EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update

Laure Gossec, Andreas Kerschbaumer, Ricardo J O Ferreira, Daniel Aletaha, Xenofon Baraliakos, Heidi Bertheussen, Wolf-Henning Boehncke, Bente Appel Esbensen, Iain B McInnes, Dennis McGonagle, Kevin L Winthrop, Andra Balanescu, Peter V Balint, Gerd R Burmester, Juan D Cañete, Pascal Claudepierre, Lihi Eder, Merete Lund Hetland, Annamaria Iagnocco, Lars Erik KristensenRik Lories, Rubén Queiro, Daniele Mauro, Helena Marzo-Ortega, Philip J Mease, Peter Nash, Wendy Wagenaar, Laura Savage, Georg Schett, Stephanie J W Shoop-Worrall, Yoshiya Tanaka, Filip E Van den Bosch, Annette van der Helm-van Mil, Alen Zabotti, Désirée van der Heijde, Josef S Smolen

1 Citation (Scopus)


OBJECTIVE: New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA.

METHODS: Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined.

RESULTS: The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed.

CONCLUSION: These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Issue number6
Pages (from-to)706-719
Number of pages14
Publication statusPublished - 15 May 2024


  • Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
  • Antirheumatic Agents/therapeutic use
  • Arthritis, Psoriatic/drug therapy
  • Biological Products/therapeutic use
  • Humans
  • Methotrexate/therapeutic use
  • Biological Therapy
  • Treatment
  • Biosimilar Pharmaceuticals
  • Psoriatic Arthritis


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