Patient handout

Psoriatic arthritis

PRODUCTION

1. Your condition

This handout is for psoriatic arthritis. Your care team identified this based on: inflammatory joint pain/swelling in a patient with cutaneous or nail psoriasis (caspar; grappa 2021).

Other reasons your team may use this plan: dactylitis ("sausage digit") or dip-predominant arthritis (caspar; eular 2023); enthesitis (achilles/plantar fascia) or inflammatory back pain (axial psa) (grappa 2021; asas); established psoriasis (esp. nail disease) developing musculoskeletal symptoms — psa screening visit (acr/npf 2021).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
six-domain assessment + cardiometabolic + IBD/uveitis screen	—	—	—	GRAPPA 2021 — therapy is selected by the dominant active domain (peripheral / axial / enthesitis / dactylitis / skin / nail) and comorbidity (IBD, uveitis, MetS, pregnancy); sets the treat-to-target goal (cDAPSA remission/LDA or MDA)
latent TB (IGRA/PPD) + HBV/HCV serology + vaccination update + age-appropriate malignancy screen	—	—	—	ACR/NPF 2021 — mandatory before any bDMARD/tsDMARD; treat latent TB before starting; complete inactivated vaccines, NO live vaccines once on biologic
weight loss + cardiometabolic risk modification (lipids, glucose, NAFLD, smoking, depression)	—	—	—	EULAR 2023 — weight loss improves treatment response and CV outcomes; cardiometabolic burden is a defining PsA comorbidity

Plan: PsA domain-driven treat-to-target ladder (cDAPSA / MDA)

3. When to call your provider

Contact your care team if any of the following happen:

Acute painful red eye / photophobia → emergent ophthalmology (uveitis) (GRAPPA 2021)
Erythrodermic or generalised pustular psoriasis flare → urgent dermatology / admission (GRAPPA 2021)
Serious infection or TB reactivation on biologic/JAKi → hold therapy + ID (ACR/NPF 2021)
Rapidly destructive polyarthritis / arthritis mutilans → expedite escalation + orthopedics (GRAPPA 2021)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Arthritis mutilans / rapidly destructive polyarthritis — osteolysis, telescoping ("opera-glass") digits, pencil-in-cup on radiograph (GRAPPA 2021)
Acute painful red eye, photophobia, blurred vision in a PsA/spondyloarthritis patient (GRAPPA 2021)
Erythrodermic or generalised pustular psoriasis flare — often precipitated by systemic corticosteroid withdrawal (GRAPPA 2021)(life-threatening)
Sepsis / serious opportunistic infection / latent TB reactivation in a patient on bDMARD or JAKi (ACR/NPF 2021)(life-threatening)
Acute spinal pain / neurologic deficit in long-standing axial PsA — fragility/ankylosed-spine fracture risk (GRAPPA 2021)

5. Follow-up

Long-term DMARD/biologic continuation with periodic taper consideration at sustained remission; lifelong cardiometabolic risk modification (weight, lipids, glucose, smoking), depression management, dermatology co-care, physical therapy for enthesitis/axial mobility, vaccination upkeep, orthopedic referral for arthritis mutilans / fixed deformity (GRAPPA 2021; EULAR 2023)

6. Sources

Guideline: 2021 ACR/NPF PsA Guideline + 2023 EULAR PsA recommendations + GRAPPA 2021 + CASPAR criteria