First-line treatment for psoriatic arthritis includes which of the following?

• A. TNF Inhibitors
• B. IL-17A Inhibitors
• C. IL-12/23 Inhibitors
• D. All of the above

Answer: (D)

The main idea is that psoriatic arthritis can be effectively treated by targeting different inflammatory pathways, and several classes of targeted therapies have proven benefit and approved indications for PsA. Each class works by a distinct mechanism to dampen the immune processes driving joint and skin disease.

TNF inhibitors block tumor necrosis factor-alpha, a key driver of inflammation in many PsA patients. They often produce rapid relief of joint symptoms and can also help skin lesions, making them a strong first-line option for many with active arthritis.

IL-17A inhibitors block interleukin-17A, another central cytokine in PsA pathogenesis. By inhibiting IL-17A, they address both joint inflammation and skin involvement, providing robust control of symptoms for many patients who may not respond optimally to TNF inhibitors alone.

IL-12/23 inhibitors target the IL-12 and IL-23 pathways, which influence the Th1/Th17 axis and have proven efficacy in both skin and joint manifestations of PsA. They offer another effective route for disease control, especially in patients with prominent skin disease or a need to modulate the broader inflammatory milieu.

Because all three classes have demonstrated efficacy and have approved use in psoriatic arthritis, they are all considered viable first-line options in appropriate patients, depending on disease features, prior therapies, and individual risk factors. Safety considerations include infection risk and the need for infection screening (such as TB), vaccination planning, and monitoring for adverse effects.

So, all of the above is correct, reflecting the range of first-line biologic options available for psoriatic arthritis.