Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021

Overview

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published these updated treatment recommendations in 2021. Rheumatologists, dermatologists and patient research partners developed them together. They are designed to support shared decision-making about treatment for people with psoriatic arthritis.

Domain-based approach

The recommendations are organised around the clinical domains of the disease: peripheral arthritis, axial disease, enthesitis, dactylitis, skin psoriasis and nail psoriasis. Related conditions such as uveitis and inflammatory bowel disease are also considered. Treatment choice should take every active domain into account, together with comorbidities and patient preferences, rather than focusing on joints alone.

Treatment strategy

Available options include conventional synthetic disease-modifying drugs, biologic therapies that target different cytokine pathways, and targeted synthetic small molecules. The evidence for each class is summarised domain by domain. This helps clinicians choose a therapy that covers the patient's full disease profile. The recommendations support a treat-to-target approach with regular reassessment and escalation when disease activity remains unacceptable.

Comorbidities and holistic care

The recommendations pay attention to cardiovascular, metabolic and mental health comorbidities, which are common in psoriatic arthritis and can affect treatment choice. Non-pharmacological measures and patient education are part of overall management.

Implications for practice

The practical message is individualised care. Clinicians should assess every disease domain, choose therapy that covers them, involve patients in decisions and review response systematically, with close cooperation between rheumatology and dermatology.