Psoriatic arthritis treatment to the target: a consensus, evidence-based clinical practice recommendations for the management of psoriatic arthritis and its concomitant clinical manifestations

Egyptian Rheumatology and Rehabilitation

Table 6 Personalized management. A suggested management approach to psoriatic patients tailored to their clinical manifestations and prognostic markers

N	Status	Recommendation	LE	GoR	Mean rate ±SD	% of agreement	Level of agreement
1	Patient resisted/intolerable to csDMARDs without poor prognostic factor	Consider combined DMARDs therapy	2	B	8.42 ±0.96	89.5	H
2	Patient resisted/intolerable to csDMARDs with poor prognostic factor	Consider biological therapy	2	B	8.42 ±0.77	89.5	H
3	Patient is mainly presented with axial affection mainly	Choosing biological therapy among TNFi, IL-17i, or JAKi as not all biological therapy has good response with axial affection	2	B	8.58 ±0.77	100	H
4	Patient is presented with skin affection	IL-17 inhibitor, IL-12/23, or IL-23 inhibitor are more recommended among biologics.	2	B	8.42 ±0.76	100	H
5	Patient is presented with monoarthritis or enthesitis	Using local CS injection is considered	2	B	8.21 ±.31	89.5	H

GoR grade of recommendation, bDMARDS biological disease modifying anti-rheumatic drugs. csDMARDS conventional synthetic disease modifying anti-rheumatic drugs, tsDMARDS target synthetic disease modifying anti-rheumatic drugs. Cs corticosteroids, JAKi janus kinase inhibitors, TNF tumor necrosis factor, IL interleukin