Fig. 1: Interplay between complex-to-manage and treatment-refractory psoriatic arthritis.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) consensus definitions define two distinct states of psoriatic arthritis (PsA) in the context of inadequate response to treatment: complex-to-manage PsA (C2M-PsA) and treatment-refractory PsA (TR-PsA). b/tsDMARD), biologic or targeted synthetic DMARD.