena SR, Casasola Vargas JC, Meghnathi B, Prasad R, Richette P, Miranda JRS, Malliotis N, Lindqvist U, Simon D, Ezeonyeji A, Soriano ER, FitzGerald O (2023)

Publication Type: Journal article, Review article

Publication year: 2023


Book Volume: 50

Pages Range: 119-130

Journal Issue: 1

DOI: 10.3899/jrheum.220315


OBJECTIVE: We aimed to compile evidence for the efficacy and safety of therapeutic options for the peripheral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. METHODS: A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naïve to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings. RESULTS: The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naïve to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodiesterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recommends adequate physical activity, smoking cessation, and diet to control weight gain. CONCLUSION: Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations.

Authors with CRIS profile

Involved external institutions

St George’s University Hospitals NHS Foundation Trust GB United Kingdom (GB) Hospital Italiano de Buenos Aires AR Argentina (AR) Care Institute of Medical Sciences / CIMS Hospital IN India (IN) National Institute of Rheumatic Diseases / Národný Ustav Reumatických Chorôb SK Slovakia (SK) Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INR) MX Mexico (MX) Universidad Juárez del Estado de Durango (UJED) MX Mexico (MX) National Autonomous University of Mexico / Universidad Nacional Autónoma de México (UNAM) MX Mexico (MX) University College Dublin (UCD) IE Ireland (IE) Singapore General Hospital SG Singapore (SG) Uppsala University Hospital / Akademiska sjukhuset SE Sweden (SE) V.A. Nasonova Research Institute of Rheumatology RU Russian Federation (RU) Rigshospitalet DK Denmark (DK) Hospital Universitário Fundación Santa Fe de Bogotá CO Colombia (CO) Sisters of Charity Hospital / Klinički Bolnički Centar Sestre Milosrdnice (KBCSM) HR Croatia (HR) Maasstad Ziekenhuis NL Netherlands (NL) Hospital Civil de Guadalajara MX Mexico (MX) Western University CA Canada (CA) Inselspital, Universitätsspital Bern CH Switzerland (CH) University of KwaZulu-Natal (UKZN) ZA South Africa (ZA) Cambridge University Hospitals GB United Kingdom (GB) University Hospital of Wales (UHW) GB United Kingdom (GB) Northwestern University US United States (USA) (US) Université Sorbonne Paris Cité FR France (FR) University of São Paulo / Universidade de São Paulo (USP) BR Brazil (BR) Hospital de Clínicas Presidente Dr. Nicolás Avellaneda AR Argentina (AR) Eindhoven University of Technology / Technische Universiteit Eindhoven (TU/e) NL Netherlands (NL)

How to cite


Leung, Y.Y., Korotaeva, T.V., Candia, L., Pedersen, S.J., Molano, W.B., Ruderman, E.M.,... FitzGerald, O. (2023). Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations. Journal of Rheumatology, 50(1), 119-130.


Leung, Ying Ying, et al. "Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations." Journal of Rheumatology 50.1 (2023): 119-130.

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