Early diagnosis prevents poor outcomes for psoriatic arthritis

January 20, 2016

With one-third of psoriasis patients likely to be affected by psoriatic arthritis, dermatologists should review distinguishing clinical features, ask patients about joint complaints

A new review paper describes the clinical features of psoriatic arthritis and considers the differential diagnosis of this condition. 1

“It highlights the unique features of the disease, [and] the fact that we need to diagnose patients early to avoid bad outcomes,” said the author and rheumatologist Dafna D. Gladman, M.D., senior scientist, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada.

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According to the abstract, psoriatic arthritis’s clinical presentations are complex and varied, including peripheral arthritis, axial disease, dactylitis, enthesitis, and skin and nail manifestations. Specific clinical and imaging features distinguish psoriatic arthritis from other forms of arthritis, such as rheumatoid arthritis, gout, osteoarthritis and other forms of spondyloarthritis.

The current definition of psoriatic arthritis is an inflammatory musculoskeletal disease associated with psoriasis.2

This is a shift from when psoriatic arthritis was first described by Wright and, later by Wright and Moll, according to Dr. Gladman. Previous scientists had described five clinical patterns of the disease: distal, oligoarticular, polyarticular, primarily axial and arthritis mutilans. But researchers have since found patients change disease patterns with time, and since they may present at different times of their disease course, these patterns are not useful for identifying disease.

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“The most important thing for dermatologists to appreciate is that about 30% of their psoriasis patients are likely to develop psoriatic arthritis. Patients with more severe psoriasis, patients with nail lesions and patients with certain genetic markers are more likely to develop psoriatic arthritis,” Dr. Gladman says. “It is important for dermatologists to at least ask their patients if they have joint complaints. Patients can then be referred to a rheumatologist to make a definitive diagnosis.”

Reference:

Gladman DD. Clinical Features and Diagnostic Considerations in Psoriatic Arthritis. Rheum Dis Clin North Am. 2015 Nov;41(4):569-79. http://www.ncbi.nlm.nih.gov/pubmed/26476219

Taylor WJ, Gladman DD, Helliwell PS, Marchesoni A, Mease P, Mielants H. Classification criteria for psoriatic arthritis: development of new criteria from a large international study Arthritis Rheum 2006;54:2665-2673.