Treatment Choices and Sequencing in PsA, With Eric Ruderman, MD

As therapeutic options in psoriatic arthritis (PsA) continue to expand, one of the most pressing clinical questions is no longer what to start, but what to do next. Treatment sequencing remains an area of active debate, particularly after biologic failure, where evidence is evolving but far from definitive.

At the 2026 Rheumatology Winter Clinical Symposium (RWCS) held in Maui, Hawaii, on February 11-14, RheumatologyLive sat down with Eric Ruderman, MD, to learn more about how our understanding of this complexity shifted in 2025 and the ongoing search for actionable biomarkers in PsA.^1,2

Recent data have begun to explore whether mechanism switching meaningfully alters outcomes after TNF inhibitor failure. Patients who stopped a TNF inhibitor due to inefficacy, rather than intolerance, may be more likely to benefit from targeting a different inflammatory pathway.³

Ruderman highlighted broader questions that remain unanswered. Why do some patients persist on therapy longer than others? Why do women, on average, appear to have shorter drug survival than men? Why do patients with non-radiographic axial disease show different persistence patterns compared with those with radiographic involvement?

Lastly, Ruderman touched on the long-standing pursuit of reliable biomarkers. Despite decades of investigation, no single marker has emerged to direct therapy in PsA. The future may lie not in one test, but in composite panels capable of capturing multiple inflammatory signals and disease domains, similar to multi-biomarker approaches used in other rheumatic diseases.

‘We've been looking for the right biomarkers for so many years. And every time something comes along, it sounds really great. It just doesn't pan out. So it's tough, and I don't think it's going to be 1 biomarker. I think it's going to be a panel of biomarkers that may help sort it out,” Ruderman said.

References

1. Ruderman E. Rheumatology 2025: Year in Review. What’s new in PsA. Presented at: RWCS 2026, February 11-14 in Maui, Hawaii.

2. Ruderman E. Rheumatology 2025: Year in Review. What’s new in Spondyloarthritis. Presented at: RWCS 2026, February 11-14 in Maui, Hawaii.

3. Behrens F, Sternad P, Krueger K, et al. AgAIN Study: First Head-to-Head Trial of Secukinumab vs. Ustekinumab in TNFα Inhibitor-Experienced Psoriatic Arthritis Patients Reveals Better Efficacy Across Multiple Domains. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Poster #LB06.