Table 2.

Overview of PsA treatment algorithms: PsA severity^*

	AAD (32,33)	GRAPPA (31)	EULAR (30)
Mild	Step 1. NSAIDs	NSAIDs	NSAIDs
	Step 2. conventional DMARD
Moderate	Step 1. conventional DMARD	Step 1. conventional DMARD	Step 1. NSAIDs
	Step 2. combination DMARD/TNF inhibitor	Step 2. combination DMARD/TNF inhibitor	Step 2. methotrexate
			Step 3. switch to different DMARD
Severe or high risk†	Combination synthetic DMARD/TNF inhibitor or other biologic agent	TNF inhibitor	Step 1. methotrexate
			Step 2. different DMARD or TNF inhibitor (axial disease, high risk)
			Step 3. begin (or switch) to different biologic agent, combination + DMARD

^*PsA = psoriatic arthritis; AAD = American Academy of Dermatology; GRAPPA = Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; EULAR = European League Against Rheumatism; NSAIDs = nonsteroidal antiinflammatory drugs; DMARD = disease-modifying antirheumatic drug; TNF = tumor necrosis factor.

^†High risk refers to patients with adverse prognostic factors, including ≥5 active joints, high functional impairment, radiographic damage, or past glucocorticoid use.