Medical Necessity of Infliximab for Psoriatic Arthritis

Patient Selection and Treatment Criteria

The American College of Rheumatology recommends infliximab therapy for patients with psoriatic arthritis who have failed multiple biologic therapies, with a strength of evidence rating of "high" 2, 3
The American Academy of Dermatology guidelines support the use of infliximab in patients with psoriatic arthritis who have failed methotrexate or have a contraindication to methotrexate, with a strength of recommendation of "B" 4, 1
Patients with a history of hemochromatosis may be contraindicated for methotrexate use, making infliximab an appropriate alternative therapy 4, 1

The American Academy of Dermatology guidelines support dose escalation of infliximab up to 10 mg/kg for better disease control, with a strength of recommendation of "B" 1
Clinical evidence demonstrates that approximately 39% of patients lose efficacy with standard maintenance dosing, supporting the need for dose and interval adjustments 1
The 2018 ACR/NPF guidelines support continuation of therapy when patients achieve or maintain positive clinical response with improvement in swollen joints and skin/nail involvement 2, 3

The American College of Rheumatology recommends tuberculosis screening prior to initiating infliximab therapy, with a strength of evidence rating of "high" 2, 1
Patients on infliximab therapy should be monitored for signs of active tuberculosis and concomitant biologic use, with documentation of negative TB test results and absence of concomitant biologic use 2, 1

Clinical trials demonstrate sustained response through 50-54 weeks with continuous infliximab therapy, with significant improvements in physical function and general health measures 5, 4
Infliximab therapy has been shown to improve quality of life, with a 91% improvement in Dermatology Life Quality Index after 10 weeks of therapy 5