Which therapy is NOT considered first-line for psoriatic arthritis according to the material?

• A. TNF Inhibitors
• B. IL-17A Inhibitors
• C. IL-12/23 Inhibitors
• D. Methotrexate

Answer: (D)

The main idea is that psoriatic arthritis management prioritizes agents that directly block key inflammatory pathways. Therapies that inhibit TNF, IL-17A, or IL-12/23 have shown strong and broad efficacy across joint symptoms, skin disease, and related features, making them preferred first-line options for many patients with moderate-to-severe disease or those needing rapid control.

Methotrexate, while a traditional and widely used disease-modifying drug, has less consistent evidence for modifying the disease in psoriatic arthritis—especially for axial disease and skin involvement—and so is not considered first-line in the material. It can be used when biologics aren’t suitable or as part of combination therapy, but it isn’t the initial preferred choice.