Fig. 2: GRAPPA 2021 treatment schema.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2021 treatment recommendations for psoriatic arthritis (PsA) use a domain-based approach, but, considering that most patients present with disease in multiple domains, this treatment schema combines the recommendations for each domain to guide therapeutic decisions. Disease activity should be assessed in each of the domains and consideration given to comorbidities, previous therapies and patient preference. Standard ‘step-up’ approaches, as well as expedited treatment routes, are indicated. Treatment efficacy and tolerability should be re-evaluated periodically and treatment adjusted as appropriate. The order of the products in the boxes is sorted by mechanism of action and does not reflect guidance on relative efficacy or suggested usage. Bold text indicates a strong recommendation, standard text a conditional recommendation. The asterisks indicate a conditional recommendation based on data from abstracts only. bDMARD, biologic DMARD; CTLA4-Ig, CTLA4–immunoglobulin fusion protein; csDMARD, conventional synthetic DMARD; ETN, etanercept; GC, glucocorticoid; IBD, inflammatory bowel disease; JAKi, Janus kinase inhibitor; MTX, methotrexate; PDE4i, phosphodiesterase 4 inhibitor; TNFi, TNF inhibitor.