Deucravacitinib-TNFi Combination Therapy for Difficult-to-Control Psoriatic Disease

Inclusion Criteria: * Adults aged 18-65 with confirmed psoriatic arthritis based on CASPAR criteria. * Ability to provide informed consent and comply with study procedures. * Patients with plaque psoriasis BSA\>3% OR PsA with \[SJC\>2 AND TJC \>3\] despite stable background anti-TNF therapy for at least 6 months, with or without csDMARDs (i.e MTX, leflunomide, sulfasalazine, hydroxychloroquine). * Concurrent use of 1 csDMARD, and/or NSAID, and/or oral glucocorticoid is permitted but not required during the study. If such treatment was administered, then participants must meet the following requirements: * If on csDMARD (methotrexate \[MTX\], sulfasalazine \[SSZ\], leflunomide \[LEF\], hydroxychloroquine \[HCQ\]), the participant must have been on it for at least 12 weeks and be on a stable dose for at least 28 days prior to Day 1. * If on MTX, the route of administration and dose must be stable and the dose must be ≤ 25 mg/week. * If on SSZ, the dose must be ≤ 3 g/day. * If on HCQ, the dose must be ≤ 400 mg/day. * If on LEF, the dose must be ≤ 20 mg/day. Note: If currently not on MTX, SSZ, or HCQ, the participant must not have received it for at least 28 days prior to Day 1. If currently not on LEF, the participant must not have received it for at least 12 weeks prior to Day 1. * If on an NSAID, the participant must be on a stable dose for at least 14 days prior to Day 1. * Stable background use of prednisone 15 mg daily or equiva…