Psoriatic Arthritis

Think of the four steps of psoriatic arthritis treatment. If the first step isn't doing enough, move on to the next step for treatment. The first step is NSAIDS, the second step is methotrexate (or another conventional DMARD), the third step is TNF-alpha inhibitors, and the last step is biological DMARDs. Although we're very used to using steroids for rheumatological disease flares, for psoriatic arthritis it can flare the skin by causing erythroderma or pustular psoriasis. Don't forget to include non pharmacological treatment options in your plan. If a patient already has erosive disease, start with step 3 (TNF-alpha inhibitors). Also for axial disease start with step 1 but skip step 2 if needed.