Difficult to treat psoriatic arthritis — how should we manage?

Anand Kumthekar, Maedeh Ashrafi, Atul Deodhar

Research output: Contribution to journalReview articlepeer-review


Psoriatic arthritis (PsA) is a chronic, multi-domain immune–mediated inflammatory arthritis with a high disease burden. PsA patients have significant co-morbidities like obesity, depression, fibromyalgia which can impact disease activity assessment. The management of PsA has undergone a paradigm shift over the last decade due to the availability of multiple biologic and targeted synthetic disease modifying anti-rheumatic drugs. Despite the availability of multiple therapeutic agents, it is not uncommon to find patients not responding adequately and continuing to have active disease and/or high disease burden. In our review, we propose what is “difficult to treat PsA”, discuss differential diagnosis, commonly overlooked factors, co-morbidities that affect treatment responses, and suggest a stepwise algorithm to manage these patients.

Original languageEnglish (US)
Pages (from-to)2251-2265
Number of pages15
JournalClinical Rheumatology
Issue number9
StatePublished - Sep 2023


  • Biologic therapy
  • Comorbidities
  • Difficult-to-treat
  • Disease activity
  • Psoriatic arthritis (PsA)

ASJC Scopus subject areas

  • Rheumatology


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