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 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, commonly affecting distal interphalangeal joints and, in some patients, axial disease occurs together with peripheral arthritis 1.
- PsA is associated with an adverse impact on health-related quality of life and high health care costs and utilization, with greater disease activity linked to progressive joint damage and higher mortality 1.
Importance of Early Identification and Treatment
- Early identification of PsA and early initiation of therapy are crucial for improving long-term outcomes, as greater disease activity is associated with progressive joint damage and higher mortality 1.
- Both nonpharmacologic and pharmacologic treatment can ameliorate PsA symptoms and occasionally result in disease remission, with clinicians and patients having a wide variety of pharmacologic therapies to choose from, including symptomatic treatments and immunomodulatory therapies 1.
Treatment Approach
- Treatment typically involves a combination approach with nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, disease-modifying antirheumatic drugs (DMARDs) to slow disease progression, and biologics for more severe cases, along with physical therapy and regular exercise to maintain joint flexibility and strength.
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, 5.
- It is a complex condition with heterogeneous clinical features, complicating psoriasis in approximately 30% of patients 3.
- PsA can affect the peripheral joints, spine, and/or sacroiliac joints, leading to progressive and irreversible bone destruction if left untreated 4.
Diagnosis and Clinical Features
- Diagnosis of PsA is often made by identifying inflammatory musculoskeletal features in joints, entheses, or the spine, in the presence of skin and/or nail psoriasis 3.
- There are no diagnostic criteria or tests available, and diagnosis can be difficult due to clinical and radiological variability 3, 5.
- PsA can involve six different domains: peripheral joint, axial skeleton, skin psoriasis, nail psoriasis, enthesitis, and dactylitis 5.
Treatment and Management
- Treatment of PsA ranges from non-steroidal anti-inflammatory drugs (NSAIDs) to disease-modifying antirheumatic drugs (DMARDs) and biologics 2, 6, 4.
- Early detection and treatment of impending joint deformities are necessary to avoid impairment of PsA patients' quality of life 4.
- Advances in immunological mechanisms and joint management have improved the therapeutic approach in patients with PsA 5.