Early Psoriatic Arthritis Screening Can Help Prevent Irreversible Damage, Friedman Says

As part of Dermatology Times’ Expert Perspectives series, Adam Friedman, MD, professor and chair of dermatology at the George Washington University School of Medicine and Health Sciences in Washington, DC, discusses the importance of early psoriatic arthritis (PsA) screening and long-term treatment data.

For patients with psoriasis, identifying signs of PsA before significant joint involvement develops can provide an important opportunity for earlier intervention. Friedman shared practical strategies for incorporating PsA screening into routine dermatology visits and explained why longer-term data are important for guiding treatment decisions in chronic inflammatory disease.

Screening Beyond Obvious Joint Symptoms

Friedman emphasized that screening should not be limited to patients who already present with clear signs of arthritis.

“It is essential, at a minimum, to screen for the early signs—the not-so-overt or even arthritic signs—of psoriatic arthritis, because that's the best time to intervene,” he said.

Validated screening tools can help, but Friedman said several straightforward questions can also be incorporated into routine visits. He asks patients about prolonged stiffness at rest that improves with movement, previous diagnoses of arthritis, unexplained swelling of a finger or toe, heel pain, and lower back pain that occurs during the night.

He also evaluates clinical features associated with an increased likelihood of PsA, including nail involvement such as pitting or onycholysis, as well as psoriasis affecting the scalp or intertriginous areas.

The screening process does not necessarily need to add significant time to a visit. Friedman noted that he has trained staff members to ask some of these questions before he enters the examination room.

Because PsA can lead to permanent structural damage, identifying patients earlier may have important implications for treatment.

“Because this is a deforming arthritis, and the fact that we have ways to prevent, let alone even reverse, early damage with some of our systemics, it is so important to identify this early,” Friedman said.

Looking Beyond Short-Term Trial End Points

Friedman also emphasized the importance of considering how treatments perform beyond the relatively short windows commonly evaluated in clinical trials.

Although trials increasingly incorporate validated measures that may provide greater insight into patients’ experiences, he noted that chronic inflammatory diseases require clinicians to understand what happens with treatment over time.

“These are chronic diseases that are not just going to go poof up in smoke; they will always be there,” Friedman said.

For that reason, long-term extension data can help clinicians assess whether improvements in disease signs and symptoms are maintained and better inform treatment decisions.

“Whether it's 12 weeks, 24 weeks, or even a year plus, we need that long-term data in order to make the right decisions for our patients,” Friedman said.