TNF and psoriatic arthritis: This is more in line with the 2015 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations [3] and the updated 2019 EULAR recommendations [4] which place secukinumab as a first line agent alongside other biologics, unlike the earlier 2015 EULAR [32] as well as the 2018 American College of Rheumatology (ACR)/National Psoriasis Foundation (NPF) [33] guidelines, which specified TNFα blockers as first line biologic therapy and anti-IL-17 agents to be considered when TNFα blockers are “inappropriate.”