These are my experience-based recommendations on treating PsA: 1) Use a csDMARD (eg MTX) whenever possible. It adds to the response (even if you’re using a biologic), and may allow you to ween off the costly biologic for maintenence. In dire straits, start with subcutaneous MTX 25mg weekly. 2) If main problem is arthritis, go for anti-TNF. Anti-IL17 or IL12/23 don’t work as well nor as quickly for the joints. 3) When joints come under control and the psoriasis worsens or is refractory, or if prefer maintenance with a more convenient and “safer” agent, you can consider switching to TH17 targeting (sequential therapy). If both skin and joints are bad and respond inadequately to either TNF or TH17 targeting, consider combination therapy.
Psoriatic Arthritis patients are at higher risk for heart attack and stroke.
Psoriasis alone may not increase your cardiovascular risk, but it’s association with arthritis, obesity and gout may.