Introduction
Psoriatic arthritis (PsA) is a multifaceted inflammatory condition characterized by peripheral arthritis, enthesitis, dactylitis, and axial involvement, often occurring alongside cutaneous psoriasis. The management of early PsA has undergone a paradigm shift toward a treat-to-target (T2T) approach, emphasizing the importance of achieving low disease activity or remission as quickly as possible. The concept of a “window of opportunity”—a period early in the disease course where aggressive intervention can fundamentally alter the long-term radiographic and functional trajectory—is widely accepted in rheumatoid arthritis and is increasingly applied to PsA. However, the optimal first-line strategy remains a subject of intense debate among clinicians. While conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), specifically methotrexate (MTX), remain the standard first-line therapy, the early introduction of biologic DMARDs (bDMARDs) has been proposed as a means to achieve deeper and more rapid responses.
