{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:02:17Z","timestamp":1786122137778,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin. Pract.","Clinics and Practice"],"abstract":"<jats:p>Background: Guselkumab, a monoclonal antibody selectively targeting the p19 subunit of interleukin-23, is typically administered with an induction phase at weeks 0 and 4 followed by maintenance dosing every 8 weeks for the treatment of psoriatic arthritis (PsA). In Europe, a four-week regimen (Q4W) has recently been approved for patients at high risk of joint damage progression; however, real-world evidence on this intensified schedule remains limited. This study aimed to evaluate the effectiveness and safety of guselkumab Q4W in routine clinical practice. Methods: This retrospective observational study included 18 PsA patients at high risk of structural damage treated with guselkumab Q4W at two psoriasis referral centers in the Lazio region of Italy. Baseline and 24-week clinical data were collected from medical records. Outcome measures included Disease Activity Index for Psoriatic Arthritis (DAPSA), Minimal Disease Activity (MDA), pain Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), and Psoriasis Area and Severity Index (PASI). Results: After 24 weeks, mean DAPSA decreased from 34.3 \u00b1 7.6 to 3.7 \u00b1 3.0; 55.6% of patients achieved DAPSA remission and 77.8% achieved MDA. Significant improvements were observed in pain VAS, DLQI, and PASI scores. All patients achieved PASI 75, while 83.3% achieved PASI 90 and PASI 100. Treatment was generally well tolerated, with no adverse events or new safety signals documented during follow-up. Conclusions: In our study, guselkumab Q4W showed marked multidomain effectiveness and a favorable safety profile, supporting its use in PsA patients at high risk of joint damage progression.<\/jats:p>","DOI":"10.3390\/clinpract16080146","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:01:36Z","timestamp":1786089696000},"page":"146","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Guselkumab Every 4 Weeks as a Real-World Therapeutic Option for Psoriatic Arthritis Patients at High Risk of Joint Damage"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6295-3574","authenticated-orcid":false,"given":"Nicoletta","family":"Bernardini","sequence":"first","affiliation":[{"name":"Dermatology Unit \u201cDaniele Innocenzi\u201d, Department of Medical-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9543-0191","authenticated-orcid":false,"given":"Giorgio","family":"Marotta","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, Department of Medical and Cardiovascular Sciences, La Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4478-5404","authenticated-orcid":false,"given":"Nevena","family":"Skroza","sequence":"additional","affiliation":[{"name":"Dermatology Unit \u201cDaniele Innocenzi\u201d, Department of Medical-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Graceffa","sequence":"additional","affiliation":[{"name":"Department of Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3626-8546","authenticated-orcid":false,"given":"Maria Consiglia","family":"Bragazzi","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Finistauri Guacci","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, Department of Medical and Cardiovascular Sciences, La Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ersilia","family":"Tolino","sequence":"additional","affiliation":[{"name":"Dermatology Unit \u201cDaniele Innocenzi\u201d, Department of Medical-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Paola","family":"Sasso","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, Department of Medical and Cardiovascular Sciences, La Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2712-2792","authenticated-orcid":false,"given":"Umberto","family":"Gallo","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, Department of Medical and Cardiovascular Sciences, La Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8755-9178","authenticated-orcid":false,"given":"Antonio Giovanni","family":"Richetta","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, Department of Medical and Cardiovascular Sciences, La Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9504-5882","authenticated-orcid":false,"given":"Annunziata","family":"Dattola","sequence":"additional","affiliation":[{"name":"Unit of Dermatology, Department of Medical and Cardiovascular Sciences, La Sapienza University of Rome, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3211","DOI":"10.1093\/rheumatology\/keae198","article-title":"The worldwide prevalence of psoriatic arthritis: A systematic review and meta-analysis","volume":"63","author":"Lembke","year":"2024","journal-title":"Rheumatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s13075-024-03339-0","article-title":"Epidemiological trends in psoriatic arthritis: A comprehensive population-based study","volume":"26","author":"Haddad","year":"2024","journal-title":"Arthritis Res. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1056\/NEJMra1505557","article-title":"Psoriatic arthritis","volume":"376","author":"Ritchlin","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1136\/annrheumdis-2017-211433","article-title":"The effects of structural damage on functional disability in psoriatic arthritis","volume":"76","author":"Kerschbaumer","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Novelli, L., Lubrano, E., Venerito, V., Perrotta, F.M., Marando, F., Curradi, G., and Iannone, F. (2021). Extra-articular manifestations and comorbidities in psoriatic disease: A journey into the immunologic crosstalk. Front. Med., 8.","DOI":"10.3389\/fmed.2021.737079"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1002\/art.21972","article-title":"Classification criteria for psoriatic arthritis: Development of new criteria from a large international study","volume":"54","author":"Taylor","year":"2006","journal-title":"Arthritis Rheum."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/s41572-021-00293-y","article-title":"Psoriatic arthritis","volume":"7","author":"FitzGerald","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1136\/annrheumdis-2013-204858","article-title":"Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis","volume":"74","author":"Haroon","year":"2015","journal-title":"Ann. Rheum. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1038\/s41584-019-0175-0","article-title":"Preventing psoriatic arthritis: Focusing on patients with psoriasis at increased risk of transition","volume":"15","author":"Scher","year":"2019","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1002\/msc.1694","article-title":"The role of IL-23 and the use of IL-23 inhibitors in psoriatic arthritis","volume":"20","author":"Fragoulis","year":"2022","journal-title":"Musculoskelet. Care"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Yi, R.C., Akbik, M., Smith, L.R., Klionsky, Y., and Feldman, S.R. (2025). Therapeutic advancements in psoriasis and psoriatic arthritis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041312"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1136\/ard-2024-225531","article-title":"EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update","volume":"83","author":"Gossec","year":"2024","journal-title":"Ann. Rheum. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41584-022-00798-0","article-title":"Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): Updated treatment recommendations for psoriatic arthritis 2021","volume":"18","author":"Coates","year":"2022","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"103819","DOI":"10.1016\/j.autrev.2025.103819","article-title":"Janus kinase inhibitors for psoriatic arthritis: Evidence from a systematic review and network meta-analysis","volume":"24","author":"Tsiogkas","year":"2025","journal-title":"Autoimmun. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"keaf489","DOI":"10.1093\/rheumatology\/keaf489","article-title":"Psoriatic arthritis risk in psoriasis patients receiving anti-IL-23 vs. anti-IL-17: Comparison of drug classes and individual agents","volume":"65","author":"Lin","year":"2026","journal-title":"Rheumatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2025-5-1","DOI":"10.7573\/dic.2025-5-1","article-title":"Real-world analysis of IL-23 inhibitors in patients with moderate-to-severe psoriasis and early musculoskeletal symptoms","volume":"14","author":"Dattola","year":"2025","journal-title":"Drugs Context"},{"key":"ref_17","first-page":"e51405","article-title":"Guselkumab, a novel monoclonal antibody inhibitor of the p19 subunit of IL-23, for psoriatic arthritis and plaque psoriasis: A review of its mechanism, use, and clinical effectiveness","volume":"15","author":"Kerut","year":"2023","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/S0140-6736(20)30263-4","article-title":"Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): A double-blind, randomised, placebo-controlled phase 3 trial","volume":"395","author":"Mease","year":"2020","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1016\/j.ard.2025.08.006","article-title":"Inhibition of structural damage progression with the selective interleukin-23 inhibitor guselkumab in participants with active PsA: Results through week 24 of the phase 3b, randomised, double-blind, placebo-controlled APEX study","volume":"84","author":"Mease","year":"2025","journal-title":"Ann. Rheum. Dis."},{"key":"ref_20","unstructured":"European Medicines Agency (2026, July 08). Tremfya: EMEA\/H\/C\/004271\u2014Guselkumab. Summary of Product Characteristics. Available online: https:\/\/www.ema.europa.eu\/en\/medicines\/human\/EPAR\/tremfya."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"215","DOI":"10.63032\/IEXQ7963","article-title":"Real-world efficacy and retention of guselkumab in psoriatic arthritis: Insights from a 12-month multicenter study","volume":"4","author":"Farina","year":"2025","journal-title":"ARP Rheumatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/S0140-6736(20)30265-8","article-title":"Guselkumab in patients with active psoriatic arthritis who were biologic-naive or had previously received TNF\u03b1 inhibitor treatment (DISCOVER-1): A double-blind, randomised, placebo-controlled phase 3 trial","volume":"395","author":"Deodhar","year":"2020","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1136\/annrheumdis-2021-220991","article-title":"Efficacy and safety of guselkumab in patients with active psoriatic arthritis who are inadequate responders to tumour necrosis factor inhibitors: Results through one year of a phase IIIb, randomised, controlled study (COSMOS)","volume":"81","author":"Coates","year":"2022","journal-title":"Ann. Rheum. Dis."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/8\/146\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:40:57Z","timestamp":1786092057000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/8\/146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":23,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["clinpract16080146"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16080146","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}