How do you approach management of patients with psoriatic arthritis who have significant improvement in skin disease, but ongoing inflammatory arthritis despite multiple DMARDs and/or biologics? 

Psoriatic arthritis is a heterogeneous disease and often the severity of MSK involvement and psoriasis are not well correlated. This is also true regarding treatment response. The approach to management in these cases depends on several factors:

Psoriasis type and severity: If the patient has mild ps...

This is 'Difficult to treat - D2T - PsA'. Some general principles: For oligoarticular (4 or less joints) arthritis, I would inject joints with corticosteroids, for secondary failure ("loss of response") of a biologic, I would choose another biologic from the same class, for primary failure ("lack of...

This is a challenging group, and they often require combination therapy with multiple cDMARDs and a biologic. I have been cautious about the use of combinations of biologics (and insurers are unlikely to approve this because of the cost), but there are ongoing clinical trials that may help us determ...