Peripheral Arthritis Initiate Therapy: NSAID IA Steroids DMARD (MTX, CsA, SSZ, LEF) Biologics (anti-TNF) Skin and Nail Diseases Axial Disease Initiate Therapy: Topicals PUVA/UVB Systemics (MTX, CsA, etc) Biologics (anti-TNF, etc) Initiate Therapy: NSAID PT Biologics (anti-TNF) Dactylitis Initiate Therapy: NSAID Injection Biologics (anti-TNF) Reassess Response to Therapy and Toxicity Enthesitis Initiate Therapy: NSAID PT Biologics (anti-TNF)

Anti-TNF = tumor necrosis factor inhibitor; CsA = cyclosporin A; DMARD = disease-modifying antirheumatic drugs; IA = intra-articular; LEF = leflunomide; MTX = methotrexate; NSAID = nonsteroidal anti-inflammatory drugs; PT = physiotherapy; PUVA = psoralen plus ultraviolet light A; SSZ = sulfasalazine; UVB = ultraviolet light B. (1) with permission