From the Guidelines
Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease associated with psoriasis, manifesting with peripheral arthritis, dactylitis, enthesitis, and spondylitis, affecting approximately 1-2 per 1,000 people in the general population 1.
Key Characteristics of PsA
- The condition is characterized by a heterogeneous presentation, with symptoms including peripheral arthritis, dactylitis, enthesitis, and spondylitis, as well as nail lesions such as pitting and onycholysis 1.
- PsA affects men and women equally, with the majority of patients developing skin symptoms first, followed by arthritis, although in some cases, the skin and joint symptoms present simultaneously or the arthritis presents first 1.
- The distribution of peripheral arthritis varies from asymmetric oligoarthritis to symmetric polyarthritis, with distal interphalangeal joints commonly affected 1.
Impact of PsA on Quality of Life and Mortality
- PsA is associated with an adverse impact on health-related quality of life, high healthcare costs, and utilization, as well as greater disease activity, which is linked to progressive joint damage and higher mortality 1.
- Early identification and initiation of therapy are crucial for improving long-term outcomes, highlighting the importance of prompt medical evaluation for individuals with psoriasis who develop joint pain 1.
Treatment Options for PsA
- Treatment for PsA includes nonpharmacologic and pharmacologic therapies, such as nonsteroidal anti-inflammatory drugs (NSAIDs), intraarticular injections, and immunomodulatory therapies, which can ameliorate symptoms and occasionally result in disease remission 1.
From the Research
Definition and Characteristics of Psoriatic Arthritis
- Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by arthritis and psoriasis, with variable extra-articular manifestations 2, 3, 4.
- It is a type of inflammatory arthritis included within the spondyloarthritis group, which can compromise the quality of life of patients 4.
- PsA mainly affects the peripheral joints, spine, and/or sacroiliac joints, and can lead to progressive, irreversible bone destruction if left untreated 3.
Clinical Manifestations and Diagnosis
- The diagnosis of PsA can be difficult due to its enormous clinical and radiological variability, with six different domains of involvement: peripheral joint, axial skeleton, skin psoriasis, nail psoriasis, enthesitis, and dactylitis 4.
- There are no biomarkers that allow the detection of PsA in patients with psoriasis, making a high level of suspicion important for diagnosis 4.
- Approaches such as magnetic resonance imaging, ultrasound imaging, and symptom questionnaires can be helpful in diagnosing PsA, especially in cases where radiographic findings are not present in the early stage 3.
Treatment and Management
- The treatment of PsA ranges from non-steroidal anti-inflammatory drugs (NSAIDs) to disease-modifying anti-rheumatic agents (DMARDs) for the suppression of inflammation in patients with recalcitrant peripheral joint disease 2, 5.
- Biologics are also a main treatment for PsA, and when used with an aggressive approach, can result in better patient outcomes 3.
- The efficacy of traditional DMARDs, such as methotrexate, sulfasalazine, and ciclosporin, has been supported by some evidence, although more research is needed to fully assess their effectiveness 2, 5.