Complex-to-manage and treatment-refractory psoriatic arthritis in Argentina: real-world evidence from the RECCAPSO...

To characterize complex-to-manage PsA (C2M-PsA) and, within it, treatment-refractory PsA (TR-PsA), using a pragmatic registry-based operationalization of emerging GRAPPA-adapted constructs, and to describe prevalence, drivers, and real-world treatment trajectories in Argentina.

Multicenter cross-sectional analysis of 350 adults with PsA from the RECCAPSO network. C2M-PsA was defined per GRAPPA (PsA-related and/or comorbidity drivers). TR-PsA required objective inflammatory activity plus failure of ≥ 2 distinct mechanisms among biologics or JAK inhibitors. We summarized clinical features, comorbidities, current therapies, and sequencing across lines.

C2M-PsA prevalence was 49.4% (173/350), most commonly mixed drivers (PsA + comorbidity, 59.5%), followed by PsA-only (31.8%) and comorbidity-only (8.7%). TR-PsA accounted for 9.7% (34/350) overall and 19.7% (34/173) within C2M. In C2M, current treatment was dominated by TNF inhibitors and IL17 inhibitors. In D2T, sequencing typically started with TNF inhibition and shifted toward IL17 pathways in later lines.

Using a pragmatic real-world operationalization of emerging GRAPPA-adapted constructs, about half of patients met C2M-PsA criteria, largely driven by mixed PsA-comorbidity factors; approximately one in five of these fulfilled TR-PsA criteria. Key Points • A GRAPPA-aligned initiative: Operationalized C2M-PsA and TR-PsA in a national cohort; ~ 50% were C2M, predominantly with mixed (PsA + comorbidity) drivers. • TR within C2M: ≈1 in 5 C2M cases were TR-PsA; most frequent domains were skin, arthritis, enthesitis; ~ 50% had ≥ 2 active domains; one dactylitis. • Treatment trajectories: Real-world sequencing commonly shifted from TNF to IL-17 over successive lines, with later diversification to IL-12/23, IL-23, and JAK inhibitors.