Fig. 3.

European League Against Rheumatism (EULAR) recommended treatment algorithm for management of psoriatic arthritis. The recommendations have been divided into four phases. Small fonts within the ellipses in phases II and III refer to dose modifications or an alternative therapy, as detailed within the body of the recommendations. ^aBecause of the variable nature of the disease, not all situations can be covered by this figure; therefore, it is important to consult the full text to which the numbers or letters in parentheses refer; dotted lines refer to situations where deleting a phase is recommended. ^bActive disease: ≥1 tender and inflamed joint and/or tender enthesis point, and/or dactylitic digit, and/or inflammatory back pain; adverse prognostic factors: ≥5 active joints; or high functional impairment due to activity; or damage; or past glucocorticoid use. ^cThe treatment target is clinical remission or, if remission is unlikely to be achievable, at least low disease activity; clinical remission is the absence of signs and symptoms. Reproduced from Gossec et al. [89]. Copyright © 2012 with permission from BMJ Publishing Group Ltd. DMARD disease-modifying anti-rheumatic drug, MTX methotrexate, TNF tumour necrosis factor