The diverse clinical picture of PsA suggests the need to identify suitable 
therapies to address the different combinations of clinical manifestations. This 
review aimed to classify the available biologic agents and new small molecule 
inhibitors (licensed and nonlicensed) based on their proven efficacy in treating 
different clinical manifestations associated with psoriasis and PsA. This review 
presents the level of evidence of efficacy of different biologic treatments and 
small molecule inhibitors for certain clinical features of treatment of PsA and 
psoriasis, which was graded in categories I-IV. The literature searches were 
performed on the following classes of biologic agents and small molecules: TNF 
inhibitors (adalimumab, etanercept, infliximab, golimumab, certolizumab), 
anti-IL12/IL23 (ustekinumab), anti-IL17 (secukinumab, brodalumab, ixekizumab), 
anti-IL6 (tocilizumab), T cell modulators (alefacept, efalizumab, abatacept, 
itolizumab), B cell depletion therapy (rituximab), phosphodiesterase 4 inhibitor 
(apremilast) and Janus kinase inhibitor (tofacitinib). A comprehensive table 
including 17 different biologic agents and small molecule inhibitors previously 
tested in psoriasis and PsA was generated, including the level of evidence of 
their efficacy for each of the clinical features included in our review (axial 
and peripheral arthritis, enthesitis, dactylitis, and nail and skin disease). We 
also proposed a limited set of recommendations for a sequential biologic 
treatment algorithm for patients with PsA who failed the first anti-TNF therapy, 
based on the available literature data. There is good evidence that many of the 
biologic treatments initially tested in psoriasis are also effective in PsA. 
Further research into both prognostic biomarkers and patient stratification is 
required to allow clinicians the possibility to make better use of the various 
biologic treatment options available. This review showed that there are many 
potentially new treatments that are not included in the current guidelines that 
can be used for selected categories of patients based on their disease 
phenotype, clinician experience and access to new biologic therapies.