PsA GRAPPA Domains: Outcomes With a JAKi

This episode of the Rheumnow Podcast explores the multidimensional nature of psoriatic arthritis (PSA) through the lens of GRAPA's six disease domains: peripheral arthritis, axial arthritis, enthesitis, dactylitis, skin psoriasis, and nail disease. Host Dr. Sergio Schwartzman and guest Dr. Eric Ruderman emphasize that PSA is not just a joint condition but a systemic disease affecting multiple organ systems, requiring a holistic treatment approach. They review clinical evidence for upadacitinib, a JAK inhibitor, highlighting its efficacy across all six domains in pivotal trials like SELECT-PSA2 and the real-world UpJoint Study. The discussion underscores the importance of considering comorbidities such as inflammatory bowel disease (IBD) and uveitis when selecting therapies, noting that upadacitinib may have favorable outcomes in these areas. Safety concerns, including boxed warnings for serious infections, malignancies, cardiovascular events, and thrombosis, are thoroughly addressed, with emphasis on patient selection and risk-benefit assessment. The hosts advocate for using upadacitinib as a broad-spectrum option for patients who have failed TNF inhibitors, particularly those with multi-domain disease or comorbidities.