Would you use an anti-IL 17 over an anti-TNFa as your first line biologic in psoriatic arthritis?

For the treatment of active psoriatic arthritis, I would use an IL17 inhibitor over a TNF inhibitor. Recent evidence supports this approach, and I review these data in the paragraphs below. Two studies of IL-17 inhibitors have now shown equivalent efficacy to TNF inhibitors for the psoriatic musculo...

We do this in patients with a heavy psoriasis and lighter arthritis burden.

I absolutely would. We tend to choose TNF inhibitors as our first line biologic, largely as a result of therapeutic inertia and a perception that these agents will have an easier path to approval. In patients with very active skin disease, however, using an IL17 inhibitor as the first biologic makes...