Treatment preferences among clinical subgroups in patients with psoriatic arthritis

Psoriatic arthritis (PsA) is a heterogeneous, chronic, immune-mediated inflammatory disease characterized by musculoskeletal inflammation, typically occurring in patients with psoriasis. In this study, we aimed to determine the distribution of patients among five clinical subgroups of PsA and to compare the treatments used at baseline and at each subsequent follow-up visit over a one-year period. The study included 200 patients diagnosed with PsA and followed in the Rheumatology Clinic of Eskishehir Osmangazi University Faculty of Medicine. Additionally, we assessed whether our treatment preferences were consistent with GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) recommendations, and we evaluated the effects of smoking status, gender, body mass index (BMI), and PsA subtypes on treatment decisions. Our study included 47 (68%) female and 22 (32%) male patients with asymmetric oligoarthritis; 25 (62%) female and 15 (38%) male patients with symmetric polyarthritis; 32 (62%) female and 20 (38%) male patients with distal interphalangeal (DIP) involvement; 12 (36%) female and 21 (64%) male patients with axial involvement; and 3 (50%) female and 3 (50%) male patients with arthritis mutilans. We observed that treatment approaches largely adhered to GRAPPA and EULAR recommendations, applying a stepwise escalation strategy targeting the involved domains. Conventional synthetic DMARDs, predominantly methotrexate, were used as first-line therapy, with escalation to biologic or targeted synthetic DMARDs when necessary. Non-smoking patients were found to transition to targeted biologic agents earlier. Although sex-based differences were not statistically conclusive due to the predominance of female patients, pain control appeared to be prioritized in the management of female PsA patients. A higher BMI was observed in the arthritis mutilans subgroup, suggesting that obesity and this severe phenotype are associated with reduced treatment response and more aggressive disease course.