The Evolving Spectrum of TNF Inhibitors in the Management of Psoriatic Disease - Episode 3

Challenges in Diagnosing Psoriasis

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Expert dermatologists discuss challenges in diagnosing a patient with PsA.

Mark G. Lebwohl, MD: Psoriatic arthritis can be missed easily. We have a number of diagnostic criteria. They’re far from perfect. What’s the impact of a diagnostic delay that might lead to irreversible joint pain or damage?

Joseph F. Merola, MD, MMSc: One of the frequently quoted pieces of data—we can go a little deeper, but there was a wonderful paper years ago that looked at what the impact is—is a delay in diagnosis as brief as 6 months. We frequently quote this 1. It showed that patients who had a delay had increased erosive disease, more damage, a worse impact in terms of functional outcomes, and had more arthritis mutilans, although that’s fortunately an uncommon phenotype with less than 1% or 5% of patients who have that. The point is there are data to suggest that our diagnostic delays potentially lead to some irreversible joint disease. That’s an important point in our discussion.

On the flip side, I also don’t want to be an alarmist. We know that 40% to 60% of our patients don’t have erosive or damaging disease necessarily. Still, we want to get them to a timely diagnosis. We don’t want them to suffer unnecessarily in terms of joint pain and quality of life. How do we think about that in the current era? We’ll come to this a little later, but particularly for the dermatologist, screening of our psoriasis patients in a timely manner can likely get at that piece. We can unpack that further as well.

Transcript edited for clarity