EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update

Gossec L, Kerschbaumer A, Ferreira RJ, Aletaha D, Baraliakos X, Bertheussen H, Boehncke WH, Esbensen BA, McInnes IB, McGonagle D, Winthrop KL, Balanescu A, Balint PV, Burmester GR, Cañete JD, Claudepierre P, Eder L, Hetland ML, Iagnocco A, Kristensen LE, Lories R, Queiro R, Mauro D, Marzo-Ortega H, Mease PJ, Nash P, Wagenaar W, Savage L, Schett G, Shoop-Worrall SJ, Tanaka Y, Van Den Bosch FE, Van Der Helm-Van Mil A, Zabotti A, Van Der Heijde D, Smolen JS (2024)

Publication Type: Journal article

Publication year: 2024


Article Number: ard-2024-225531

DOI: 10.1136/ard-2024-225531


Objective: New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA. Methods: Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined. Results: The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed. Conclusion: These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.

Authors with CRIS profile

Involved external institutions

Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) RO Romania (RO) National Institute for Health and Medical Research / Institut national de la santé et de la recherche médicale (INSERM) FR France (FR) Medizinische Universität Wien AT Austria (AT) Griffith University AU Australia (AU) Rigshospitalet DK Denmark (DK) University of Glasgow GB United Kingdom (GB) NIHR Leeds Musculoskeletal Biomedical Research Unit (LMBRU) GB United Kingdom (GB) Oregon Health and Science University (OSHU) US United States (USA) (US) Semmelweis University / Semmelweis Egyetem HU Hungary (HU) Universiteit Gent (UGent) / Ghent University BE Belgium (BE) Nursing School of Lisbon / Escola Superior de Enfermagem de Lisboa PT Portugal (PT) Humboldt-Universität zu Berlin DE Germany (DE) Central University Hospital of Asturias ES Spain (ES) Hospital Clínic de Barcelona ES Spain (ES) Università degli studi della Campania Luigi Vanvitelli IT Italy (IT) Tilburg University NL Netherlands (NL) University of Leeds GB United Kingdom (GB) University of Manchester GB United Kingdom (GB) University of Occupational and Environmental Health Japan / 産業医科大学 JP Japan (JP) Leiden University Medical Center NL Netherlands (NL) Azienda sanitaria universitaria Friuli Centrale (ASU FC) IT Italy (IT) Katholieke Universiteit Leuven (KUL) / Catholic University of Leuven BE Belgium (BE) Rheumazentrum Ruhrgebiet DE Germany (DE) Diakonhjemmet Hospital NO Norway (NO) Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG) CH Switzerland (CH) Centre hospitalier universitaire Henri-Mondor (CHU Henri-Mondor) FR France (FR) University of Toronto CA Canada (CA) University of Turin / Università degli Studi di Torino (UNITO) IT Italy (IT)

How to cite


Gossec, L., Kerschbaumer, A., Ferreira, R.J., Aletaha, D., Baraliakos, X., Bertheussen, H.,... Smolen, J.S. (2024). EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Annals of the Rheumatic Diseases.


Gossec, Laure, et al. "EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update." Annals of the Rheumatic Diseases (2024).

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