Apremilast and Adalimumab in Psoriatic Arthritis Patients

Inclusion Criteria: * This study will include 60 adult Psoriatic arthritis patients \>18 years old, fulfilling the (CASPAR) classification criteria of Psoriatic arthritis and have an inadequate response to methotrexate therapy for at least 3 months. * Psoriatic arthritis patients with peripheral musculoskeletal domains (peripheral arthritis, dactylitis and enthesitis) as well as skin and nail domains Exclusion Criteria: * Patients who received previous biologic agents or Janus kinase inhibitors. * Patients with axial and ocular involvement. * Current or recent serious infection including tuberculosis or hepatitis B/C . * Current or past history of malignancy (within five year). * Pregnant or breastfeeding women or women planning pregnancy during the study period . * Severe uncontrolled comorbidities such as heart failure, severe liver disease, or chronic kidney disease (eGFR \<30 mL/min/1.73m²) .