For the management of psoriatic arthritis in adults, NICE recommends considering local corticosteroid injections as monotherapy for non-progressive monoarthritis NICE NG65.
Standard disease-modifying anti-rheumatic drugs (DMARDs) should be offered to people with peripheral polyarthritis, oligoarthritis, or persistent or progressive monoarthritis associated with peripheral spondyloarthritis NICE NG65.
If a person has active psoriatic arthritis that has not responded to at least 2 standard DMARDs, either individually or in combination, NICE guidance recommends treatments such as tofacitinib, ixekizumab, certolizumab pegol, secukinumab, apremilast, golimumab, adalimumab, etanercept, or infliximab NICE NG65.
For patients who have not controlled their condition well enough or cannot tolerate biological DMARDs, options include bimekizumab, guselkumab, risankizumab, upadacitinib, tofacitinib, ixekizumab, certolizumab pegol, secukinumab, or ustekinumab, with specific guidance on previous biological treatment and disease severity NICE NG65.
In addition, NICE advises that treatment should be reviewed regularly, and treatment decisions should involve discussion of risks, benefits, and patient preferences NICE NG65.