Ustekinumab performed better than TNFi in psoriatic skin disease (p=0.03) in ECLIPSA study.14 Newer IL-23 inhibitors, especially guselkumab and rizankizumab, have achieved impressive PASI75 and PASI90 scores, even better than ustekinumab, in clinical trials.13 As expected, guselkumab was superior to adalimumab in a head-to-head comparison in psoriasis patients.29 Taking the above data into account, IL-17 and IL-12/23 inhibitors are preferred over TNFi in PsA patients with severe skin disease, according to EULAR guidelines.7 Here, IL17A is linked to psoriasis.