Preventing Structural Damage in Early Psoriatic Arthritis

Inclusion Criteria: * ≥18 years old * without severe deformity in MCPJ * with active disease, which is defined as ≥1 tender joints and ≥1 swollen joints, despite previous treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) for ≥ 4 weeks * with at least one poor prognostic factor (eg, polyarthritis, structural damage on HR-pQCT or CR, elevated acute phase reactants, dactylitis, nail involvement or HAQ-DI\>1) * symptom duration ≤ 2 years Exclusion Criteria: * on csDMARDs unless being prescribed for skin psoriasis (e.g. cyclosporin) * limited in ability to perform usual self-care, vocational, and avocational activities * pregnancy * previous therapy with b/tsDMARDs * predominant active axial PsA or significant uveitis/inflammatory bowel disease requiring immediate b/tsDMARDs therapy * the presence of active inflammatory diseases other than PsA * active infection in 2 weeks before randomization or a history of ongoing, chronic, or recurrent infections including tuberculosis * history of malignant disease within the past 5 years (excluding basal cell carcinoma or actinic keratosis, in-situ cervical cancer, or non-invasive malignant colon polyps) * contraindications to MTX or adalimumab