How do we treat psoriatic arthritis in the era of GRAPPA recommendations: predictive factors for bDMARDs usage in PsA patients in a real life setting

Psoriatic arthritis’s therapeutic approach has recently improved, as indicated by the recent GRAPPA recommendations, since the introduction of bDMARDs with different targets. Purpose of this study was to evaluate usage of PsA recommendations for bDMARDs selection based on baseline predictive factors. A retrospective study was conducted on bDMARD-naïve patients, in stable condition. Study population was divided in two groups based on the period they started treatment: between January 2006-December 2013 and between January 2014-December 2022. Then, impact of clinical PsA features and comorbidities was evaluated as an influencing factor in bDMARD selection. 146 patients were included in the 1st period (all receiving TNFi) and 250 in the 2nd (175 received TNFi and 75 ILi). Comparing only TNFi treated patients, subjects treated in the 2nd period presented less frequently PsO, enthesitis, poly-arthritis, bone erosions, CV risk factors, while those presenting PsO familiarity, oligo-arthritis and axial involvement resulted more frequently treated. Comparisons of patients treated in 2nd period with TNFi and ILi resulted that those presenting PsO, nail PsO, axial involvement and CV risk factors were more frequently treated with ILi while those presenting bone erosions with TNFi. Therefore, it is possible to speculate that PsA clinical features/comorbidities may influence treatment choices.