Table 2

Treatment recommendations for peripheral spondyloarthritis and psoriatic arthritis

Source	Peripheral spondyloarthritis			Psoriatic arthritis
Source	ASAS-EULAR 201772	NICE 202173	ACR-NPF 2018	EULAR 202074	GRAPPA 202115
First line	NSAIDs	NSAIDs (adjunct therapy)	NSAIDs	NSAIDs (adjunct therapy)	NSAIDs
First line	Local corticosteroids injections	Local or intramuscular corticosteroids		Local or intramuscular corticosteroids
Second line	cs-DMARDs (Sulfasalazine)	cs-DMARDs (two trials)	cs-DMARDs PDE4i (can be used as additional therapy)	cs-DMARDs (Methotrexate preferred for skin) (Skip this step if axial disease, enthesitis)	Domain Approach cs-DMARDs (mostly Methotrexate) (Skip this step if axial disease, IBD, uveitis)
Third line	TNFi, IL17i	TNFi, PDE4i	TNFi IL17i or IL12/23 if severe psoriasis, contra-indication to TNFi, IBD (for IL12/123)	b-DMARDs: IL17i, IL12/23i preferred if relevant skin involvement TNFi preferred if active axial disease	Domain Approach If peripheral arthritis: b-DMARDs (TNFi, IL12/23i, IL23i, CTLA4-Ig) or JAKi or PDE4i
Fourth line	TNFi, IL-17i	IL17i, IL12/23i or Tofacitinib; IL23i (if moderate to severe psoriasis)	JAKi CTLA4-Ig	JAKi, PDE4i

ACR, American College of Rheumatology; ASAS, Assessment of SpondyloArthritis international Society; b-DMARDs, biological disease-modifying antirheumatic drugs; cs-DMARDs, conventional synthetic DMARDs; EULAR, European League of Associations for Rheumatology; GRAPPA, Group For Research And Assessment Of Psoriasis And Psoriatic Arthritis; IBD, Inflammatory Bowel Disease; IL, interleukin; JAKi, Janus Kinase inhibitor; NICE, National Institute for Health and Care Excellence; NPF, National Psoriasis Foundation; NSAIDs, non-steroidal anti-inflammatory drugs; PDE4i, phosphodiesterase 4 inhibitor; TNFi, Tumour Necrosis Factor inhibitor.