What type of specialist should a patient with psoriatic arthritis see?

Specialist Care for Psoriatic Arthritis

Patients with psoriatic arthritis should see a rheumatologist as their primary specialist for managing the musculoskeletal manifestations of the disease. 1

Primary Specialist: Rheumatology

• Rheumatologists are the specialists who should primarily care for patients with psoriatic arthritis, given their expertise with the complex array of disease-modifying antirheumatic drugs (DMARDs), biologics, and JAK inhibitors used to treat this condition, as well as their knowledge of safety profiles and comorbidity management. 1

• Rheumatologists possess optimal depth and breadth of experience regarding all types of DMARDs, including efficacy outcomes, risk assessment, and management of comorbidities that commonly accompany psoriatic arthritis. 1

Collaborative Care with Dermatology

• When patients have clinically relevant skin involvement in addition to joint disease, a rheumatologist and dermatologist should collaborate in both diagnosis and management. 1

• This collaborative approach is particularly important because up to 30-40% of patients with psoriasis will develop psoriatic arthritis, typically within 5-10 years of skin disease onset. 2, 3

• Dermatologists are uniquely positioned to detect psoriatic arthritis early through routine screening of psoriasis patients, as skin manifestations usually precede joint symptoms. 3

Multidisciplinary Considerations

• Psoriatic arthritis is a heterogeneous and potentially severe disease that may require multidisciplinary treatment beyond rheumatology and dermatology. 1

• Additional specialists may need to be consulted for non-musculoskeletal manifestations, including:

  • Ophthalmologists for eye involvement (uveitis) 1
  • Gastroenterologists for inflammatory bowel disease 1
  • Cardiologists for cardiovascular disease management, given the high prevalence of metabolic syndrome and cardiovascular comorbidities 1

Clinical Pitfalls to Avoid

• Do not delay referral to rheumatology when psoriatic arthritis is suspected, as early treatment with DMARDs has the potential to slow disease progression, prevent irreversible joint damage, and maintain quality of life. 3, 4

• Psoriatic arthritis is frequently misdiagnosed as osteoarthritis or rheumatoid arthritis due to overlapping clinical presentations, which can lead to delays in optimal treatment. 4

• The presence of dactylitis (sausage digits), enthesitis, nail dystrophy, or DIP joint involvement should prompt immediate rheumatology referral, as these are distinguishing features of psoriatic arthritis. 3, 4

Treatment Decision-Making

• Treatment decisions should be based on shared decision-making between the patient and rheumatologist, considering efficacy, safety, patient preferences, and costs. 1

• For patients with both significant joint and skin involvement, treatment selection should address both manifestations—for example, methotrexate is preferred when clinically relevant skin disease coexists with arthritis. 1